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Penel N, Robin YM, Blay JY. Personalised management of alveolar soft part sarcoma: a promising phase 2 study. Lancet Oncol 2019; 20:750-752. [PMID: 31078464 DOI: 10.1016/s1470-2045(19)30286-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 03/21/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Nicolas Penel
- Department of Medical Oncology, Centre Oscar Lambret Lille, 59020 France; Lille University, Lille, France.
| | | | - Jean-Yves Blay
- Department of Medical Oncology and University Claude Bernard, Léon Bérard Cancer Center, Lyon, France
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102
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Cornillie J, Wozniak A, Li H, Wang Y, Boeckx B, Gebreyohannes YK, Wellens J, Vanleeuw U, Hompes D, Stas M, Sinnaeve F, Wafa H, Lambrechts D, Debiec-Rychter M, Sciot R, Schöffski P. Establishment and Characterization of Histologically and Molecularly Stable Soft-tissue Sarcoma Xenograft Models for Biological Studies and Preclinical Drug Testing. Mol Cancer Ther 2019; 18:1168-1178. [PMID: 30962320 DOI: 10.1158/1535-7163.mct-18-1045] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 01/13/2019] [Accepted: 04/01/2019] [Indexed: 11/16/2022]
Abstract
Soft-tissue sarcomas (STS) represent a heterogeneous group of rare, malignant tumors of mesenchymal origin. Reliable in vivo sarcoma research models are scarce. We aimed to establish and characterize histologically and molecularly stable patient-derived xenograft (PDX) models from a broad variety of STS subtypes. A total of 188 fresh tumor samples from consenting patients with localized or advanced STS were transplanted subcutaneously in NMRI-nu/nu-immunodeficient mice. Once tumor growth was observed, the material was passaged to a next generation of mice. A patient-derived tumor sample was considered "successfully engrafted" whenever the sample was transplanted to passage 1. A PDX model was considered "established" when observing stable morphologic and molecular features for at least two passages. With every passage, histologic and molecular analyses were performed. Specific genomic alterations and copy-number profile were assessed by FISH and low coverage whole-genome sequencing. The tumor engraftment rate was 32% (61/188) and 188 patient samples generated a total of 32 PDX models, including seven models of myxofibrosarcoma, five dedifferentiated liposarcoma, five leiomyosarcoma, three undifferentiated pleomorphic sarcoma, two malignant peripheral nerve sheet tumor models, and single models of synovial sarcoma and some other (ultra)rare subtypes. Seventeen additional models are in early stages of engraftment (passage 1-2). Histopathologic and molecular features were compared with the original donor tumor and were stable throughout passaging. The platform is used for studies on sarcoma biology and suited for in vivo preclinical drug testing as illustrated by a number of completed and ongoing laboratory studies.
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Affiliation(s)
- Jasmien Cornillie
- Laboratory of Experimental Oncology, Department of Oncology, KU Leuven, and Department of General Medical Oncology, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - Agnieszka Wozniak
- Laboratory of Experimental Oncology, Department of Oncology, KU Leuven, and Department of General Medical Oncology, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - Haifu Li
- Laboratory of Experimental Oncology, Department of Oncology, KU Leuven, and Department of General Medical Oncology, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - Yannick Wang
- Laboratory of Experimental Oncology, Department of Oncology, KU Leuven, and Department of General Medical Oncology, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - Bram Boeckx
- Laboratory for Translational Genetics, KU Leuven, Leuven, Belgium.,VIB Center for Cancer Biology, Leuven, Belgium
| | - Yemarshet K Gebreyohannes
- Laboratory of Experimental Oncology, Department of Oncology, KU Leuven, and Department of General Medical Oncology, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - Jasmien Wellens
- Laboratory of Experimental Oncology, Department of Oncology, KU Leuven, and Department of General Medical Oncology, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium.
| | - Ulla Vanleeuw
- Laboratory of Experimental Oncology, Department of Oncology, KU Leuven, and Department of General Medical Oncology, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - Daphne Hompes
- Department of Surgical Oncology, KU Leuven and University Hospitals Leuven, Leuven, Belgium
| | - Marguerite Stas
- Department of Surgical Oncology, KU Leuven and University Hospitals Leuven, Leuven, Belgium
| | - Friedl Sinnaeve
- Department of Orthopedic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Hazem Wafa
- Department of Orthopedic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Diether Lambrechts
- Laboratory for Translational Genetics, KU Leuven, Leuven, Belgium.,VIB Center for Cancer Biology, Leuven, Belgium
| | - Maria Debiec-Rychter
- Department of Human Genetics, KU Leuven and University Hospitals Leuven, Leuven, Belgium
| | - Raf Sciot
- Department of Pathology, KU Leuven and University Hospitals Leuven, Leuven, Belgium
| | - Patrick Schöffski
- Laboratory of Experimental Oncology, Department of Oncology, KU Leuven, and Department of General Medical Oncology, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
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103
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Abstract
OPINION STATEMENT Soft tissue sarcomas are rare cancers with an expected incidence of about 14,000 new cases in 2018, and account for less than 1% of all cancers. It includes in excess of 75 heterogeneous subtypes with varying biology, molecular aberrations, and variable response to treatment. Because of the rarity of these tumors and the many different subtypes, there is no large-scale data to guide treatment, and hence the need for a multidisciplinary individualized approach to treatment, preferably at a high-volume tertiary referral center. For localized disease, surgery with or without radiation is the preferred treatment. In metastatic disease, the longest track record is with use of anthracyclines, either alone or in combination with ifosfamide, but the median overall survival even with combination was just over a year. There have been recent advances in understanding the heterogeneity of these tumors and the need for an individualized approach. With that new knowledge, recent approvals of trabectedin, eribulin, and pazopanib have been limited to some select histologic subtypes with improved outcomes. More recently, immunotherapy has been tested in select histotypes of sarcoma with encouraging activity and has led to further evaluation in combination with immunotherapeutic agents, as well as with chemotherapy and radiation treatments. Here, in this article, we summarize the data of the currently approved therapies in metastatic soft tissue sarcoma, with the principal focus on first-line therapies. We also review the recent encouraging data with PDGFR-targeted antibody (olaratumab) with doxorubicin which showed an impressive improvement in overall survival in phase II study. Molecular characterization of sarcoma subtypes will likely improve understanding of these very diverse tumors and improve target characterization. The ongoing efforts in better understanding these rare tumors hold the key to make a difference in the outcome of these patients.
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Affiliation(s)
- Megan Meyer
- Internal Medicine, Mayo Clinic, 5777 E Mayo Blvd., Phoenix, AZ, 85054, USA
| | - Mahesh Seetharam
- Hematology and Oncology, Mayo Clinic, 5881 E Mayo Blvd., Phoenix, AZ, 85054, USA.
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104
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Dickson BC, Swanson D. Targeted RNA sequencing: A routine ancillary technique in the diagnosis of bone and soft tissue neoplasms. Genes Chromosomes Cancer 2018; 58:75-87. [DOI: 10.1002/gcc.22690] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 09/19/2018] [Accepted: 10/11/2018] [Indexed: 12/25/2022] Open
Affiliation(s)
- Brendan C. Dickson
- Department of Pathology and Laboratory Medicine; Sinai Health System; Toronto Ontario Canada
- Department of Laboratory Medicine and Pathobiology; University of Toronto; Toronto Ontario Canada
- Lunenfeld-Tanenbaum Research Institute; Sinai Health System; Toronto Ontario Canada
| | - David Swanson
- Department of Pathology and Laboratory Medicine; Sinai Health System; Toronto Ontario Canada
- Department of Laboratory Medicine and Pathobiology; University of Toronto; Toronto Ontario Canada
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105
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Hahn E, Huang SH, Hosni A, Razak AA, Jones RL, Dickson BC, Sturgis EM, Patel SG, O'Sullivan B. Ending 40 years of silence: Rationale for a new staging system for soft tissue sarcoma of the head and neck. Clin Transl Radiat Oncol 2018; 15:13-19. [PMID: 30582016 PMCID: PMC6293017 DOI: 10.1016/j.ctro.2018.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 11/26/2018] [Accepted: 11/26/2018] [Indexed: 11/25/2022] Open
Abstract
For 40 years, all soft tissue sarcoma (STS) used the same TNM where T1 was <=5 cm. This staging is unsuited for STS of the head and neck (STSHN) since only a minority are >5 cm. Despite smaller size, local recurrence is higher in STSHN compared to other STS. A new T classification with 2 and 4 cm cut-offs for STSHN was introduced in TNM-8. Future requirements for STSHN Stage Group development are mentioned.
The tumor, node, metastases (TNM) anatomic staging system plays a pivotal role in cancer care, research, and cancer control activities. Since the first edition of the American Joint Committee on Cancer TNM staging classification published in 1977, soft tissue sarcomas have been staged in an anatomic site agnostic fashion whereby the primary tumor size (T) was categorized as T1 if <=5 cm and T2 if >5 cm; this remained unchanged through the 7th edition of the TNM. However, soft tissue sarcomas of the head and neck (STSHN) usually present smaller than sarcomas of other sites, but carry a disproportionate risk of local recurrence. Up to 70% of tumors are less than 5 cm at presentation, and therefore classified together as T1. Given the rarity of STSHN, there is a paucity of data to guide progress in their classification. Moreover, the majority of publications only report tumor size as less than or greater than 5 cm, presumably based on conventions of the TNM system that remained unchanged for 40 years, thereby affecting progress of STSHN classification. This formed the impetus for change in the 8th edition in 2 key ways: 1) several soft tissue sarcoma site based changes occurred including STSHN now having its own system, and 2) primary tumor size cut-offs of 2 cm and 4 cm used in STSHN now reflect sizes that head and neck specialists commonly encounter in their practice. This update was pragmatic in modifying the TNM from a system with a T category not serving STSHN and which was originally based on sarcoma data from non-head and neck anatomic sites. The background to this change is outlined which provides a framework in which data can be reported to generate evidence for future staging modifications.
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Affiliation(s)
- Ezra Hahn
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network/University of Toronto, Toronto, Canada
| | - Shao Hui Huang
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network/University of Toronto, Toronto, Canada
| | - Ali Hosni
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network/University of Toronto, Toronto, Canada
| | - Albiruni Abdul Razak
- Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network/University of Toronto, Toronto, Canada
| | - Robin L Jones
- Royal Marsden Hospital/Institute of Cancer Research, United Kingdom
| | - Brendan C Dickson
- Department of Pathology & Laboratory Medicine, Sinai Health System, Toronto, Canada
| | - Erich M Sturgis
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Snehal G Patel
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Brian O'Sullivan
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network/University of Toronto, Toronto, Canada
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106
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Lopez-Beltran A, Canas-Marques R, Cheng L, Montironi R. Histopathologic challenges: The second OPINION issue. Eur J Surg Oncol 2018; 45:12-15. [PMID: 30360986 DOI: 10.1016/j.ejso.2018.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 09/06/2018] [Indexed: 01/12/2023] Open
Abstract
Classification and definition criteria for rare cancer is still an open issue in clinical practice due to several factors, which include the limited available molecular data to better defining specific tumor groups or "families" of interest. An important issue related to the proper management of these entities is the correct diagnosis and subtyping of a given entity. The high complexity associated with the histopathologic diagnosis and eventual molecular analysis may suggest the use of a histopathologic second opinion from a specialized pathologist. Diagnostic inaccuracies and difference between primary diagnosis and second opinion are expected at the population level: however, the magnitude of this difference is remarkably high and calls for implementation of second opinion in routine practice outside reference centers.
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Affiliation(s)
- Antonio Lopez-Beltran
- Department of Surgery and Pathology, University of Cordoba Medical School, Cordoba, Spain; Champalimaud Clinical Center, Lisbon, Portugal.
| | | | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Rodolfo Montironi
- Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy
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107
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Fayet Y, Coindre JM, Dalban C, Gouin F, De Pinieux G, Farsi F, Ducimetière F, Chemin-Airiau C, Jean-Denis M, Chabaud S, Blay JY, Ray-Coquard I. Geographical Accessibility of the Referral Networks in France. Intermediate Results from the IGéAS Research Program. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15102204. [PMID: 30308955 PMCID: PMC6210416 DOI: 10.3390/ijerph15102204] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 10/04/2018] [Accepted: 10/06/2018] [Indexed: 12/17/2022]
Abstract
Rare cancer patients face lower survival and experience delays in diagnosis and therapeutic mismanagement. Considering the specificities of rare cancers, referral networks have been implemented in France to improve the management and survival of patients. The IGéAS research program aims to assess the networks’ ability to reduce inequalities. Data analysis of the IGéAS cohort (n = 20,590, sarcoma diagnosed between 2011 and 2014) by gathering medical data and geographical index will identify risk factors associated with the belated access to expertise or with no access to expertise. Intermediate results show that referral networks give sarcoma patients access to sarcoma expertise despite the remoteness of some of them. Regional expert centers mostly receive requests from within their area while national referral centers receive requests from the whole country. Delays in the access to expertise may be reduced by making outside practitioners more sensitive to the issues of rare cancers. The perception and involvement of outside practitioners in this device will be assessed using a qualitative survey. All the results are discussed and will contribute to design guidelines to improve early access to expertise and reduce inequalities. Results of the IGéAS research program may contribute to the assessment of referral sarcoma networks and provide some useful lessons to improve cancer care management.
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Affiliation(s)
- Yohan Fayet
- Equipe Evaluation Médicale et Sarcomes, Centre Léon Bérard, Université Claude Bernard Lyon 1, HESPER EA 7425, 69008 Lyon, France.
| | | | - Cécile Dalban
- Direction de la Recherche Clinique et de l'Innovation, Centre Léon Bérard, 69008 Lyon, France.
| | - François Gouin
- Centre Hospitalier Universitaire Nantes, ResOs Network, 44000 Nantes, France.
| | | | - Fadila Farsi
- Réseau Régional de Cancérologie Auvergne⁻Rhône⁻Alpes, 69008 Lyon, France.
| | - Françoise Ducimetière
- Equipe Evaluation Médicale et Sarcomes, Centre Léon Bérard, Netsarc RRePS ResOs Networks, 69008 Lyon, France.
| | - Claire Chemin-Airiau
- Equipe Evaluation Médicale et Sarcomes, Centre Léon Bérard, Netsarc RRePS ResOs Networks, 69008 Lyon, France.
| | - Myriam Jean-Denis
- Equipe Evaluation Médicale et Sarcomes, Centre Léon Bérard, Netsarc RRePS ResOs Networks, 69008 Lyon, France.
| | - Sylvie Chabaud
- Direction de la Recherche Clinique et de l'Innovation, Centre Léon Bérard, 69008 Lyon, France.
| | - Jean-Yves Blay
- Centre Léon Bérard, Netsarc Network, Université Claude Bernard Lyon 1, 69008 Lyon, France.
| | - Isabelle Ray-Coquard
- Centre Léon Bérard, Netsarc Network, Université Claude Bernard Lyon 1, HESPER EA 7425, 69008 Lyon; France.
