1
|
Alnajjar A, Alfadda A, Alqaraawi AM, Alajlan B, Atallah JP, AlHussaini HF. Pleomorphic leiomyosarcoma of the maxilla with metastasis to the colon: A case report. World J Gastrointest Endosc 2024; 16:361-367. [PMID: 38946849 PMCID: PMC11212521 DOI: 10.4253/wjge.v16.i6.361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 04/26/2024] [Accepted: 05/17/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Pleomorphic leiomyosarcomas make up around 8.6% of all leiomyosarcomas. They behave aggressively and often have poor prognoses. They can affect the gastrointestinal tract and retroperitoneum. To date, pleomorphic leiomyosarcoma involving the mesocolon have been reported in nine patients. CASE SUMMARY The patient was a 44-year-old man with a history of pleomorphic leiomyosarcoma of the left maxilla with metastasis to the lung and liver. His most recent positron emission tomography-computed tomography (PET-CT) scan showed uptake in the ascending and transverse colons. A colonoscopy revealed a 5.0 cm × 3.5 cm × 3.0 cm pedunculated polyp in the ascending colon. The polyp was removed using hot snare polypectomy technique and retrieved with Rothnet. Histopathologic examination of the polyp showed a metastatic pleomorphic leiomyosarcoma. CONCLUSION Uptake(s) on PET-CT in a patient with pleomorphic leiomyosarcoma should raise suspicion for metastasis.
Collapse
Affiliation(s)
- Asma Alnajjar
- Section of Gastroenterology, Department of Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh 11211, Saudi Arabia
| | - Abdulrahman Alfadda
- Section of Gastroenterology, Department of Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh 11211, Saudi Arabia
| | - Abdullah Mohammad Alqaraawi
- Section of Gastroenterology, Department of Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh 11211, Saudi Arabia
| | - Bader Alajlan
- Section of Gastroenterology, Department of Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh 11211, Saudi Arabia
| | - Jean Paul Atallah
- Department of Oncology, King Faisal Specialist Hospital & Research Centre, Riyadh 11211, Saudi Arabia
| | - Hussah Fahad AlHussaini
- Department of Pathology, King Faisal Specialist Hospital & Research Centre, Riyadh 11211, Saudi Arabia
| |
Collapse
|
2
|
Makris EA, Tran TB, Delitto DJ, Lee B, Ethun CG, Grignol V, Harrison Howard J, Bedi M, Clark Gamblin T, Tseng J, Roggin KK, Chouliaras K, Votanopoulos K, Cullinan D, Fields RC, Cardona K, Poultsides G, Kirane A. Natural history of undifferentiated pleomorphic sarcoma: Experience from the US Sarcoma Collaborative. J Surg Oncol 2024; 129:1354-1363. [PMID: 38562002 DOI: 10.1002/jso.27620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 02/13/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Undifferentiated pleomorphic sarcoma (UPS) is a relatively rare but aggressive neoplasm. We sought to utilize a multi-institutional US cohort of sarcoma patients to examine predictors of survival and recurrence patterns after resection of UPS. METHODS From 2000 to 2016, patients with primary UPS undergoing curative-intent surgical resection at seven academic institutions were retrospectively reviewed. Epidemiologic and clinicopathologic factors were reviewed by site of origin. Overall survival (OS), recurrence-free survival (RFS), time-to-locoregional (TTLR), time-to-distant recurrence (TTDR), and patterns of recurrence were analyzed. RESULTS Of the 534 UPS patients identified, 53% were female, with a median age of 60 and median tumor size of 8.5 cm. The median OS, RFS, TTLR, and TTDR for the entire cohort were 109, 49, 86, and 46 months, respectively. There were no differences in these survival outcomes between extremity and truncal UPS. Compared with truncal, extremity UPS were more commonly amenable to R0 resection (87% vs. 75%, p = 0.017) and less commonly associated with lymph node metastasis (1% vs. 6%, p = 0.031). R0 resection and radiation treatment, but not site of origin (extremity vs. trunk) were independent predictors of OS and RFS. TTLR recurrence was shorter for UPS resected with a positive margin and for tumors not treated with radiation. CONCLUSION For patients with resected extremity and truncal UPS, tumor size >5 cm and positive resection margin are associated with worse survival OS and RFS, irrespectively the site of origin. R0 surgical resection and radiation treatment may help improve these survival outcomes.