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108
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Casali PG, Abecassis N, Aro HT, Bauer S, Biagini R, Bielack S, Bonvalot S, Boukovinas I, Bovee JVMG, Brodowicz T, Broto JM, Buonadonna A, De Álava E, Dei Tos AP, Del Muro XG, Dileo P, Eriksson M, Fedenko A, Ferraresi V, Ferrari A, Ferrari S, Frezza AM, Gasperoni S, Gelderblom H, Gil T, Grignani G, Gronchi A, Haas RL, Hassan B, Hohenberger P, Issels R, Joensuu H, Jones RL, Judson I, Jutte P, Kaal S, Kasper B, Kopeckova K, Krákorová DA, Le Cesne A, Lugowska I, Merimsky O, Montemurro M, Pantaleo MA, Piana R, Picci P, Piperno-Neumann S, Pousa AL, Reichardt P, Robinson MH, Rutkowski P, Safwat AA, Schöffski P, Sleijfer S, Stacchiotti S, Sundby Hall K, Unk M, Van Coevorden F, van der Graaf WTA, Whelan J, Wardelmann E, Zaikova O, Blay JY. Soft tissue and visceral sarcomas: ESMO-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2018; 29:iv51-iv67. [PMID: 29846498 DOI: 10.1093/annonc/mdy096] [Citation(s) in RCA: 437] [Impact Index Per Article: 72.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- P G Casali
- Fondazione IRCCS Istituto Nazionale dei Tumori and University of Milan, Milan, Italy
| | - N Abecassis
- Instituto Portugues de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal
| | - H T Aro
- Turku University Hospital (Turun Yliopistollinen Keskussairaala), Turlu, Finland
| | - S Bauer
- University Hospital Essen, Essen, Germany
| | - R Biagini
- Department of Oncological Orthopedics, Musculoskeletal Tissue Bank, IFO, Regina Elena National Cancer Institute, Rome, Italy
| | - S Bielack
- Klinikum Stuttgart-Olgahospital, Stuttgart, Germany
| | | | | | - J V M G Bovee
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - T Brodowicz
- Vienna General Hospital (AKH), Medizinische Universität Wien, Vienna, Austria
| | - J M Broto
- Hospital Universitario Virgen del Rocio-CIBERONC, Seville, Spain
| | - A Buonadonna
- Centro di Riferimento Oncologico di Aviano, Aviano
| | - E De Álava
- Hospital Universitario Virgen del Rocio-CIBERONC, Seville, Spain
| | - A P Dei Tos
- Ospedale Regionale di Treviso "S.Maria di Cà Foncello", Treviso, Italy
| | - X G Del Muro
- Integrated Unit ICO Hospitalet, HUB, Barcelona, Spain
| | - P Dileo
- Sarcoma Unit, University College London Hospitals, London, UK
| | - M Eriksson
- Skane University Hospital-Lund, Lund, Sweden
| | - A Fedenko
- N. N. Blokhin Russian Cancer Research Center, Moscow, Russian Federation
| | - V Ferraresi
- Institute of Scientific Hospital Care (IRCCS), Regina Elena National Cancer Institute, Rome
| | - A Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - S Ferrari
- Istituto Ortopedico Rizzoli, Bologna
| | - A M Frezza
- Fondazione IRCCS Istituto Nazionale dei Tumori and University of Milan, Milan, Italy
| | - S Gasperoni
- Azienda Ospedaliera Universitaria Careggi Firenze, Florence, Italy
| | - H Gelderblom
- Department of Medical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | - T Gil
- Institut Jules Bordet, Brussels, Belgium
| | - G Grignani
- Candiolo Cancer Institute, FPO IRCCS, Candiolo, Italy
| | - A Gronchi
- Fondazione IRCCS Istituto Nazionale dei Tumori and University of Milan, Milan, Italy
| | - R L Haas
- Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam and Department of Radiotherapy, Leiden University Medical Centre, Leiden, The Netherlands
| | - B Hassan
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - R Issels
- Department of Medicine III, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - H Joensuu
- Helsinki University Central Hospital (HUCH), Helsinki, Finland
| | | | - I Judson
- The Institute of Cancer Research, London, UK
| | - P Jutte
- University Medical Center Groningen, Groningen
| | - S Kaal
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - B Kasper
- Mannheim University Medical Center, Mannheim
| | | | - D A Krákorová
- Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - A Le Cesne
- Gustave Roussy Cancer Campus, Villejuif, France
| | - I Lugowska
- Maria Sklodowska Curie Institute, Oncology Centre, Warsaw, Poland
| | - O Merimsky
- Tel Aviv Sourasky Medical Center (Ichilov), Tel Aviv, Israel
| | - M Montemurro
- Medical Oncology, University Hospital of Lausanne, Lausanne, Switzerland
| | - M A Pantaleo
- Azienda Ospedaliera, Universitaria, Policlinico S Orsola-Malpighi Università di Bologna, Bologna
| | - R Piana
- Azienda Ospedaliero, Universitaria Cita della Salute e della Scienza di Torino, Turin, Italy
| | - P Picci
- Istituto Ortopedico Rizzoli, Bologna
| | | | - A L Pousa
- Fundacio de Gestio Sanitaria de L'hospital de la SANTA CREU I Sant Pau, Barcelona, Spain
| | - P Reichardt
- Helios Klinikum Berlin Buch, Berlin, Germany
| | - M H Robinson
- YCRC Department of Clinical Oncology, Weston Park Hospital NHS Trust, Sheffield, UK
| | - P Rutkowski
- Maria Sklodowska Curie Institute, Oncology Centre, Warsaw, Poland
| | - A A Safwat
- Aarhus University Hospital, Aarhus, Finland
| | | | - S Sleijfer
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - S Stacchiotti
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milan, Italy
| | - K Sundby Hall
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - M Unk
- Institute of Oncology of Ljubljana, Ljubljana, Slovenia
| | - F Van Coevorden
- Netherlands Cancer Institute Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | | | - J Whelan
- University College Hospital, London, UK
| | - E Wardelmann
- Gerhard-Domagk-Institut für Pathologie, Universitätsklinikum Münster, Münster, Germany
| | - O Zaikova
- Oslo University Hospital, Norwegian Radium Hospital, Oslo, Norway
| | - J Y Blay
- Centre Leon Bernard and UCBL1, Lyon, France
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109
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Survival of adults with cancers of bone or soft tissue in Europe-Report from the EUROCARE-5 study. Cancer Epidemiol 2018; 56:146-153. [PMID: 30179828 DOI: 10.1016/j.canep.2018.08.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 08/21/2018] [Accepted: 08/26/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Five-year relative survival (RS) of adults with bone and soft-tissue cancers in Europe was still <60% by 1995-1999. There was large geographical survival variability, mainly for bone tumours, and survival decreased with increasing age at diagnosis. METHODS Data from 87 population-based cancer registries in 29 countries, extracted from the EUROCARE-5 database, were used to provide updated estimates of survival and describe trends in survival of adults with cancers of these sites across Europe. We calculated 5-year RS for patients diagnosed in 2000-2007. We estimated 5-year RS by the period approach to assess changes in survival between 1999-2001, 2002-2004 and 2005-2007, and provide reliable predictions for recently diagnosed patients. RESULTS Five-year RS was 60% for adults diagnosed with soft-tissue cancer in 2000-2007 and 53% for those with bone cancer. RS declined with increasing age at diagnosis, especially for bone cancer. Survival from bone cancer varied widely between European regions, from 63 to 62% in Northern and Central Europe to 39% in Eastern Europe. Inter-regional variation was much less for soft-tissue cancer. For both site groupings, there was little evidence of change in five-year RS up to 2002-2004, followed by increases of 3-4% during 2005-2007. CONCLUSIONS Outcomes for adults with bone and soft-tissue cancer in Europe began to improve around 2005; new therapeutic developments are expected to result in further progress. Survival improvements already achieved must be brought more fully to elderly patients and those in Eastern Europe. European Reference Networks on rare cancers will have a vital role in future progress.
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110
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Hasnaoui A, Jouini R, Haddad D, Zaafouri H, Bouhafa A, Ben Maamer A, Ben Brahim E. Gastric leiomyosarcoma and diagnostic pitfalls: a case report. BMC Surg 2018; 18:62. [PMID: 30119659 PMCID: PMC6098616 DOI: 10.1186/s12893-018-0393-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 08/13/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Since the advent of immunohistochemistry for the diagnosis of stromal tumours, the incidence of leiomyosarcomas has significantly decreased. Nowadays, gastric leiomyosarcoma is an exceptionally rare tumour. We report the second case in the English literature of gastric leiomyosarcoma revealed with massive bleeding and hemodynamic instability and diagnostic pitfalls that we encountered. CASE PRESENTATION A 63-year-old woman, with 2 years' history of dizziness and weakness probably related to an anaemic syndrome, presented to the emergency room with hematemesis, melena and hemodynamic instability. On examination, she had conjunctival pallor with reduced general condition, blood pressure of 90/45 mmHg and a pulse between 110 and 120 beats per minute. On digital rectal examination, she had melena. Laboratory blood tests revealed a haemoglobin level at 38 g/L. The patient was admitted to the intensive care department. After initial resuscitation, transfusion and intravenous Omeprazole continuous infusion, her condition was stabilized. She underwent upper gastrointestinal endoscopy showing a tumour of the cardia, protruding in the lumen with mucosal ulceration and clots in the stomach. Biopsies were taken. Histological examination showed interlacing bundles of spindle cells, ill-defined cell borders, elongated hyperchromatic nuclei with marked pleomorphism and paranuclear vacuolization. Immunohistochemistry showed positivity for Vimentine, a strong and diffuse immunoreactivity for smooth muscle actin (SMA). Immunoreactivities for KIT and DOG1 were doubtful. Computed tomography scan revealed a seven-cm tumour of the cardia, without adenopathy or liver metastasis. The patient underwent laparotomy. A total gastrectomy was performed without lymphadenectomy. Post-operative course was uneventful. Histological examination of the tumour specimen found the same features as preoperative biopsies with negative margins. We solicited a second opinion of an expert in a reference centre for sarcomas in France, who confirmed the diagnosis of a high grade gastric leiomyosarcoma. CONCLUSION Gastric leiomyosarcoma is a rare tumour. Diagnosis is based on histological examination with immunohistochemistry, which could be sometimes confusing like in our case. The validation of a pathological expert is recommended.
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Affiliation(s)
- Anis Hasnaoui
- Department of General Surgery, Habib Thameur Hospital, Tunis El Manar University, Ali Ben Ayed Street 2037 Montfleury, Tunis, Tunisia
| | - Raja Jouini
- Department of Histopathology and Cytology, Habib Thameur Hospital, Tunis El Manar University, Tunis, Tunisia
| | - Dhafer Haddad
- Department of General Surgery, Habib Thameur Hospital, Tunis El Manar University, Ali Ben Ayed Street 2037 Montfleury, Tunis, Tunisia
| | - Haithem Zaafouri
- Department of General Surgery, Habib Thameur Hospital, Tunis El Manar University, Ali Ben Ayed Street 2037 Montfleury, Tunis, Tunisia
| | - Ahmed Bouhafa
- Department of General Surgery, Habib Thameur Hospital, Tunis El Manar University, Ali Ben Ayed Street 2037 Montfleury, Tunis, Tunisia
| | - Anis Ben Maamer
- Department of General Surgery, Habib Thameur Hospital, Tunis El Manar University, Ali Ben Ayed Street 2037 Montfleury, Tunis, Tunisia
| | - Ehsen Ben Brahim
- Department of Histopathology and Cytology, Habib Thameur Hospital, Tunis El Manar University, Tunis, Tunisia
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111
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Sbaraglia M, Dei Tos AP. The pathology of soft tissue sarcomas. Radiol Med 2018; 124:266-281. [PMID: 29948548 DOI: 10.1007/s11547-018-0882-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 03/29/2018] [Indexed: 12/27/2022]
Abstract
Soft tissue sarcomas represent a heterogeneous group of rare malignancies exhibiting mesenchymal differentiation with an overall incidence of around 5/100,000/year. Rarity and morphologic heterogeneity significantly affect diagnostic accuracy; therefore, expertise can be achieved only through access to large number of cases. Soft tissue sarcomas are currently classified on the basis of the 2013 WHO classification of soft tissue tumors that integrate conventional morphology with immunohistochemistry and molecular genetics. The morphologic diagnosis of sarcoma relies on the evaluation as well as the integration of four main features: the shape of the neoplastic cells; the pattern of growth; the quality of the background; the architecture of the vascular network. Immunohistochemical characterization plays a key role in the diagnostic workup of soft tissue sarcomas. The majority of classic differentiation markers tend to show good sensitivity, however, associated with rather limited specificity, making interpretation in context with morphology mandatory. Molecular genetics is increasingly used for diagnostic purposes to distinguish specific subtypes of sarcomas, to support diagnosis in non-canonical clinical presentations and also to distinguish true sarcomas from benign mimickers. With many exceptions, histologic typing does not provide sufficient information for predicting the clinical course of the disease and, therefore, grading systems based on histological parameters were introduced to provide a more accurate estimation of the degree of malignancy of tumors. The three-tiered system devised by the French Federation of Cancer Centers Sarcoma Group (FNCLCC) systems is widely adopted; however, several limitations exist that have led to the development of prognostic nomograms that incorporate the specific histotype as one of the relevant parameters.
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Affiliation(s)
- Marta Sbaraglia
- Department of Pathology, Azienda ULSS 2 "Marca Trevigiana", Piazza Ospedale, 1, 31100, Treviso, Italy
| | - Angelo P Dei Tos
- Department of Pathology, Azienda ULSS 2 "Marca Trevigiana", Piazza Ospedale, 1, 31100, Treviso, Italy.
- Department of Medicine, University of Padua School of Medicine, Padua, Italy.
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Abstract
PURPOSE OF REVIEW Primary cardiac tumors are a rare disease, which may have severe clinical consequences. Malignant tumors may be misdiagnosed as mixomas, with improper treatment. The aim of this review is to report how to make a differential diagnosis using old and modern tools, the latest trends in tumor classification and treatment, and their possible impact on prognosis. RECENT FINDINGS Papillary fibroelastomas seem to be more frequent than previously reported, and surgery is also suggested in asymptomatic patients. A genetic background has been identified for some myxomas and angiosarcomas. Malignant tumors are now classified as soft-tissue sarcomas of other organs. Immunohistochemistry and molecular diagnosis aid in recognizing several subtypes of sarcomas, leading to the possibility of targeted chemotherapy. The reports of single-center and multicenter experiences, collecting a large number of treated patients, analyzed the impact on prognosis of different approaches. The best results for survival and event-free survival are obtained with the multimodality approach. SUMMARY Before referring a patient with cardiac tumor to the cardiac surgeon, a presumptive diagnosis of benignity or malignancy should be obtained. Malignant tumors should be referred to a cardiac tumor team with special expertise, in order to plan the best therapeutic approach.
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113
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Kawai A, Goto T, Shibata T, Tani K, Mizutani S, Nishikawa A, Shibata T, Matsumoto S, Nagata K, Narukawa M, Matsui S, Ando M, Toguchida J, Monden M, Heike T, Kimura S, Ueda R. Current state of therapeutic development for rare cancers in Japan, and proposals for improvement. Cancer Sci 2018; 109:1731-1737. [PMID: 29878624 PMCID: PMC5980298 DOI: 10.1111/cas.13568] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 03/02/2018] [Accepted: 03/07/2018] [Indexed: 12/30/2022] Open
Abstract
This article discusses current obstacles to the rapid development of safe and effective treatments for rare cancers, and considers measures required to overcome these challenges. In order to develop novel clinical options for rare cancers, which tend to remain left out of novel therapeutic development because of their paucity, efficient recruitment of eligible patients, who tend to be widely dispersed across the country and treated at different centers, is necessary. For this purpose, it is important to establish rare cancer registries that are linked with clinical studies, to organize a central pathological diagnosis system and biobanks for rare cancers, and to consolidate patients with rare cancers to facilities that can conduct clinical studies meeting international standards. Establishing an all-Japan cooperative network is essential. Clinical studies of rare cancers have considerable limitations in study design and sample size as a result of paucity of eligible patients and, as a result, the level of confirmation of the efficacy and safety shown by the studies is relatively low. Therefore, measures to alleviate these weaknesses inherent to external conditions need to be explored. It is also important to reform the current research environment in order to develop world-leading treatment for rare cancers, including promotion of basic research, collaboration between industry and academia, and improvement of the infrastructure for clinical studies. Collaboration among a wide range of stakeholders is required to promote the clinical development of treatment for rare cancers under a nationwide consensus.
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Affiliation(s)
- Akira Kawai
- Subcommittee on Rare CancersThe Science Board to the Pharmaceuticals and Medical Devices AgencyTokyoJapan
- Department of Musculoskeletal Oncology and RehabilitationRare Cancer CenterNational Cancer Center HospitalTokyoJapan
| | - Toshio Goto
- Subcommittee on Rare CancersThe Science Board to the Pharmaceuticals and Medical Devices AgencyTokyoJapan
- Program for Drug Discovery and Medical Technology Platforms, RIKENTsukubaJapan
| | - Tatsuhiro Shibata
- Subcommittee on Rare CancersThe Science Board to the Pharmaceuticals and Medical Devices AgencyTokyoJapan
- Laboratory of Molecular MedicineHuman Genome CenterInstitute of Medical ScienceThe University of TokyoTokyoJapan
| | - Kenzaburo Tani
- Subcommittee on Rare CancersThe Science Board to the Pharmaceuticals and Medical Devices AgencyTokyoJapan
- Project Division of ALA Advanced Medical ResearchThe Institute of Medical ScienceThe University of TokyoTokyoJapan
| | - Shuki Mizutani
- Subcommittee on Rare CancersThe Science Board to the Pharmaceuticals and Medical Devices AgencyTokyoJapan
- Tokyo Medical and Dental UniversityTokyoJapan
| | - Akiyoshi Nishikawa
- Subcommittee on Rare CancersThe Science Board to the Pharmaceuticals and Medical Devices AgencyTokyoJapan
- Biological Safety Research CenterNational Institute of Health SciencesTokyoJapan
| | - Taro Shibata
- Subcommittee on Rare CancersThe Science Board to the Pharmaceuticals and Medical Devices AgencyTokyoJapan
- Biostatistics DivisionCenter for Research Administration and SupportNational Cancer CenterTokyoJapan
| | - Seiichi Matsumoto
- Subcommittee on Rare CancersThe Science Board to the Pharmaceuticals and Medical Devices AgencyTokyoJapan
- Sarcoma CenterThe Cancer Institute Hospital of JFCRTokyoJapan
| | - Kyosuke Nagata
- Subcommittee on Rare CancersThe Science Board to the Pharmaceuticals and Medical Devices AgencyTokyoJapan
- University of TsukubaTsukubaJapan
| | - Mamoru Narukawa
- Subcommittee on Rare CancersThe Science Board to the Pharmaceuticals and Medical Devices AgencyTokyoJapan
- Department of Clinical Medicine (Pharmaceutical Medicine)School of PharmacyKitasato UniversitySagamiharaJapan
| | - Shigeyuki Matsui
- Subcommittee on Rare CancersThe Science Board to the Pharmaceuticals and Medical Devices AgencyTokyoJapan
- Department of BiostatisticsNagoya University Graduate School of MedicineNagoyaJapan
| | - Masashi Ando
- Subcommittee on Rare CancersThe Science Board to the Pharmaceuticals and Medical Devices AgencyTokyoJapan
- Department of Clinical OncologyAichi Cancer Center HospitalNagakuteJapan
| | - Junya Toguchida
- Subcommittee on Rare CancersThe Science Board to the Pharmaceuticals and Medical Devices AgencyTokyoJapan
- Institute for Frontier Life and Medical Sciences/Center for iPS Cell Research and ApplicationKyoto UniversityTokyoJapan
| | - Morito Monden
- Subcommittee on Rare CancersThe Science Board to the Pharmaceuticals and Medical Devices AgencyTokyoJapan
- Sakai City Hospital OrganizationSakaiJapan
| | - Toshio Heike
- Subcommittee on Rare CancersThe Science Board to the Pharmaceuticals and Medical Devices AgencyTokyoJapan
- Hyogo Prefectural Amagasaki General Medical CenterAmagasakiJapan
| | - Shinya Kimura
- Subcommittee on Rare CancersThe Science Board to the Pharmaceuticals and Medical Devices AgencyTokyoJapan
- Division of Hematology, Respiratory Medicine and OncologyDepartment of Internal MedicineFaculty of MedicineSaga UniversitySagaJapan
| | - Ryuzo Ueda
- Subcommittee on Rare CancersThe Science Board to the Pharmaceuticals and Medical Devices AgencyTokyoJapan
- Department of Tumor ImmunologyAichi Medical University School of MedicineNagakuteJapan
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114
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Dei Tos AP, Bonvalot S, Haas R. The key role of pathology, surgery and radiotherapy in the initial management of soft tissue sarcoma. Future Oncol 2018; 14:15-23. [DOI: 10.2217/fon-2018-0075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Soft tissue sarcomas are a heterogeneous group of rare malignancies. The diagnostic gold standard is conventional histomorphology with integrated immunohistochemistry. Molecular genetic profiling has identified new subgroups of undifferentiated sarcomas involving genetic rearrangements with creation of fusion genes. Accurate classification of sarcomas is critical for appropriate clinical decision-making which should involve a multidisciplinary team. A preoperative biopsy is necessary to confirm a diagnosis. Strategy is discussed in the multidisciplinary board. Reconstructive surgery must be planned in advance taking into account possible surgical morbidity. In high-risk situations, neo-adjuvant treatment could facilitate surgery in some cases, increase survival and provide indications of tumor biology. The decision is based on tumor subtype, grade and location, patient age and presence of comorbidities.
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Affiliation(s)
- Angelo Paolo Dei Tos
- Department of Pathology, Treviso, Italy; & Department of Medicine, University of Padua School of Medicine, Padua, Italy
| | - Sylvie Bonvalot
- Department of Surgery, Institut Curie, PSL Research University, Paris, France
| | - Rick Haas
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam & Leiden University Medical Center, The Netherlands
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115
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Working to improve the management of sarcoma patients across Europe: a policy checklist. BMC Cancer 2018; 18:424. [PMID: 29661168 PMCID: PMC5902948 DOI: 10.1186/s12885-018-4320-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 03/29/2018] [Indexed: 12/29/2022] Open
Abstract
Background The Sarcoma Policy Checklist was created by a multidisciplinary expert group to provide policymakers with priority areas to improve care for sarcoma patients. Main body This paper draws on this research, by looking more closely at how France, Germany, Italy, Spain, Sweden and the United Kingdom are addressing each of these priority areas. It aims to highlight key gaps in research, policy and practice, as well as ongoing initiatives that may impact the future care of sarcoma patients in different European countries. A pragmatic review of the published and web-based literature was undertaken. Telephone interviews were conducted in each country with clinical and patient experts to substantiate findings. Research findings were discussed within the expert group and developed into five core policy recommendations. The five identified priority areas were: the development of designated and accredited centres of reference; more professional training; multidisciplinary care; greater incentives for research and innovation; and more rapid access to effective treatments. Most of the countries studied have ongoing initiatives addressing many of these priorities; however, many are in early stages of development, or require additional funding and resources. Conclusion Gaps in access to quality care are particularly concerning in many of Europe’s lower-resourced countries. Equitable access to information, clinical trials, innovative treatments and quality specialist care should be available to all sarcoma patients. Achieving this across Europe will require close collaboration between all stakeholders at both the national and European level.
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Perrier L, Rascle P, Morelle M, Toulmonde M, Ranchere Vince D, Le Cesne A, Terrier P, Neuville A, Meeus P, Farsi F, Ducimetière F, Blay JY, Ray Coquard I, Coindre JM. The cost-saving effect of centralized histological reviews with soft tissue and visceral sarcomas, GIST, and desmoid tumors: The experiences of the pathologists of the French Sarcoma Group. PLoS One 2018; 13:e0193330. [PMID: 29621244 PMCID: PMC5886412 DOI: 10.1371/journal.pone.0193330] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 02/08/2018] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE This study examined the types of discordance occurring in the diagnosis of soft tissue and visceral sarcomas, gastrointestinal stromal tumors (GIST), and desmoid tumors, as well as the economic impact of diagnostic discrepancies. METHODS We carried out a retrospective, multicenter analysis using prospectively implemented databases performed on a cohort of patients within the French RRePS network in 2010. Diagnoses were deemed to be discordant based on the 2013 World Health Organization (WHO) classification. Predictive factors of discordant diagnoses were explored. A decision tree was used to assess the expected costs of two strategies of disease management: one based on revised diagnoses after centralized histological review (option 1), the other on diagnoses without centralized review (option 2). Both were defined based on the patient and the disease characteristics, according to national or international guidelines. The time horizon was 12 months and the perspective of the French National Health Insurance (NHI) was retained. Costs were expressed in Euros for 2013. Sensitivity analyses were performed using low and high scenarios that included ± 20% estimates for cost. RESULTS A total of 2,425 patients were included. Three hundred forty-one patients (14%) had received discordant diagnoses. These discordances were determined to mainly be benign tumors diagnosed as sarcomas (n = 124), or non-sarcoma malignant tumors diagnosed as sarcomas (n = 77). The probability of discordance was higher for a final diagnosis of desmoid tumors when compared to liposarcomas (odds ratio = 5.1; 95%CI [2.6-10.4]). The expected costs per patient for the base-case analysis (low- and high-case scenarios) amounted to €8,791 (€7,033 and €10,549, respectively) for option 1 and €8,904 (€7,057 and €10,750, respectively) for option 2. CONCLUSIONS Our findings highlight misdiagnoses of sarcomas, which were found to most often be confused with benign tumors. Centralized histological reviews are likely to provide cost-savings for the French NHI.
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Affiliation(s)
- Lionel Perrier
- University of Lyon, Léon Bérard Cancer Centre, GATE L-SE UMR 5824, Lyon, France.,Direction of Clinical Research and Innovation, DRCI, Léon Bérard Cancer Centre, Lyon, France
| | - Pauline Rascle
- Direction of Clinical Research and Innovation, DRCI, Léon Bérard Cancer Centre, Lyon, France
| | - Magali Morelle
- University of Lyon, Léon Bérard Cancer Centre, GATE L-SE UMR 5824, Lyon, France.,Direction of Clinical Research and Innovation, DRCI, Léon Bérard Cancer Centre, Lyon, France
| | - Maud Toulmonde
- Department of Medicine, Institut Bergonié, Bordeaux, France
| | | | - Axel Le Cesne
- Department of Medecine, Institut Gustave Roussy, Villejuif, France
| | | | - Agnès Neuville
- Department of Anatomopathology, Institut Bergonié, Bordeaux, France
| | - Pierre Meeus
- Department of Surgery, Cancer Centre Léon Bérard, Lyon, France
| | - Fadila Farsi
- Réseau Espace Santé Cancer Rhône-Alpes, Lyon, France
| | | | - Jean-Yves Blay
- Department of Medicine, Cancer Centre Léon Bérard, Lyon, France
| | - Isabelle Ray Coquard
- Santé-Individu-société EA-INSERM 4129, Cancer centre Léon Bérard, Lyon, France.,Department of Medicine, Cancer Centre Léon Bérard, Lyon, France
| | - Jean-Michel Coindre
- Department of Anatomopathology, Institut Bergonié, Bordeaux, France.,University Victor Ségalen, Bordeaux, France
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Nakano K, Takahashi S. Current Molecular Targeted Therapies for Bone and Soft Tissue Sarcomas. Int J Mol Sci 2018; 19:E739. [PMID: 29510588 PMCID: PMC5877600 DOI: 10.3390/ijms19030739] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 03/01/2018] [Accepted: 03/03/2018] [Indexed: 12/16/2022] Open
Abstract
Systemic treatment options for bone and soft tissue sarcomas remained unchanged until the 2000s. These cancers presented challenges in new drug development partly because of their rarity and heterogeneity. Many new molecular targeting drugs have been tried in the 2010s, and some were approved for bone and soft tissue sarcoma. As one of the first molecular targeted drugs approved for solid malignant tumors, imatinib's approval as a treatment for gastrointestinal stromal tumors (GISTs) has been a great achievement. Following imatinib, other tyrosine kinase inhibitors (TKIs) have been approved for GISTs such as sunitinib and regorafenib, and pazopanib was approved for non-GIST soft tissue sarcomas. Olaratumab, the monoclonal antibody that targets platelet-derived growth factor receptor (PDGFR)-α, was shown to extend the overall survival of soft tissue sarcoma patients and was approved in 2016 in the U.S. as a breakthrough therapy. For bone tumors, new drugs are limited to denosumab, a receptor activator of nuclear factor κB ligand (RANKL) inhibitor, for treating giant cell tumors of bone. In this review, we explain and summarize the current molecular targeting therapies approved and in development for bone and soft tissue sarcomas.
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Affiliation(s)
- Kenji Nakano
- Department of Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto, Tokyo 135-8550, Japan.
| | - Shunji Takahashi
- Department of Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto, Tokyo 135-8550, Japan.
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118
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Mathoulin-Pélissier S, Pritchard-Jones K. Evidence-based data and rare cancers: The need for a new methodological approach in research and investigation. Eur J Surg Oncol 2018. [PMID: 29526369 DOI: 10.1016/j.ejso.2018.02.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Rare cancers are not so rare, their incidence is increasing and, as a group, they have worse survival than the common cancers. These factors emphasise the societal need to ensure sufficient focus on research into their biological basis, aetiological factors, new more effective therapies and organisation of healthcare to improve access to best practice and innovation. Accuracy of diagnosis is one of the first hurdles to be overcome, with around one third of tumours being reclassified - by type or risk group - when subject to a centralised pathology review process. Timely access to appropriate expert knowledge is a second challenge for patients - in Europe this is being addressed by the establishment of European Reference Networks (ERNs) as part of the EU cross border healthcare initiative. There are ERNs for adult solid and haematological cancers and childhood cancers, all of which are individually rare. These ERNs will facilitate creation of large databases of rare tumours that will incorporate knowledge of their molecular features and build an evidence base for the effectiveness of innovative, biology-directed therapies. With an increasing focus on 'real world' outcome data, research methodologies are evolving, to include randomised registry trials and data linkage approaches that exploit the ever-richer information held on patients in routine health care data. The inclusion of genomic analysis into cancer diagnosis, treatment and risk prediction raises many issues for the conduct of clinical research and cohort studies and personal data sharing. Sophisticated means of pseudonymisation, together with full involvement of affected and 'at risk' patients, are supporting novel research designs and access to data that will continue to build the evidence base to improve outcomes for patients with rare cancers.
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Affiliation(s)
- S Mathoulin-Pélissier
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene Team, UMR 1219, F-33000 Bordeaux, France; Clinical and Epidemiological Research Unit, INSERM CIC1401, Institut Bergonie, Comprehensive Cancer Centre, F-33000 Bordeaux, France.
| | - K Pritchard-Jones
- University College London, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
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119
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Merabi Z, Boulos F, Santiago T, Jenkins J, Abboud M, Muwakkit S, Tarek N, Zaatari G, Jeha S, El-Solh H, Saab R. Pediatric cancer pathology review from a single institution: Neuropathology expert opinion is essential for accurate diagnosis of pediatric brain tumors. Pediatr Blood Cancer 2018; 65. [PMID: 28675683 DOI: 10.1002/pbc.26709] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 06/08/2017] [Accepted: 06/08/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES Second pathology review has been reported to improve accuracy in oncologic diagnoses, including pediatric malignancies. We assessed the impact of second review on the diagnosis of pediatric malignancies at a tertiary care referral center in Beirut, Lebanon. METHODS Pathology reports of patients treated at the Children's Cancer Institute in Lebanon were retrospectively reviewed for the period 2008-2016 and compared with same samples' diagnoses at St. Jude Children's Research Hospital. Diagnostic disagreements were divided into major, minor, and none based on their effect on diagnosis and/or patient management. RESULTS Second review was requested for 171 cases, accounting for 19% of all cases during that period. Second opinion was mostly requested for brain tumors (62% of all brain tumor cases) and neuroblastoma for NMYC testing (65% of all neuroblastoma), while hematologic malignancies had the fewest referrals (3% of all hematologic cases). Major disagreements in second review occurred in 20 cases (12% of total), and minor disagreements in 21 cases (12% of total). The largest proportion of major disagreements (71%) occurred in pediatric brain tumors, and novel molecular tests contributed to the diagnosis in 55% of these cases. CONCLUSIONS The availability of a specialized pediatric neuropathologist and a basic panel of relevant molecular testing are essential for appropriate diagnosis of pediatric brain tumors. Centers that do not have the available infrastructure in place can benefit greatly from second review referrals for this challenging subset of tumors.
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Affiliation(s)
- Zeina Merabi
- Department of Pediatric and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fouad Boulos
- Department of Pediatric and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Jesse Jenkins
- St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Miguel Abboud
- Department of Pediatric and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Samar Muwakkit
- Department of Pediatric and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nidale Tarek
- Department of Pediatric and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ghazi Zaatari
- Department of Pediatric and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sima Jeha
- St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Hassan El-Solh
- Department of Pediatric and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Raya Saab
- Department of Pediatric and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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120
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Penel N, Coindre JM, Giraud A, Terrier P, Ranchere-Vince D, Collin F, Guellec SLE, Bazille C, Lae M, de Pinieux G, Ray-Coquard IL, Bonvalot S, Cesne ALE, Robin YM, Stoeckle E, Toulmonde M, Blay JY. Presentation and outcome of frequent and rare sarcoma histologic subtypes: A study of 10,262 patients with localized visceral/soft tissue sarcoma managed in reference centers. Cancer 2017; 124:1179-1187. [PMID: 29211310 DOI: 10.1002/cncr.31176] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 10/16/2017] [Accepted: 10/23/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND The objective of this study was to describe characteristics at diagnosis and outcomes of adults with soft tissue sarcoma. METHODS The authors conducted a retrospective multicenter study of 12,262 patients who were treated between January 1980 and 31 December 2013 in French Sarcoma Group centers and enrolled in the "Conticabase." Diagnoses were systematically reviewed by expert pathologists, and entities were classified according to the 2013 World Health Organization classification. Diagnostic characteristics, treatments, and outcomes are described for the entire cohort, for the subgroup of patients with translocation-related sarcomas, and for 9 different histologic subtypes. RESULTS The results stressed the magnitude of heterogeneity among adult sarcomas. For example, compared with other sarcomas, translocation-related sarcomas (2143 tumors; 20.8%) were associated with a younger age at presentation (40.6 vs 60.0 years; P < .0001), a low rate of predisposing conditions (0.01% vs 22.3%; P < .0001), a higher rate of lymph node involvement (4.7% vs 1.3%; P < .0001), and a higher rate of synchronous metastasis (11.9% vs 6.7%; P < .001); and complete (R0) resection (41.6% vs 31.9%; P < .0001), receipt of (neo)adjuvant radiation therapy (62.6% vs 42.2%; P < .0001), and receipt of (neo)adjuvant chemotherapy (36.6% vs 22.3%; P < .0001) were significantly more frequent. Overall, translocation-related sarcomas were associated with a lower rate of local relapse (18.1% vs 26.0%; P < .0001) but a higher rate of metastatic relapse (42.0% vs 30.7%; P < .0001). CONCLUSIONS Collaborative efforts are urgently needed to better assess the natural history and management options for every histologic subtype of sarcoma. Cancer 2018;124:1179-87. © 2017 American Cancer Society.
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Affiliation(s)
- Nicolas Penel
- Department of Medical Oncology, Oscar Lambret Center, Lille, France.,Methodology Clinical Research Platform, Lille French Comprehensive Cancer Center (SIRIC OncoLille), Lille, France
| | - Jean-Michel Coindre
- Department of Biopathology, National Institute of Health and Medical Research (INSERM) Unit 916, Bergonie Institute, University of Bordeaux, Bordeaux, France
| | - Antoine Giraud
- Clinical and Epidemiologic Research Unit, INSERM Clinical Investigation Center 1401, Bergonie Institute, Bordeaux, France
| | - Philippe Terrier
- Department of Pathology, Gustave Roussy Institute, Villejuif, France
| | | | - Françoise Collin
- Department of Pathology, Georges-Francois Leclerc Center, Dijon, France
| | - Sophie L E Guellec
- Department of Pathology, University Cancer Institute of Toulouse-Oncopole, Toulouse, France
| | - Céline Bazille
- Department of Pathologic Anatomy, University Hospital, Caen, Basse-Normandie, France
| | - Marick Lae
- Department of Pathology, Curie Institute, Paris, France
| | - Gonzague de Pinieux
- Department of Pathology, University Hospital of Tours and Francois Rabelais University, Tours, France
| | | | - Sylvie Bonvalot
- Department of Medical Oncology and Surgery, Gustave Roussy Institute, Villejuif, France
| | - Axel L E Cesne
- Department of Medical Oncology and Surgery, Gustave Roussy Institute, Villejuif, France
| | | | | | - Maud Toulmonde
- Department of Medical Oncology, Bergonie Institute, Bordeaux, France
| | - Jean-Yves Blay
- Department of Medical Oncology, Leon Berard Center, Lyon, France
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121
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Lou S, Balluff B, de Graaff MA, Cleven AHG, Briaire-de Bruijn I, Bovée JVMG, McDonnell LA. High-grade sarcoma diagnosis and prognosis: Biomarker discovery by mass spectrometry imaging. Proteomics 2017; 16:1802-13. [PMID: 27174013 DOI: 10.1002/pmic.201500514] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 05/04/2016] [Accepted: 05/09/2016] [Indexed: 12/24/2022]
Abstract
The combination of high heterogeneity, both intratumoral and intertumoral, with their rarity has made diagnosis, prognosis of high-grade sarcomas difficult. There is an urgent need for more objective molecular biomarkers, to differentiate between the many different subtypes, and to also provide new treatment targets. Mass spectrometry imaging (MSI) has amply demonstrated its ability to identify potential new markers for patient diagnosis, survival, metastasis and response to therapy in cancer research. In this study, we investigated the ability of MALDI-MSI of proteins to distinguish between high-grade osteosarcoma (OS), leiomyosarcoma (LMS), myxofibrosarcoma (MFS) and undifferentiated pleomorphic sarcoma (UPS) (Ntotal = 53). We also investigated if there are individual proteins or protein signatures that are statistically associated with patient survival. Twenty diagnostic protein signals were found characteristic for specific tumors (p ≤ 0.05), amongst them acyl-CoA-binding protein (m/z 11 162), macrophage migration inhibitory factor (m/z 12 350), thioredoxin (m/z 11 608) and galectin-1 (m/z 14 633) were assigned. Another nine protein signals were found to be associated with overall survival (p ≤ 0.05), including proteasome activator complex subunit 1 (m/z 9753), indicative for non-OS patients with poor survival; and two histone H4 variants (m/z 11 314 and 11 355), indicative of poor survival for LMS patients.
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Affiliation(s)
- Sha Lou
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, The Netherlands
| | - Benjamin Balluff
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, The Netherlands.,Maastricht MultiModal Molecular Imaging Institute, Maastricht University, Maastricht, The Netherlands
| | - Marieke A de Graaff
- Department of Pathology, Leiden University, Medical Center, Leiden, The Netherlands
| | - Arjen H G Cleven
- Department of Pathology, Leiden University, Medical Center, Leiden, The Netherlands
| | | | - Judith V M G Bovée
- Department of Pathology, Leiden University, Medical Center, Leiden, The Netherlands
| | - Liam A McDonnell
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, The Netherlands.,Department of Pathology, Leiden University, Medical Center, Leiden, The Netherlands.,Fondazione Pisana per la Scienza ONLUS, Pisa, Italy
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Pasquali S, Bonvalot S, Tzanis D, Casali PG, Trama A, Gronchi A. Treatment challenges in and outside a network setting: Soft tissue sarcomas. Eur J Surg Oncol 2017; 45:31-39. [PMID: 28985973 DOI: 10.1016/j.ejso.2017.09.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 08/22/2017] [Accepted: 09/06/2017] [Indexed: 12/21/2022] Open
Abstract
Patients with soft tissue sarcoma (STS) experienced better outcomes when treated according to existing clinical practice guidelines either at reference institution or dedicated treatment networks. Despite increasing evidence supporting referral to sarcoma specialised units, up to half of patients are not managed according to guidelines, particularly those in the early stage of their disease requiring surgery. Also, criteria to certify expertise of institutions, such as the treatment volume, are debated and health authorities have only recently started identification of these centres and creation of treatment networks in Europe as well as in several countries. This process have important implications for both patient outcomes and innovation of existing treatment strategies through clinical research, making improvement of clinical pathways a priority for health care authorities. This article will discuss issues with management of patients with STS, such as pathological diagnosis and adherence to guidelines, and the definition of referral centres and networks will be illustrated along with existing experiences and population-based data.
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Affiliation(s)
- Sandro Pasquali
- Sarcoma Service, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Sylvie Bonvalot
- Department of Surgery, Institut Curie, PSL Research University, Paris, France
| | - Dimitri Tzanis
- Department of Surgery, Institut Curie, PSL Research University, Paris, France
| | - Paolo G Casali
- Medical Oncology Unit 2, Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Oncology & Heamato-Oncology Department, University of Milano, Italy
| | - Annalisa Trama
- Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Alessandro Gronchi
- Sarcoma Service, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
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124
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Chiannilkulchai N, Pautier P, Genestie C, Bats A, Vacher-Lavenu M, Devouassoux-Shisheboran M, Treilleux I, Floquet A, Croce S, Ferron G, Mery E, Pomel C, Penault-Llorca F, Lefeuvre-Plesse C, Henno S, Leblanc E, Lemaire A, Averous G, Kurtz J, Ray-Coquard I. Networking for ovarian rare tumors: a significant breakthrough improving disease management. Ann Oncol 2017; 28:1274-1279. [DOI: 10.1093/annonc/mdx099] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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125
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Ray-Coquard I, Collard O, Ducimetiere F, Laramas M, Mercier F, Ladarre N, Manson S, Tehard B, Clippe S, Suchaud JP, Stefani L, Blay JY. Treatment patterns and survival in an exhaustive French cohort of pazopanib-eligible patients with metastatic soft tissue sarcoma (STS). BMC Cancer 2017; 17:111. [PMID: 28173774 PMCID: PMC5297166 DOI: 10.1186/s12885-017-3057-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 01/11/2017] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The French EMS study prospectively collected exhaustive data from STS patients diagnosed in the Rhone-Alpes region from 2005 to 07. METHODS The database included diagnosis/histology, surgery, radiotherapy, systemic treatments and treatment response. Treatment patterns and outcomes of patients with metastatic disease, excluding adipocytic sarcoma and GIST were analyzed. RESULTS Of 888 total patients, 145 were included based on having metastatic disease and appropriate subtypes. All patients received treatment with systemic therapy being most common (74%, n = 107), followed by radiotherapy (30%, n = 44) and surgery (23%, n = 33). Doxorubicin, alone or in combination, was the most common first line systemic therapy (65%, n = 46). Drugs without license in sarcoma were used in 38-83% of treatments depending on treatment line. 24% of frontline patients demonstrated an objective response, decreasing to 11% objective responses in second line but no responses were documented beyond second line, with median PFS declining with each additional line. Median PFS also declined in patients receiving surgery compared to those receiving no surgery (8-15 m vs 5 m). Median OS from metastatic diagnosis for patients receiving systemic therapy was double that of patients without systemic treatment (24 m vs 12 m, p = 0.007). CONCLUSIONS Outcomes in this population were poor and declined with successive treatment. However, results suggest that further anticancer therapies in recurrent sarcoma might be beneficial.
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Affiliation(s)
- Isabelle Ray-Coquard
- Centre Léon-Bérard, University Claude Bernard Lyon I, 28 rue Laennec, 69008, Lyon, France. .,Service D'oncologie Médicale, Centre Léon Bérard, 28, rue Laennec, 69008, Lyon, France.
| | - Olivier Collard
- Institut de Cancérologie de la Loire Lucien Neuwirth, 108 Bis av. Albert Raimond, 42270, Saint-Priest en Jarez, France
| | - Françoise Ducimetiere
- Centre Léon-Bérard, University Claude Bernard Lyon I, 28 rue Laennec, 69008, Lyon, France
| | - Mathieu Laramas
- CHU de Grenoble, Avenue Maquis du Grésivaudan, 38700, La Tronche, France
| | | | - Nadine Ladarre
- Novartis, 2-4, rue Lionel Terray, Boite postale 308, F-92506, Rueil-Malmaison Cedex, France
| | - Stephanie Manson
- Novartis, Park View, Riverside Way, Watchmoor Park, Camberley, Surrey, GU15 3YL, UK
| | - Bertrand Tehard
- Novartis, 2-4, rue Lionel Terray, Boite postale 308, F-92506, Rueil-Malmaison Cedex, France
| | - Sébastien Clippe
- Centre Marie Curie, 137 Avenue de Romans, 26000, Valence, France
| | - Jean-Philippe Suchaud
- Service de Radiothérapie, Centre Hospitalier de Roanne, 28 Rue de Charlieu, 42300, Roanne, France
| | - Laetitia Stefani
- Centre Hospitalier Annecy-Genevois, 1 Avenue de l'Hôpital, 74370, Metz-Tessy, France
| | - Jean-Yves Blay
- Centre Léon-Bérard, University Claude Bernard Lyon I, 28 rue Laennec, 69008, Lyon, France
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Andritsch E, Beishon M, Bielack S, Bonvalot S, Casali P, Crul M, Delgado-Bolton R, Donati DM, Douis H, Haas R, Hogendoorn P, Kozhaeva O, Lavender V, Lovey J, Negrouk A, Pereira P, Roca P, de Lempdes GR, Saarto T, van Berck B, Vassal G, Wartenberg M, Yared W, Costa A, Naredi P. ECCO Essential Requirements for Quality Cancer Care: Soft Tissue Sarcoma in Adults and Bone Sarcoma. A critical review. Crit Rev Oncol Hematol 2017; 110:94-105. [DOI: 10.1016/j.critrevonc.2016.12.002] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 12/05/2016] [Indexed: 01/04/2023] Open
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Lou S, Balluff B, Cleven AHG, Bovée JVMG, McDonnell LA. Prognostic Metabolite Biomarkers for Soft Tissue Sarcomas Discovered by Mass Spectrometry Imaging. JOURNAL OF THE AMERICAN SOCIETY FOR MASS SPECTROMETRY 2017; 28:376-383. [PMID: 27873216 PMCID: PMC5227002 DOI: 10.1007/s13361-016-1544-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 10/14/2016] [Accepted: 10/15/2016] [Indexed: 05/22/2023]
Abstract
Metabolites can be an important read-out of disease. The identification and validation of biomarkers in the cancer metabolome that can stratify high-risk patients is one of the main current research aspects. Mass spectrometry has become the technique of choice for metabolomics studies, and mass spectrometry imaging (MSI) enables their visualization in patient tissues. In this study, we used MSI to identify prognostic metabolite biomarkers in high grade sarcomas; 33 high grade sarcoma patients, comprising osteosarcoma, leiomyosarcoma, myxofibrosarcoma, and undifferentiated pleomorphic sarcoma were analyzed. Metabolite MSI data were obtained from sections of fresh frozen tissue specimens with matrix-assisted laser/desorption ionization (MALDI) MSI in negative polarity using 9-aminoarcridine as matrix. Subsequent annotation of tumor regions by expert pathologists resulted in tumor-specific metabolite signatures, which were then tested for association with patient survival. Metabolite signals with significant clinical value were further validated and identified by high mass resolution Fourier transform ion cyclotron resonance (FTICR) MSI. Three metabolite signals were found to correlate with overall survival (m/z 180.9436 and 241.0118) and metastasis-free survival (m/z 160.8417). FTICR-MSI identified m/z 241.0118 as inositol cyclic phosphate and m/z 160.8417 as carnitine. Graphical Abstract ᅟ.
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Affiliation(s)
- Sha Lou
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, The Netherlands
| | - Benjamin Balluff
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, The Netherlands
- Maastricht MultiModal Molecular Imaging institute (M4I), Maastricht University, Maastricht, The Netherlands
| | - Arjen H G Cleven
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Judith V M G Bovée
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Liam A McDonnell
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, The Netherlands.
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands.
- Fondazione Pisana per la Scienza ONLUS, Pisa, Italy.
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Rekhi B, Badanale R, Jambhekar NA, Gulia A, Bajpai J, Laskar S, Khanna N, Chinnaswamy G, Puri A. Histopathologic review of 400 biopsies and resection specimens of trunk and extremity-based soft tissue tumors. Indian J Cancer 2017; 54:401-408. [DOI: 10.4103/ijc.ijc_259_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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129
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Shahi F, Alishahi R, Pashaiefar H, Jahanzad I, Kamalian N, Ghavamzadeh A, Yaghmaie M. Differentiating and Categorizing of Liposarcoma and Synovial Sarcoma Neoplasms by Fluorescence in Situ Hybridization. IRANIAN JOURNAL OF PATHOLOGY 2017; 12. [PMID: 29531545 PMCID: PMC5835368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
BACKGROUND & OBJECTIVE Soft tissue sarcomas (STS) constitute an uncommon and heterogeneous group of tumors of mesenchymal origin and various cytogenetic abnormalities ranging from distinct genomic rearrangements, such as chromosomal translocations and amplifications, to more intricate rearrangements involving multiple chromosomes. Fluorescence in situ hybridization (FISH) can be used to identify these chromosomal translocations and amplifications, and sub classify STS precisely. The current study aimed at investigating the usefulness of FISH, as a diagnostic ancillary aid, to detect cytogenetic abnormalities such as MDM2 (murine double minute 2) amplification and CHOP(C/EBP homologous protein) rearrangement in liposarcoma, as well as SYT (synaptotagmin) rearrangement in synovial sarcoma. METHODS The FISH technique was used to analyze 17 specimens of liposarcoma for MDM2 amplification and CHOP rearrangement, and 10 specimens of synovial sarcoma for SYT rearrangement. The subtypes of liposarcoma and synovial sarcomas were reclassified according to the FISH results and compared with those of the respective histological findings. RESULTS According to the FISH results in 17 liposarcoma cases, well-differentiated liposarcoma(WDLPS), dedifferentiated liposarcoma (DDLPS), and myxoidliposarcoma (MLPS)subtypes were 41%, 53%, and 6%, respectively. In different subtypes of liposarcoma, a total of 30% mismatches were observed between pathologic and cytogenetic results. According to the histological findings from FISH analysis, SYT rearrangement was found only in three out of 10 (30%) synovial sarcomas. CONCLUSION The detection of cytogenetic abnormalities in patients with liposarcoma and synovial sarcoma by FISH technique provides an important objective tool to confirm sarcoma diagnosis and sub classification of specific sarcoma subtypes in such patients.
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Affiliation(s)
- Farhad Shahi
- Dept. of Hematology and Medical Oncology, Cancer Research Center, Cancer Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Razieh Alishahi
- Dept. of Biology, Faculty of Sciences, International Pardis, University of Guilan, Rasht, Iran
| | - Hossein Pashaiefar
- Dept. of Medical Genetics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Isa Jahanzad
- Dept. of Pathology, Cancer Research Center, Cancer Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Naser Kamalian
- Dept. of Pathology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ardeshir Ghavamzadeh
- Hematology, Oncology and Stem Cell Transplantation Research center, Tehran University of Medical Sciences, Tehran, Iran
| | - Marjan Yaghmaie
- Hematology, Oncology and Stem Cell Transplantation Research center, Tehran University of Medical Sciences, Tehran, Iran,Corresponding Information: Dr. Marjan Yaghmaie, Hematology, Oncology and Stem Cell Transplantation Research center, Tehran University of Medical Sciences, Tehran, Iran, e-mail to: , tel: +98-2184902709
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Stoeckle E, Michot A, Henriques B, Sargos P, Honoré C, Ferron G, Meeus P, Babre F, Bonvalot S. [Surgery for soft-tissue sarcomas of the limbs and trunk wall]. Cancer Radiother 2016; 20:657-65. [PMID: 27599681 DOI: 10.1016/j.canrad.2016.07.068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 07/08/2016] [Accepted: 07/11/2016] [Indexed: 11/16/2022]
Abstract
Soft-tissue sarcoma of the limbs or the trunk wall determine a heterogeneous group of tumours that tends to receive a more individualized approach. The surgeon in charge with soft-tissue sarcoma has to be familiar with these tumours in order to deliver an adequate treatment. Most important is the initial diagnostic procedure, comprising imaging with MRI, a core needle biopsy, and in France, referral to a centre of expertise within the clinical network NETSARC. Prior to surgery, a multidisciplinary conference determines its moment and the extent of surgical resection within the frame of a multidisciplinary approach, and also plans reconstructive surgery, when needed. A standardized operative report summarizes items necessary to describe the resection quality (i.e. tumour seen, tumour infiltrated?). In multidisciplinary staff meetings, they are compared to margins measured by the pathologist on the operative specimen. Hence, resection quality is determined collegially and defined by resection type R (R0, R1, R2) as a qualitative result. The quality of resection directly determines the 5-year risk of local recurrence, estimated between 10 and 20% in specialized centres, with the objective to attain 10%. Early rehabilitation favours better functional outcome. The surgeon's experience with soft-tissue sarcoma, as part of a multidisciplinary treatment, is key in achieving the best adequacy between oncological resection and favourable functional outcome. In France, a specific university course for soft-tissue sarcoma will be set-up.
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Affiliation(s)
- E Stoeckle
- Service de chirurgie, institut Bergonié, 229, cours de l'Argonne, 33076 Bordeaux cedex, France.
| | - A Michot
- Service de chirurgie, institut Bergonié, 229, cours de l'Argonne, 33076 Bordeaux cedex, France
| | - B Henriques
- Service de radiothérapie, institut Bergonié, 229, cours de l'Argonne, 33076 Bordeaux cedex, France
| | - P Sargos
- Service de radiothérapie, institut Bergonié, 229, cours de l'Argonne, 33076 Bordeaux cedex, France
| | - C Honoré
- Service de chirurgie, institut Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France
| | - G Ferron
- Service de chirurgie, institut universitaire du cancer de Toulouse, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
| | - P Meeus
- Service de chirurgie, centre Léon-Bérard, 28, rue Laënnec, 69373 Lyon cedex, France
| | - F Babre
- Service d'anesthésie-réanimation, institut Bergonié, 229, cours de l'Argonne, 33076 Bordeaux cedex, France
| | - S Bonvalot
- Service de chirurgie, institut Curie, 26, rue d'Ulm, 75248 Paris, France
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Dickson MA, Mahoney MR, Tap WD, D'Angelo SP, Keohan ML, Van Tine BA, Agulnik M, Horvath LE, Nair JS, Schwartz GK. Phase II study of MLN8237 (Alisertib) in advanced/metastatic sarcoma. Ann Oncol 2016; 27:1855-60. [PMID: 27502708 DOI: 10.1093/annonc/mdw281] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 07/08/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Aurora kinase A (AURKA) is commonly overexpressed in sarcoma. The inhibition of AURKA by shRNA or by a specific AURKA inhibitor blocks in vitro proliferation of multiple sarcoma subtypes. MLN8237 (alisertib) is a novel oral adenosine triphosphate-competitive AURKA inhibitor. PATIENTS AND METHODS This Cancer Therapy Evaluation Program-sponsored phase II study of alisertib was conducted through the Alliance for Clinical Trials in Oncology (A091102). Patients were enrolled into histology-defined cohorts: (i) liposarcoma, (ii) leiomyosarcoma, (iii) undifferentiated sarcoma, (iv) malignant peripheral nerve sheath tumor, or (v) other. Treatment was alisertib 50 mg PO b.i.d. d1-d7 every 21 days. The primary end point was response rate; progression-free survival (PFS) was secondary. One response in the first 9 patients expanded enrollment in a cohort to 24 using a Simon two-stage design. RESULTS Seventy-two patients were enrolled at 24 sites [12 LPS, 10 LMS, 11 US, 10 malignant peripheral nerve sheath tumor (MPNST), 29 Other]. The median age was 55 years; 54% were male; 58%/38%/4% were ECOG PS 0/1/2. One PR expanded enrollment to the second stage in the other sarcoma cohort. The histology-specific cohorts ceased at the first stage. There were two confirmed PRs in the other cohort (both angiosarcoma) and one unconfirmed PR in dedifferentiated chondrosarcoma. Twelve-week PFS was 73% (LPS), 44% (LMS), 36% (US), 60% (MPNST), and 38% (Other). Grade 3-4 adverse events: oral mucositis (12%), anemia (14%), platelet count decreased (14%), leukopenia (22%), and neutropenia (42%). CONCLUSIONS Alisertib was well tolerated. Occasional responses, yet prolonged stable disease, were observed. Although failing to meet the primary RR end point, PFS was promising. TRIAL REGISTRATION ID NCT01653028.
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Affiliation(s)
- M A Dickson
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York Weill Cornell Medical College, New York
| | - M R Mahoney
- Biomedical Statistics & Informatics, Alliance Statistics and Data Center, Mayo Clinic, Rochester
| | - W D Tap
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York Weill Cornell Medical College, New York
| | - S P D'Angelo
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York Weill Cornell Medical College, New York
| | - M L Keohan
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York Weill Cornell Medical College, New York
| | - B A Van Tine
- Department of Internal Medicine, Washington University School of Medicine, Saint Louis
| | - M Agulnik
- Department of Hematology and Oncology, Northwestern University, Chicago
| | - L E Horvath
- Department of Medicine, Alliance for Clinical Trials in Oncology, Chicago
| | - J S Nair
- Department of Medicine, Columbia University Medical Center, New York, USA
| | - G K Schwartz
- Department of Medicine, Columbia University Medical Center, New York, USA
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Al-Ibraheemi A, Folpe AL. Voluntary Second Opinions in Pediatric Bone and Soft Tissue Pathology: A Retrospective Review of 1601 Cases From a Single Mesenchymal Tumor Consultation Service. Int J Surg Pathol 2016; 24:685-691. [PMID: 27363432 DOI: 10.1177/1066896916657591] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The diagnosis of bone and soft tissue tumors in children is challenging. These lesions are especially difficult for general pathologists. We reviewed our experience with pediatric mesenchymal tumors sent in consultation to our service, with the goal of identifying issues that most often prompted second-opinion referral. Roughly 16 000 cases were seen in toto, of which 1601 occurred in children. These included 491 bone cases and 1110 soft tissue cases. The cases were referred by private practices/nonacademic medical centers (85%), academic medical centers (8%), and pediatric hospitals (7%). Reasons for referral were (a) self-perceived lack of experience with pediatric mesenchymal tumors (n = 930), (b) second opinion requested by the clinician or patient (n = 132), and (c) perceived or real need for ancillary studies not available at the referring institution (n = 116). The referring pathologists suggested a diagnosis for 670 cases; of these, 476 (71%) were in essential agreement with our final diagnosis. Of the remaining, 139 (21%) were considered "minor disagreements" and 55 (8%) "major disagreements." The "major disagreement" cases could be divided into (a) malignant tumors submitted with benign diagnoses (58%), (b) benign tumors submitted with malignant diagnoses (25%), (c) nonneoplastic conditions submitted as representing neoplasms (11%), and (d) neoplasm submitted as representing nonneoplastic conditions (6%). Pediatric mesenchymal tumors comprised 10% of cases sent to our mesenchymal tumor consultation practice. The rates of diagnostic disagreement found in this study are roughly in accordance with prior studies of mandatory and voluntary second opinion in adult soft tissue tumors. Given the rarity of these tumors, expert second opinion may be of value.
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L’organisation française en réseau de soins pour la prise en charge des sarcomes. ONCOLOGIE 2016. [DOI: 10.1007/s10269-016-2615-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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134
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Italiano A, Di Mauro I, Rapp J, Pierron G, Auger N, Alberti L, Chibon F, Escande F, Voegeli AC, Ghnassia JP, Keslair F, Laé M, Ranchère-Vince D, Terrier P, Baffert S, Coindre JM, Pedeutour F. Clinical effect of molecular methods in sarcoma diagnosis (GENSARC): a prospective, multicentre, observational study. Lancet Oncol 2016; 17:532-538. [PMID: 26970672 DOI: 10.1016/s1470-2045(15)00583-5] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 11/30/2015] [Accepted: 12/03/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Advances in molecular genetics of sarcoma have enabled the identification of type-specific aberrations. We aimed to assess the clinical effect of systematic implementation of molecular assays to improve sarcoma misdiagnosis. METHODS In this multicentre, observational study, we recruited patients from 32 centres of the French Sarcoma Group/Reference Network in Pathology of Sarcomas. Eligibility criteria included: biopsy or surgical resection; suspicion of: dermatofibrosarcoma protuberans (cohort 1), dedifferentiated liposarcoma (cohort 2), Ewing's sarcoma family of tumours (cohort 3), synovial sarcoma (cohort 4), alveolar rhabdomyosarcoma (cohort 5), and myxoid or round cell liposarcoma (cohort 6); review by one sarcoma-expert pathologist; availability of frozen material (except for cohort 1 of patients with dermatofibrosarcoma protuberans because anti-CD34 immunohistochemistry is performed on paraffin-embedded tissue); and patient information. For each case, the pathologist made one primary diagnosis followed by up to two differential diagnoses, based on histological characteristics only. Each diagnosis was classified as certain, probable, or possible. For each case to determine the molecular classification, we did fluorescence in-situ hybridisation on paraffin-embedded samples. We also did comparative genomic hybridisation and quantitative PCR (cohort 2) or reverse transcriptase PCR (cohorts 3-6) on frozen and paraffin-embedded samples. We made a final diagnosis based on the molecular results. The clinical effect of diagnosis correction was assessed by a board of experts. FINDING Between June 22, 2009, and Oct 30, 2012, 395 patients were enrolled in the study, of which 384 were eligible for inclusion. The diagnosis was eventually modified by molecular genetics for 53 patients: eight (16%) of 50 patients with dermatofibrosarcoma (cohort 1), seven (23%) of 30 patients with dedifferentiated liposarcoma (cohort 2), 13 (12%) of 112 with Ewing's sarcoma family of tumours (cohort 3), 16 (16%) of 97 patients with synovial sarcoma (cohort 4), seven (15%) of 46 patients with alveolar rhabdomyosarcoma (cohort 5), and two (4%) of 49 patients with myxoid or round cell liposarcoma (cohort 6), with an effect on primary management or prognosis assessment in 45 cases. INTERPRETATION Molecular genetic testing should be mandatory for diagnostic accuracy of sarcoma and appropriate clinical management, even when histological diagnosis is made by pathologist experts in this field. FUNDING French National Cancer Institute and Nice University Hospital.
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Affiliation(s)
- Antoine Italiano
- Early Phase Trials and Sarcoma Units, Bergonie Cancer Institute, Bordeaux, France.
| | - Ilaria Di Mauro
- Laboratory of Solid Tumor Genetics, Nice University Hospital, Nice, France; Institute for Research on Cancer and Aging of Nice (IRCAN), Faculty of Medicine, University of Nice-Sophia-Antipolis, CNRS, Nice, France
| | - Jocelyn Rapp
- Laboratory of Solid Tumor Genetics, Nice University Hospital, Nice, France; Institute for Research on Cancer and Aging of Nice (IRCAN), Faculty of Medicine, University of Nice-Sophia-Antipolis, CNRS, Nice, France
| | | | - Nathalie Auger
- Department of Pathology and Medical Biology, Gustave-Roussy Institute, Villejuif, France
| | | | - Frédéric Chibon
- Department of Pathology, Bergonié Cancer Institute, INSERM U916, University of Bordeaux, France
| | - Fabienne Escande
- Department of Biochemistry and Molecular Biology, Lille University Hospital, Lille, France
| | - Anne-Claire Voegeli
- Department of Biochemistry and Molecular Biology, Department of Pathology, Strasbourg University Hospital, Strasbourg, France
| | | | - Frédérique Keslair
- Laboratory of Solid Tumor Genetics, Nice University Hospital, Nice, France; Institute for Research on Cancer and Aging of Nice (IRCAN), Faculty of Medicine, University of Nice-Sophia-Antipolis, CNRS, Nice, France
| | - Marick Laé
- Department of Pathology, Institut Curie, Paris, France
| | | | - Philippe Terrier
- Department of Pathology and Medical Biology, Gustave-Roussy Institute, Villejuif, France
| | | | - Jean-Michel Coindre
- Department of Pathology, Bergonié Cancer Institute, INSERM U916, University of Bordeaux, France
| | - Florence Pedeutour
- Laboratory of Solid Tumor Genetics, Nice University Hospital, Nice, France; Institute for Research on Cancer and Aging of Nice (IRCAN), Faculty of Medicine, University of Nice-Sophia-Antipolis, CNRS, Nice, France
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The value of research collaborations and consortia in rare cancers. Lancet Oncol 2016; 17:e62-e69. [DOI: 10.1016/s1470-2045(15)00388-5] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 09/28/2015] [Accepted: 10/02/2015] [Indexed: 12/31/2022]
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Nishida T, Blay JY, Hirota S, Kitagawa Y, Kang YK. The standard diagnosis, treatment, and follow-up of gastrointestinal stromal tumors based on guidelines. Gastric Cancer 2016; 19:3-14. [PMID: 26276366 PMCID: PMC4688306 DOI: 10.1007/s10120-015-0526-8] [Citation(s) in RCA: 293] [Impact Index Per Article: 36.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 07/22/2015] [Indexed: 02/07/2023]
Abstract
Although gastrointestinal stromal tumors (GISTs) are a rare type of cancer, they are the commonest sarcoma in the gastrointestinal tract. Molecularly targeted therapy, such as imatinib therapy, has revolutionized the treatment of advanced GIST and facilitates scientific research on GIST. Nevertheless, surgery remains a mainstay of treatment to obtain a permanent cure for GIST even in the era of targeted therapy. Many GIST guidelines have been published to guide the diagnosis and treatment of the disease. We review current versions of GIST guidelines published by the National Comprehensive Cancer Network, by the European Society for Medical Oncology, and in Japan. All clinical practice guidelines for GIST include recommendations based on evidence as well as on expert consensus. Most of the content is very similar, as represented by the following examples: GIST is a heterogeneous disease that may have mutations in KIT, PDGFRA, HRAS, NRAS, BRAF, NF1, or the succinate dehydrogenase complex, and these subsets of tumors have several distinctive features. Although there are some minor differences among the guidelines--for example, in the dose of imatinib recommended for exon 9-mutated GIST or the efficacy of antigen retrieval via immunohistochemistry--their common objectives regarding diagnosis and treatment are not only to improve the diagnosis of GIST and the prognosis of patients but also to control medical costs. This review describes the current standard diagnosis, treatment, and follow-up of GISTs based on the recommendations of several guidelines and expert consensus.
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Affiliation(s)
- Toshirou Nishida
- Department of Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577 Japan
| | - Jean-Yves Blay
- Department of Medical Oncology, Centre Leon-Bernard, University Claude Bernard Lyon I, Lyon, France
| | - Seiichi Hirota
- Department of Surgical Pathology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yoon-Koo Kang
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Nakhleh RE, Nosé V, Colasacco C, Fatheree LA, Lillemoe TJ, McCrory DC, Meier FA, Otis CN, Owens SR, Raab SS, Turner RR, Ventura CB, Renshaw AA. Interpretive Diagnostic Error Reduction in Surgical Pathology and Cytology: Guideline From the College of American Pathologists Pathology and Laboratory Quality Center and the Association of Directors of Anatomic and Surgical Pathology. Arch Pathol Lab Med 2016; 140:29-40. [PMID: 25965939 DOI: 10.5858/arpa.2014-0511-sa] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
CONTEXT Additional reviews of diagnostic surgical and cytology cases have been shown to detect diagnostic discrepancies. OBJECTIVE To develop, through a systematic review of the literature, recommendations for the review of pathology cases to detect or prevent interpretive diagnostic errors. DESIGN The College of American Pathologists Pathology and Laboratory Quality Center in association with the Association of Directors of Anatomic and Surgical Pathology convened an expert panel to develop an evidence-based guideline to help define the role of case reviews in surgical pathology and cytology. A literature search was conducted to gather data on the review of cases in surgical pathology and cytology. RESULTS The panel drafted 5 recommendations, with strong agreement from open comment period participants ranging from 87% to 93%. The recommendations are: (1) anatomic pathologists should develop procedures for the review of selected pathology cases to detect disagreements and potential interpretive errors; (2) anatomic pathologists should perform case reviews in a timely manner to avoid having a negative impact on patient care; (3) anatomic pathologists should have documented case review procedures that are relevant to their practice setting; (4) anatomic pathologists should continuously monitor and document the results of case reviews; and (5) if pathology case reviews show poor agreement within a defined case type, anatomic pathologists should take steps to improve agreement. CONCLUSIONS Evidence exists that case reviews detect errors; therefore, the expert panel recommends that anatomic pathologists develop procedures for the review of pathology cases to detect disagreements and potential interpretive errors, in order to improve the quality of patient care.
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Affiliation(s)
- Raouf E Nakhleh
- From the Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, Florida (Dr Nakhleh); the Department of Pathology, Massachusetts General Hospital, Boston (Dr Nosé); Governance (Ms Colasacco) and the Pathology and Laboratory Quality Center (Mss Fatheree and Ventura), College of American Pathologists, Northfield, Illinois; Hospital Pathology Associates, Abbott Northwestern Hospital, Minneapolis, Minnesota (Dr Lillemoe); the Department of Medicine, Duke University, Durham, North Carolina (Dr McCrory); the Department of Pathology and Laboratory Medicine, Henry Ford Health System, Detroit, Michigan (Dr Meier); the Department of Pathology, Baystate Medical Center, Springfield, Massachusetts (Dr Otis); the Department of Pathology, University of Michigan Medical School, Ann Arbor (Dr Owens); the Department of Pathology, Memorial University of Newfoundland/Eastern Health Authority, St John's, Newfoundland, Canada (Dr Raab); the Department of Pathology, St John's Health Center, Santa Monica, California (Dr Turner); and the Department of Pathology, Homestead Hospital, Homestead, Florida (Dr Renshaw). Dr Meier is currently with the Department of Pathology, Massachusetts General Hospital, Boston
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Koulaxouzidis G, Schwarzkopf E, Bannasch H, Stark GB. Is revisional surgery mandatory when an unexpected sarcoma diagnosis is made following primary surgery? World J Surg Oncol 2015; 13:306. [PMID: 26499785 PMCID: PMC4619444 DOI: 10.1186/s12957-015-0719-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 10/12/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Soft tissue sarcomas (STS) are often diagnosed unexpectedly after surgery, and many excisions are incomplete. As histopathological assessments are challenging, patients later referred to comprehensive cancer centers (CCC) often come with an unclear status. This can make treatment planning problematic. We investigated the reliability of primary histopathological assessments, whether revisional surgery improved resection status, and the prognostic value of residual tumor at re-excision. METHODS We analyzed the demographic and clinical characteristics of all patients referred to our CCC between 2003 and 2013. We compared patients treated exclusively at our CCC with those who had primary surgery elsewhere, and focused on resection margins, re-excision type, residual tumor, resection status after re-excision, and oncological outcome. RESULTS Over half (n = 110) of all patients (n = 204) were referred from elsewhere. Seventy-one had undergone an excision without suspicion of malignancy. Resection status in referred patients was significantly inferior to the CCC group (p < 0.0001), although the latter had significantly more serious tumors and advanced disease stages (p < 0.05). The residual tumor rate was 53.13%, with a significantly higher probability in an upper extremity (p = 0.001). Initial histopathological classification was misleading in 46.9% of cases. Re-excision improved resection status in 69% of cases. Residual tumor presumably leads to higher rates of local recurrence (p = 0.057) and significantly shorter times to recurrence (p < 0.05). CONCLUSIONS Re-excision should always follow unplanned STS excisions. Resection margins and histopathological assessments from referring institutions are often unreliable and unsuitable for treatment planning. Residual tumor is a risk factor for earlier and more likely local recurrence.
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Affiliation(s)
- Georgios Koulaxouzidis
- Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Freiburg, Germany.
| | - Eugenia Schwarzkopf
- Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Freiburg, Germany
| | - Holger Bannasch
- Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Freiburg, Germany.,Comprehensive Cancer Center Freiburg (CCCF), Section Plastic and Reconstructive Tumour Surgery, University of Freiburg Medical Center, Freiburg, Germany
| | - G Björn Stark
- Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Freiburg, Germany
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Rogers CL, Perry A, Pugh S, Vogelbaum MA, Brachman D, McMillan W, Jenrette J, Barani I, Shrieve D, Sloan A, Bovi J, Kwok Y, Burri SH, Chao ST, Spalding AC, Anscher MS, Bloom B, Mehta M. Pathology concordance levels for meningioma classification and grading in NRG Oncology RTOG Trial 0539. Neuro Oncol 2015; 18:565-74. [PMID: 26493095 DOI: 10.1093/neuonc/nov247] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 08/28/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND With advances in the understanding of histopathology on outcome, accurate meningioma grading becomes critical and drives treatment selection. The 2000 and 2007 WHO schema greatly increased the proportion of grade II meningiomas. Although associations with progression-free survival (PFS) and overall survival (OS) have been independently validated, interobserver concordance has not been formally assessed. METHODS Once mature, NRG Oncology RTOG-0539 will report PFS and OS in variably treated low-, intermediate-, and high-risk cohorts. We address concordance of histopathologic assessment between enrolling institutions and central review, performed by a single pathologist (AP), who is also involved in developing current WHO criteria. RESULTS The trial included 170 evaluable patients, 2 of whom had 2 eligible pathology reviews from different surgeries, resulting in 172 cases for analysis. Upon central review, 76 cases were categorized as WHO grade I, 71 as grade II, and 25 as grade III. Concordance for tumor grade was 87.2%. Among patients with WHO grades I, II, and III meningioma, respective concordance rates were 93.0%, 87.8%, and 93.6% (P values < .0001). Moderate to substantial agreement was encountered for individual grading criteria and were highest for brain invasion, ≥20 mitoses/10 high-powered field [HPF], and spontaneous necrosis, and lowest for small cells, sheeting, and ≥4 mitoses/10 HPF. In comparison, published concordance for gliomas in clinical trials have ranged from 8%-74%. CONCLUSION Our data suggest that current meningioma classification and grading are at least as objective and reproducible as for gliomas. Nevertheless, reproducibility remains suboptimal. Further improvements may be anticipated with education and clarification of subjective criteria, although development of biomarkers may be the most promising strategy.
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Affiliation(s)
- C Leland Rogers
- Virginia Commonwealth University, Richmond, Virginia (C.L.R., M.S.A.); University of California, San Francisco, California (A.P., I.B.); NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvnia (S.P.); Cleveland Clinic Foundation, Cleveland, Ohio (M.A.V., S.T.C.); Arizona Oncology Services Foundation, Phoenix, Arizona (D.B.); McMaster University, Hamilton, Ontario, Canada (W.M.); Medical University of South Carolina, Charleston, South Carolina (J.J.); University of Utah Health Science Center, Salt Lake City, Utah (D.S.); University Hospitals, Cleveland, Ohio (A.S.); Medical College of Wisconsin, Milwaukee, Wisconsin (J.B.); University of Maryland Medical System, Baltimore, Maryland (Y.K., M.M.); Carolinas Medical Center/Levine Cancer Institute, Charlotte, North Carolina (S.H.B.); Norton Cancer Institute, Louisville, Kentucky (A.C.S.); North Shore University Hospital CCOP, Manhasset, New York (B.B.)
| | - Arie Perry
- Virginia Commonwealth University, Richmond, Virginia (C.L.R., M.S.A.); University of California, San Francisco, California (A.P., I.B.); NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvnia (S.P.); Cleveland Clinic Foundation, Cleveland, Ohio (M.A.V., S.T.C.); Arizona Oncology Services Foundation, Phoenix, Arizona (D.B.); McMaster University, Hamilton, Ontario, Canada (W.M.); Medical University of South Carolina, Charleston, South Carolina (J.J.); University of Utah Health Science Center, Salt Lake City, Utah (D.S.); University Hospitals, Cleveland, Ohio (A.S.); Medical College of Wisconsin, Milwaukee, Wisconsin (J.B.); University of Maryland Medical System, Baltimore, Maryland (Y.K., M.M.); Carolinas Medical Center/Levine Cancer Institute, Charlotte, North Carolina (S.H.B.); Norton Cancer Institute, Louisville, Kentucky (A.C.S.); North Shore University Hospital CCOP, Manhasset, New York (B.B.)
| | - Stephanie Pugh
- Virginia Commonwealth University, Richmond, Virginia (C.L.R., M.S.A.); University of California, San Francisco, California (A.P., I.B.); NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvnia (S.P.); Cleveland Clinic Foundation, Cleveland, Ohio (M.A.V., S.T.C.); Arizona Oncology Services Foundation, Phoenix, Arizona (D.B.); McMaster University, Hamilton, Ontario, Canada (W.M.); Medical University of South Carolina, Charleston, South Carolina (J.J.); University of Utah Health Science Center, Salt Lake City, Utah (D.S.); University Hospitals, Cleveland, Ohio (A.S.); Medical College of Wisconsin, Milwaukee, Wisconsin (J.B.); University of Maryland Medical System, Baltimore, Maryland (Y.K., M.M.); Carolinas Medical Center/Levine Cancer Institute, Charlotte, North Carolina (S.H.B.); Norton Cancer Institute, Louisville, Kentucky (A.C.S.); North Shore University Hospital CCOP, Manhasset, New York (B.B.)
| | - Michael A Vogelbaum
- Virginia Commonwealth University, Richmond, Virginia (C.L.R., M.S.A.); University of California, San Francisco, California (A.P., I.B.); NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvnia (S.P.); Cleveland Clinic Foundation, Cleveland, Ohio (M.A.V., S.T.C.); Arizona Oncology Services Foundation, Phoenix, Arizona (D.B.); McMaster University, Hamilton, Ontario, Canada (W.M.); Medical University of South Carolina, Charleston, South Carolina (J.J.); University of Utah Health Science Center, Salt Lake City, Utah (D.S.); University Hospitals, Cleveland, Ohio (A.S.); Medical College of Wisconsin, Milwaukee, Wisconsin (J.B.); University of Maryland Medical System, Baltimore, Maryland (Y.K., M.M.); Carolinas Medical Center/Levine Cancer Institute, Charlotte, North Carolina (S.H.B.); Norton Cancer Institute, Louisville, Kentucky (A.C.S.); North Shore University Hospital CCOP, Manhasset, New York (B.B.)
| | - David Brachman
- Virginia Commonwealth University, Richmond, Virginia (C.L.R., M.S.A.); University of California, San Francisco, California (A.P., I.B.); NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvnia (S.P.); Cleveland Clinic Foundation, Cleveland, Ohio (M.A.V., S.T.C.); Arizona Oncology Services Foundation, Phoenix, Arizona (D.B.); McMaster University, Hamilton, Ontario, Canada (W.M.); Medical University of South Carolina, Charleston, South Carolina (J.J.); University of Utah Health Science Center, Salt Lake City, Utah (D.S.); University Hospitals, Cleveland, Ohio (A.S.); Medical College of Wisconsin, Milwaukee, Wisconsin (J.B.); University of Maryland Medical System, Baltimore, Maryland (Y.K., M.M.); Carolinas Medical Center/Levine Cancer Institute, Charlotte, North Carolina (S.H.B.); Norton Cancer Institute, Louisville, Kentucky (A.C.S.); North Shore University Hospital CCOP, Manhasset, New York (B.B.)
| | - William McMillan
- Virginia Commonwealth University, Richmond, Virginia (C.L.R., M.S.A.); University of California, San Francisco, California (A.P., I.B.); NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvnia (S.P.); Cleveland Clinic Foundation, Cleveland, Ohio (M.A.V., S.T.C.); Arizona Oncology Services Foundation, Phoenix, Arizona (D.B.); McMaster University, Hamilton, Ontario, Canada (W.M.); Medical University of South Carolina, Charleston, South Carolina (J.J.); University of Utah Health Science Center, Salt Lake City, Utah (D.S.); University Hospitals, Cleveland, Ohio (A.S.); Medical College of Wisconsin, Milwaukee, Wisconsin (J.B.); University of Maryland Medical System, Baltimore, Maryland (Y.K., M.M.); Carolinas Medical Center/Levine Cancer Institute, Charlotte, North Carolina (S.H.B.); Norton Cancer Institute, Louisville, Kentucky (A.C.S.); North Shore University Hospital CCOP, Manhasset, New York (B.B.)
| | - Joseph Jenrette
- Virginia Commonwealth University, Richmond, Virginia (C.L.R., M.S.A.); University of California, San Francisco, California (A.P., I.B.); NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvnia (S.P.); Cleveland Clinic Foundation, Cleveland, Ohio (M.A.V., S.T.C.); Arizona Oncology Services Foundation, Phoenix, Arizona (D.B.); McMaster University, Hamilton, Ontario, Canada (W.M.); Medical University of South Carolina, Charleston, South Carolina (J.J.); University of Utah Health Science Center, Salt Lake City, Utah (D.S.); University Hospitals, Cleveland, Ohio (A.S.); Medical College of Wisconsin, Milwaukee, Wisconsin (J.B.); University of Maryland Medical System, Baltimore, Maryland (Y.K., M.M.); Carolinas Medical Center/Levine Cancer Institute, Charlotte, North Carolina (S.H.B.); Norton Cancer Institute, Louisville, Kentucky (A.C.S.); North Shore University Hospital CCOP, Manhasset, New York (B.B.)
| | - Igor Barani
- Virginia Commonwealth University, Richmond, Virginia (C.L.R., M.S.A.); University of California, San Francisco, California (A.P., I.B.); NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvnia (S.P.); Cleveland Clinic Foundation, Cleveland, Ohio (M.A.V., S.T.C.); Arizona Oncology Services Foundation, Phoenix, Arizona (D.B.); McMaster University, Hamilton, Ontario, Canada (W.M.); Medical University of South Carolina, Charleston, South Carolina (J.J.); University of Utah Health Science Center, Salt Lake City, Utah (D.S.); University Hospitals, Cleveland, Ohio (A.S.); Medical College of Wisconsin, Milwaukee, Wisconsin (J.B.); University of Maryland Medical System, Baltimore, Maryland (Y.K., M.M.); Carolinas Medical Center/Levine Cancer Institute, Charlotte, North Carolina (S.H.B.); Norton Cancer Institute, Louisville, Kentucky (A.C.S.); North Shore University Hospital CCOP, Manhasset, New York (B.B.)
| | - Dennis Shrieve
- Virginia Commonwealth University, Richmond, Virginia (C.L.R., M.S.A.); University of California, San Francisco, California (A.P., I.B.); NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvnia (S.P.); Cleveland Clinic Foundation, Cleveland, Ohio (M.A.V., S.T.C.); Arizona Oncology Services Foundation, Phoenix, Arizona (D.B.); McMaster University, Hamilton, Ontario, Canada (W.M.); Medical University of South Carolina, Charleston, South Carolina (J.J.); University of Utah Health Science Center, Salt Lake City, Utah (D.S.); University Hospitals, Cleveland, Ohio (A.S.); Medical College of Wisconsin, Milwaukee, Wisconsin (J.B.); University of Maryland Medical System, Baltimore, Maryland (Y.K., M.M.); Carolinas Medical Center/Levine Cancer Institute, Charlotte, North Carolina (S.H.B.); Norton Cancer Institute, Louisville, Kentucky (A.C.S.); North Shore University Hospital CCOP, Manhasset, New York (B.B.)
| | - Andy Sloan
- Virginia Commonwealth University, Richmond, Virginia (C.L.R., M.S.A.); University of California, San Francisco, California (A.P., I.B.); NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvnia (S.P.); Cleveland Clinic Foundation, Cleveland, Ohio (M.A.V., S.T.C.); Arizona Oncology Services Foundation, Phoenix, Arizona (D.B.); McMaster University, Hamilton, Ontario, Canada (W.M.); Medical University of South Carolina, Charleston, South Carolina (J.J.); University of Utah Health Science Center, Salt Lake City, Utah (D.S.); University Hospitals, Cleveland, Ohio (A.S.); Medical College of Wisconsin, Milwaukee, Wisconsin (J.B.); University of Maryland Medical System, Baltimore, Maryland (Y.K., M.M.); Carolinas Medical Center/Levine Cancer Institute, Charlotte, North Carolina (S.H.B.); Norton Cancer Institute, Louisville, Kentucky (A.C.S.); North Shore University Hospital CCOP, Manhasset, New York (B.B.)
| | - Joseph Bovi
- Virginia Commonwealth University, Richmond, Virginia (C.L.R., M.S.A.); University of California, San Francisco, California (A.P., I.B.); NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvnia (S.P.); Cleveland Clinic Foundation, Cleveland, Ohio (M.A.V., S.T.C.); Arizona Oncology Services Foundation, Phoenix, Arizona (D.B.); McMaster University, Hamilton, Ontario, Canada (W.M.); Medical University of South Carolina, Charleston, South Carolina (J.J.); University of Utah Health Science Center, Salt Lake City, Utah (D.S.); University Hospitals, Cleveland, Ohio (A.S.); Medical College of Wisconsin, Milwaukee, Wisconsin (J.B.); University of Maryland Medical System, Baltimore, Maryland (Y.K., M.M.); Carolinas Medical Center/Levine Cancer Institute, Charlotte, North Carolina (S.H.B.); Norton Cancer Institute, Louisville, Kentucky (A.C.S.); North Shore University Hospital CCOP, Manhasset, New York (B.B.)
| | - Young Kwok
- Virginia Commonwealth University, Richmond, Virginia (C.L.R., M.S.A.); University of California, San Francisco, California (A.P., I.B.); NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvnia (S.P.); Cleveland Clinic Foundation, Cleveland, Ohio (M.A.V., S.T.C.); Arizona Oncology Services Foundation, Phoenix, Arizona (D.B.); McMaster University, Hamilton, Ontario, Canada (W.M.); Medical University of South Carolina, Charleston, South Carolina (J.J.); University of Utah Health Science Center, Salt Lake City, Utah (D.S.); University Hospitals, Cleveland, Ohio (A.S.); Medical College of Wisconsin, Milwaukee, Wisconsin (J.B.); University of Maryland Medical System, Baltimore, Maryland (Y.K., M.M.); Carolinas Medical Center/Levine Cancer Institute, Charlotte, North Carolina (S.H.B.); Norton Cancer Institute, Louisville, Kentucky (A.C.S.); North Shore University Hospital CCOP, Manhasset, New York (B.B.)
| | - Stuart H Burri
- Virginia Commonwealth University, Richmond, Virginia (C.L.R., M.S.A.); University of California, San Francisco, California (A.P., I.B.); NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvnia (S.P.); Cleveland Clinic Foundation, Cleveland, Ohio (M.A.V., S.T.C.); Arizona Oncology Services Foundation, Phoenix, Arizona (D.B.); McMaster University, Hamilton, Ontario, Canada (W.M.); Medical University of South Carolina, Charleston, South Carolina (J.J.); University of Utah Health Science Center, Salt Lake City, Utah (D.S.); University Hospitals, Cleveland, Ohio (A.S.); Medical College of Wisconsin, Milwaukee, Wisconsin (J.B.); University of Maryland Medical System, Baltimore, Maryland (Y.K., M.M.); Carolinas Medical Center/Levine Cancer Institute, Charlotte, North Carolina (S.H.B.); Norton Cancer Institute, Louisville, Kentucky (A.C.S.); North Shore University Hospital CCOP, Manhasset, New York (B.B.)
| | - Samuel T Chao
- Virginia Commonwealth University, Richmond, Virginia (C.L.R., M.S.A.); University of California, San Francisco, California (A.P., I.B.); NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvnia (S.P.); Cleveland Clinic Foundation, Cleveland, Ohio (M.A.V., S.T.C.); Arizona Oncology Services Foundation, Phoenix, Arizona (D.B.); McMaster University, Hamilton, Ontario, Canada (W.M.); Medical University of South Carolina, Charleston, South Carolina (J.J.); University of Utah Health Science Center, Salt Lake City, Utah (D.S.); University Hospitals, Cleveland, Ohio (A.S.); Medical College of Wisconsin, Milwaukee, Wisconsin (J.B.); University of Maryland Medical System, Baltimore, Maryland (Y.K., M.M.); Carolinas Medical Center/Levine Cancer Institute, Charlotte, North Carolina (S.H.B.); Norton Cancer Institute, Louisville, Kentucky (A.C.S.); North Shore University Hospital CCOP, Manhasset, New York (B.B.)
| | - Aaron C Spalding
- Virginia Commonwealth University, Richmond, Virginia (C.L.R., M.S.A.); University of California, San Francisco, California (A.P., I.B.); NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvnia (S.P.); Cleveland Clinic Foundation, Cleveland, Ohio (M.A.V., S.T.C.); Arizona Oncology Services Foundation, Phoenix, Arizona (D.B.); McMaster University, Hamilton, Ontario, Canada (W.M.); Medical University of South Carolina, Charleston, South Carolina (J.J.); University of Utah Health Science Center, Salt Lake City, Utah (D.S.); University Hospitals, Cleveland, Ohio (A.S.); Medical College of Wisconsin, Milwaukee, Wisconsin (J.B.); University of Maryland Medical System, Baltimore, Maryland (Y.K., M.M.); Carolinas Medical Center/Levine Cancer Institute, Charlotte, North Carolina (S.H.B.); Norton Cancer Institute, Louisville, Kentucky (A.C.S.); North Shore University Hospital CCOP, Manhasset, New York (B.B.)
| | - Mitchell S Anscher
- Virginia Commonwealth University, Richmond, Virginia (C.L.R., M.S.A.); University of California, San Francisco, California (A.P., I.B.); NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvnia (S.P.); Cleveland Clinic Foundation, Cleveland, Ohio (M.A.V., S.T.C.); Arizona Oncology Services Foundation, Phoenix, Arizona (D.B.); McMaster University, Hamilton, Ontario, Canada (W.M.); Medical University of South Carolina, Charleston, South Carolina (J.J.); University of Utah Health Science Center, Salt Lake City, Utah (D.S.); University Hospitals, Cleveland, Ohio (A.S.); Medical College of Wisconsin, Milwaukee, Wisconsin (J.B.); University of Maryland Medical System, Baltimore, Maryland (Y.K., M.M.); Carolinas Medical Center/Levine Cancer Institute, Charlotte, North Carolina (S.H.B.); Norton Cancer Institute, Louisville, Kentucky (A.C.S.); North Shore University Hospital CCOP, Manhasset, New York (B.B.)
| | - Beatrice Bloom
- Virginia Commonwealth University, Richmond, Virginia (C.L.R., M.S.A.); University of California, San Francisco, California (A.P., I.B.); NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvnia (S.P.); Cleveland Clinic Foundation, Cleveland, Ohio (M.A.V., S.T.C.); Arizona Oncology Services Foundation, Phoenix, Arizona (D.B.); McMaster University, Hamilton, Ontario, Canada (W.M.); Medical University of South Carolina, Charleston, South Carolina (J.J.); University of Utah Health Science Center, Salt Lake City, Utah (D.S.); University Hospitals, Cleveland, Ohio (A.S.); Medical College of Wisconsin, Milwaukee, Wisconsin (J.B.); University of Maryland Medical System, Baltimore, Maryland (Y.K., M.M.); Carolinas Medical Center/Levine Cancer Institute, Charlotte, North Carolina (S.H.B.); Norton Cancer Institute, Louisville, Kentucky (A.C.S.); North Shore University Hospital CCOP, Manhasset, New York (B.B.)
| | - Minesh Mehta
- Virginia Commonwealth University, Richmond, Virginia (C.L.R., M.S.A.); University of California, San Francisco, California (A.P., I.B.); NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvnia (S.P.); Cleveland Clinic Foundation, Cleveland, Ohio (M.A.V., S.T.C.); Arizona Oncology Services Foundation, Phoenix, Arizona (D.B.); McMaster University, Hamilton, Ontario, Canada (W.M.); Medical University of South Carolina, Charleston, South Carolina (J.J.); University of Utah Health Science Center, Salt Lake City, Utah (D.S.); University Hospitals, Cleveland, Ohio (A.S.); Medical College of Wisconsin, Milwaukee, Wisconsin (J.B.); University of Maryland Medical System, Baltimore, Maryland (Y.K., M.M.); Carolinas Medical Center/Levine Cancer Institute, Charlotte, North Carolina (S.H.B.); Norton Cancer Institute, Louisville, Kentucky (A.C.S.); North Shore University Hospital CCOP, Manhasset, New York (B.B.)
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Honoré C, Méeus P, Stoeckle E, Bonvalot S. Le sarcome des tissus mous en France en 2015 : épidémiologie, classification et structuration de la prise en charge. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.jchirv.2015.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Lestuzzi C, De Paoli A, Baresic T, Miolo G, Buonadonna A. Malignant cardiac tumors: diagnosis and treatment. Future Cardiol 2015; 11:485-500. [DOI: 10.2217/fca.15.10] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Primary malignant cardiac tumors are represented by sarcomas and non-Hodgkin lymphomas. They are rare, affect mostly patients in the fourth decade of life and have a severe prognosis. Both the diagnosis and the treatment require a multidisciplinary approach, and the cardiologist plays a central role both in the diagnosis and in the follow-up. The prognosis may be improved by a careful planning of surgery and by the use of multimodality treatment, including complementary chemotherapy and radiation therapy. A strict follow-up must be planned even after apparently complete cure.
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Affiliation(s)
- Chiara Lestuzzi
- Cardiology Unit, Oncology Department, CRO, National Cancer Institute (IRCCS), Aviano (PN), Italy
| | - Antonino De Paoli
- Radiation Oncology Department, CRO, National Cancer Institute (IRCCS), Aviano (PN), Italy
| | - Tanja Baresic
- Nuclear Medicine Unit, CRO, National Cancer Institute (IRCCS), Via F Gallini 2, 33081, Aviano (PN), Italy
| | - Gianmaria Miolo
- Medical Oncology, Oncology Department, CRO, National Cancer Institute (IRCCS), Aviano (PN), Italy
| | - Angela Buonadonna
- Medical Oncology, Oncology Department, CRO, National Cancer Institute (IRCCS), Aviano (PN), Italy
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142
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Abstract
Nomograms are widely used as prognostic devices in oncology and medicine. With the ability to generate an individual probability of a clinical event by integrating diverse prognostic and determinant variables, nomograms meet our desire for biologically and clinically integrated models and fulfill our drive towards personalised medicine. Rapid computation through user-friendly digital interfaces, together with increased accuracy, and more easily understood prognoses compared with conventional staging, allow for seamless incorporation of nomogram-derived prognosis to aid clinical decision making. This has led to the appearance of many nomograms on the internet and in medical journals, and an increase in nomogram use by patients and physicians alike. However, the statistical foundations of nomogram construction, their precise interpretation, and evidence supporting their use are generally misunderstood. This issue is leading to an under-appreciation of the inherent uncertainties regarding nomogram use. We provide a systematic, practical approach to evaluating and comprehending nomogram-derived prognoses, with particular emphasis on clarifying common misconceptions and highlighting limitations.
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Affiliation(s)
- Vinod P Balachandran
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Mithat Gonen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - J Joshua Smith
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ronald P DeMatteo
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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143
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Honoré C, Méeus P, Stoeckle E, Bonvalot S. Soft tissue sarcoma in France in 2015: Epidemiology, classification and organization of clinical care. J Visc Surg 2015; 152:223-30. [PMID: 26088366 DOI: 10.1016/j.jviscsurg.2015.05.001] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Four thousand new cases of soft tissue sarcomas are diagnosed each year in France, 23% of which are localized in the abdomen and pelvis; the treatment of non-metastatic tumor is based on wide surgical resection, the quality of which determines the long-term outcome. To ensure appropriate care, the European Society of Medical Oncology (ESMO) recommends that any patient with an unexplained soft tissue mass (of any size for deep lesions or of>5cm for superficial lesions) be referred to a specialized center with capacities for multidisciplinary team decision; appropriate imaging should be performed prior to treatment and a percutaneous image-guided needle biopsy should be routinely performed. In France, clinical and pathology networks (NetSarc and RRePS) currently offer patients a structured means to make a systematic diagnosis of soft tissue sarcoma and help to provide access to appropriate treatment in a specialized center.
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Affiliation(s)
- C Honoré
- Département de chirurgie générale, Gustave Roussy Cancer Center, 114, rue Édouard-Vaillant, 94805 Villejuif, France.
| | - P Méeus
- Département de chirurgie, centre Léon-Bérard, 69008 Lyon, France
| | - E Stoeckle
- Institut Bergonié, département de chirurgie, 33076 Bordeaux, France
| | - S Bonvalot
- Institut Curie, Service de chirurgie, 26, rue d'Ulm, 75005 Paris, France
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144
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Soft tissue and visceral sarcomas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2015; 25 Suppl 3:iii102-12. [PMID: 25210080 DOI: 10.1093/annonc/mdu254] [Citation(s) in RCA: 370] [Impact Index Per Article: 41.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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145
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Casali PG, Bruzzi P, Bogaerts J, Blay JY. Rare Cancers Europe (RCE) methodological recommendations for clinical studies in rare cancers: a European consensus position paper. Ann Oncol 2015; 26:300-6. [PMID: 25274616 PMCID: PMC4304377 DOI: 10.1093/annonc/mdu459] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 09/18/2014] [Accepted: 09/19/2014] [Indexed: 12/23/2022] Open
Abstract
While they account for one-fifth of new cancer cases, rare cancers are difficult to study. A higher than average degree of uncertainty should be accommodated for clinical as well as for population-based decision making. Rules of rational decision making in conditions of uncertainty should be rigorously followed and would need widely informative clinical trials. In principle, any piece of new evidence would need to be exploited in rare cancers. Methodologies to explicitly weigh and combine all the available evidence should be refined, and the Bayesian logic can be instrumental to this end. Likewise, Bayesian-design trials may help optimize the low number of patients liable to be enrolled in clinical studies on rare cancers, as well as adaptive trials in general, with their inherent potential of flexibility when properly applied. While clinical studies are the mainstay to test hypotheses, the potential of electronic patient records should be exploited to generate new hypotheses, to create external controls for future studies (when internal controls are unpractical), to study effectiveness of new treatments in real conditions. Framework study protocols in specific rare cancers to sequentially test sets of new agents, as from the early post-phase I development stage, should be encouraged. Also the compassionate and the off-label settings should be exploited to generate new evidence, and flexible regulatory innovations such as adaptive licensing could convey new agents early to rare cancer patients, while generating evidence. Though validation of surrogate end points is problematic in rare cancers, the use of an updated notion of tumor response may be of great value in the single patient to optimize the use of therapies, all the more the new ones. Disease-based communities, involving clinicians and patients, should be regularly consulted by regulatory bodies when setting their policies on drug approval and reimbursement in specific rare cancers.
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Affiliation(s)
- P G Casali
- Adult Mesenchymal Tumour Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan
| | - P Bruzzi
- Clinical Epidemiology Unit, National Institute for Cancer Research, Genova, Italy
| | - J Bogaerts
- European Organization for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - J-Y Blay
- Department of Medical Oncology, Centre Léon Bérard, Centre de Recherche en Cancérologie, Université de Lyon, Lyon, France
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146
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Somcutian O, Buiga R, Galatir M, Tudor Eniu D, Rachieru C, Coza D, Terrier P. [Histopathological diagnostic concordance in bone and soft tissue sarcomas between two comprehensive cancer centers from eastern and western Europe: a collaborative experience]. Ann Pathol 2014; 35:32-40. [PMID: 25541117 DOI: 10.1016/j.annpat.2014.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 11/13/2014] [Indexed: 11/30/2022]
Abstract
INTRODUCTION This study aims to assess the degree of concordance of histological diagnosis of bone and soft tissue sarcomas between a Comprehensive Cancer Center (CCC) of Eastern Europe - not specialized in this area of pathology - and an important CCC of Western Europe, which is one of the coordinators of a clinical reference network in sarcoma pathology. The goal is to have an overview of the sarcomatous pathology in a region of Eastern Europe and to discover diagnostic discrepancies between the two centers, while determining their cause. MATERIALS AND METHODS The initial diagnosis was compared with the revised diagnosis on 110 specimens from 88 patients with bone or soft tissue sarcomas from East-European CCC, in a one-year period of time. RESULTS Complete diagnostic agreement was observed in 55 cases (62.5%), a partial agreement in 23 cases (26.1%) and a major disagreement in 10 cases (11.4%). Major discrepancies of the histological type was observed in only 3 cases (3.4%): one case of discordance benign/malignant and 2 cases of discordance mesenchymal/non mesenchymal. Minor histological discrepancies - not affecting the management of the patient - were observed in 18 cases (20.4%). A major discordance in grading - potentially changing the management of the patient - was noted in 7 cases (7.9%), and a minor discrepancy in 5 cases (5.7%). DISCUSSIONS Some histological types were clearly overdiagnosed, like "adult fibrosarcomas" and "malignant peripheral nerve sheet tumors" (MPNST), mostly converted after the audit into "undifferentiated spindle cell sarcomas" or other types of sarcomas. Some "unclassified" sarcomas and "undifferentiated pleomorphic sarcomas" could be re-classified with the aid of an extensive panel of antibodies. Overall, immunohistochemistry was responsible, but not in exclusivity, for half of the minor discrepancies, and for 2 out of 3 cases of major histological discrepancies. Otherwise, the main cause of discrepancies was the difficulties in the interpretation of the morphology. Molecular biology was decisive in one case. Most grading discrepancies resulted from the appreciation of the mitotic index. CONCLUSIONS The profile of the sarcomatous pathology in the northwest region of Romania does not appear to differ significantly from other parts of Europe or the world, but a prospective epidemiological study would be necessary to confirm this assessment. The expansion of immunohistochemical antibody panel, the over-specialization of pathologists and, in the future, the establishment of a national network of referral centers in sarcoma pathology, are required for a high level of histological diagnosis in Eastern Europe. A periodic external audit, continuing this trans-European collaboration between the two centers, would be beneficial for monitoring progress.
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Affiliation(s)
- Oana Somcutian
- Institut oncologique Prof. Dr. I. Chiricuta, 34-36, rue Republicii, 400015 Cluj-Napoca, Roumanie
| | - Rares Buiga
- Institut oncologique Prof. Dr. I. Chiricuta, 34-36, rue Republicii, 400015 Cluj-Napoca, Roumanie.
| | - Mihaela Galatir
- Institut oncologique Prof. Dr. I. Chiricuta, 34-36, rue Republicii, 400015 Cluj-Napoca, Roumanie
| | - Dan Tudor Eniu
- Institut oncologique Prof. Dr. I. Chiricuta, 34-36, rue Republicii, 400015 Cluj-Napoca, Roumanie; Université de médecine et pharmacie Iuliu Haţieganu, 8, rue Babeş, 400012 Cluj-Napoca, Roumanie
| | - Claudiu Rachieru
- Université de médecine et pharmacie Iuliu Haţieganu, 8, rue Babeş, 400012 Cluj-Napoca, Roumanie
| | - Daniela Coza
- Institut oncologique Prof. Dr. I. Chiricuta, 34-36, rue Republicii, 400015 Cluj-Napoca, Roumanie; Registre régional de cancer du nord-ouest, 34-36, rue Republicii, 400015 Cluj-Napoca, Roumanie
| | - Philippe Terrier
- Institut Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France
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147
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Perrier L, Buja A, Mastrangelo G, Baron PS, Ducimetière F, Pauwels PJ, Rossi CR, Gilly FN, Martin A, Favier B, Farsi F, Laramas M, Baldo V, Collard O, Cellier D, Blay JY, Ray-Coquard I. Transferability of health cost evaluation across locations in oncology: cluster and principal component analysis as an explorative tool. BMC Health Serv Res 2014; 14:537. [PMID: 25399725 PMCID: PMC4241216 DOI: 10.1186/s12913-014-0537-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 10/17/2014] [Indexed: 11/10/2022] Open
Abstract
Background The transferability of economic evaluation in health care is of increasing interest in today’s globalized environment. Here, we propose a methodology for assessing the variability of data elements in cost evaluations in oncology. This method was tested in the context of the European Network of Excellence “Connective Tissues Cancers Network”. Methods Using a database that was previously aimed at exploring sarcoma management practices in Rhône-Alpes (France) and Veneto (Italy), we developed a model to assess the transferability of health cost evaluation across different locations. A nested data structure with 60 final factors of variability (e.g., unit cost of chest radiograph) within 16 variability areas (e.g., unit cost of imaging) within 12 objects (e.g., diagnoses) was produced in Italy and France, separately. Distances between objects were measured by Euclidean distance, Mahalanobis distance, and city-block metric. A hierarchical structure using cluster analysis (CA) was constructed. The objects were also represented by their projections and area of variability through correlation studies using principal component analysis (PCA). Finally, a hierarchical clustering based on principal components was performed. Results CA suggested four clusters of objects: chemotherapy in France; follow-up with relapse in Italy; diagnosis, surgery, radiotherapy, chemotherapy, and follow-up without relapse in Italy; and diagnosis, surgery, and follow-up with or without relapse in France. The variability between clusters was high, suggesting a lower transferability of results. Also, PCA showed a high variability (i.e. lower transferability) for diagnosis between both countries with regard to the quantities and unit costs of biopsies. Conclusion CA and PCA were found to be useful for assessing the variability of cost evaluations across countries. In future studies, regression methods could be applied after these methods to elucidate the determinants of the differences found in these analyses. Electronic supplementary material The online version of this article (doi:10.1186/s12913-014-0537-x) contains supplementary material, which is available to authorized users.
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148
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Yang JY, Kong SH, Ahn HS, Lee HJ, Jeong SY, Ha J, Yang HK, Park KJ, Lee KU, Choe KJ. Prognostic factors for reoperation of recurrent retroperitoneal sarcoma: The role of clinicopathological factors other than histologic grade. J Surg Oncol 2014; 111:165-72. [DOI: 10.1002/jso.23783] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 08/09/2014] [Indexed: 12/12/2022]
Affiliation(s)
- Jun-Young Yang
- Department of Surgery; Seoul National University College of Medicine; Seoul Korea
| | - Seong-Ho Kong
- Department of Surgery; Seoul National University College of Medicine; Seoul Korea
| | - Hye Seong Ahn
- Department of Surgery; Seoul National University College of Medicine; Seoul Korea
| | - Hyuk-Joon Lee
- Department of Surgery; Seoul National University College of Medicine; Seoul Korea
- Cancer Research Institute; Seoul National University College of Medicine; Seoul Korea
| | - Seung-Yong Jeong
- Department of Surgery; Seoul National University College of Medicine; Seoul Korea
| | - Jongwon Ha
- Department of Surgery; Seoul National University College of Medicine; Seoul Korea
| | - Han-Kwang Yang
- Department of Surgery; Seoul National University College of Medicine; Seoul Korea
- Cancer Research Institute; Seoul National University College of Medicine; Seoul Korea
| | - Kyu Joo Park
- Department of Surgery; Seoul National University College of Medicine; Seoul Korea
| | - Kuhn Uk Lee
- Department of Surgery; Seoul National University College of Medicine; Seoul Korea
| | - Kuk Jin Choe
- Department of Surgery; Seoul National University College of Medicine; Seoul Korea
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149
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Hameed M. Molecular diagnosis of soft tissue neoplasia: clinical applications and recent advances. Expert Rev Mol Diagn 2014; 14:961-77. [PMID: 25109831 DOI: 10.1586/14737159.2014.946909] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Sarcomas are rare and heterogeneous neoplasms of mesenchymal tissues with diverse morphologies and clinical behavior. In the last few years, the discovery of specific genetic aberrations in these tumors has allowed better classification and understanding of mechanisms driving their pathogenesis. While the majority of sarcomas are still treated by traditional modalities, molecular markers driving the pathogenesis have paved the way for more accurate diagnosis and opportunity to explore other therapeutic strategies. This review discusses the available molecular tools in sarcoma diagnostics and highlight some of the biological significance of the recent discoveries and their clinical applications.
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Affiliation(s)
- Meera Hameed
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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150
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Histopathological diagnostic discrepancies in soft tissue tumours referred to a specialist centre: reassessment in the era of ancillary molecular diagnosis. Sarcoma 2014; 2014:686902. [PMID: 25165418 PMCID: PMC4138733 DOI: 10.1155/2014/686902] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 07/15/2014] [Indexed: 11/17/2022] Open
Abstract
Introduction. Soft tissue tumour pathology is a highly specialised area of surgical pathology, but soft tissue neoplasms can occur at virtually all sites and are therefore encountered by a wide population of surgical pathologists. Potential sarcomas require referral to specialist centres for review by pathologists who see a large number of soft tissue lesions and where appropriate ancillary investigations can be performed. We have previously assessed the types of diagnostic discrepancies between referring and final diagnosis for soft tissue lesions referred to our tertiary centre. We now reaudit this 6 years later, assessing changes in discrepancy patterns, particularly in relation to the now widespread use of ancillary molecular diagnostic techniques which were not prevalent in our original study. Materials and Methods. We compared the sarcoma unit's histopathology reports with referring reports on 348 specimens from 286 patients with suspected or proven soft tissue tumours in a one-year period. Results. Diagnostic agreement was seen in 250 cases (71.8%), with 57 (16.4%) major and 41 (11.8%) minor discrepancies. There were 23 cases of benign/malignant discrepancies (23.5% of all discrepancies). 50 ancillary molecular tests were performed, 33 for aiding diagnosis and 17 mutational analyses for gastrointestinal stromal tumour to guide therapy. Findings from ancillary techniques contributed to 3 major and 4 minor discrepancies. While the results were broadly similar to those of the previous study, there was an increase in frequency of major discrepancies. Conclusion. Six years following our previous study and notably now in an era of widespread ancillary molecular diagnosis, the overall discrepancy rate between referral and tertiary centre diagnosis remains similar, but there is an increase in frequency of major discrepancies likely to alter patient management. A possible reason for the increase in major discrepancies is the increasing lack of exposure to soft tissue cases in nonspecialist centres in a time of subspecialisation. The findings support the national guidelines in which all suspected soft tissue tumour pathology specimens should be referred to a specialist sarcoma unit.
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