Collapse
Affiliation(s)
| | - Thuy B Tran
- Surgical Oncology, Stanford University, Stanford, California, USA
| | - Daniel J Delitto
- Surgical Oncology, Stanford University, Stanford, California, USA
| | - Byrne Lee
- Surgical Oncology, Stanford University, Stanford, California, USA
| | - Cecilia G Ethun
- Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Valerie Grignol
- Surgical Oncology, The Ohio State University, Columbus, Ohio, USA
| | | | - Meena Bedi
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Jennifer Tseng
- Surgical Oncology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Kevin K Roggin
- Surgical Oncology, University of Chicago Medicine, Chicago, Illinois, USA
| | | | | | - Darren Cullinan
- Surgical Oncology, Washington University, St. Louis, Missouri, USA
| | - Ryan C Fields
- Surgical Oncology, Washington University, St. Louis, Missouri, USA
| | - Kenneth Cardona
- Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | | | - Amanda Kirane
- Surgical Oncology, Stanford University, Stanford, California, USA
| |
Collapse
|
3
|
Nasr LF, Zoghbi M, Lazcano R, Nakazawa M, Bishop AJ, Farooqi A, Mitra D, Guadagnolo BA, Benjamin R, Patel S, Ravi V, Araujo DM, Livingston A, Zarzour MA, Conley AP, Ratan R, Somaiah N, Lazar AJ, Roland C, Keung EZ, Nassif Haddad EF. High-Grade Pleomorphic Sarcomas Treated with Immune Checkpoint Blockade: The MD Anderson Cancer Center Experience. Cancers (Basel) 2024; 16:1763. [PMID: 38730715 PMCID: PMC11083765 DOI: 10.3390/cancers16091763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/24/2024] [Accepted: 04/29/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Undifferentiated pleomorphic sarcomas (UPSs) are amongst the most common subtypes of soft-tissue sarcomas. Few real-world data on the use of immune checkpoint blockade (ICB) in UPS patients and other high-grade pleomorphic STS patients are available. PURPOSE The purpose of our study is to describe the efficacy and toxicity of ICB in patients with advanced UPSs and other high-grade pleomorphic sarcomas treated at our institution. METHODS This is a retrospective, observational study of all patients with metastatic high-grade pleomorphic sarcomas treated with FDA-approved ICB at MD Anderson Cancer Center between 1 January 2015 and 1 January 2023. Patients included in trials for which results are not yet published were excluded. RESULTS Thirty-six patients with advanced/metastatic pleomorphic sarcomas were included. The median age was 52 years. A total of 26 patients (72%) had UPSs and 10 patients (28%) had other high-grade pleomorphic sarcomas. The median follow-up time was 8.8 months. The median PFS was 2.9 months. The 3-month PFS and 6-month PFS were 46% and 32%, respectively. The median OS was 12.9 months. The 12-month OS and 24-month OS were 53% and 29%, respectively. The best response, previous RT, and type of ICB treatment were significantly and independently associated with shorter PFS (p = 0.0012, p = 0.0019 and p = 0.036, respectively). No new safety signal was identified, and the toxicity was overall manageable with no toxic deaths and only four patients (11%) stopping treatment due to toxicity. CONCLUSIONS Real-world retrospective data are consistent with the published literature, with a promising 6-month PFS of 32%. Partial or stable responders to ICB treatment have significantly improved PFS compared to progressors.
Collapse
Affiliation(s)
- Lewis F. Nasr
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (L.F.N.)
| | - Marianne Zoghbi
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (L.F.N.)
| | - Rossana Lazcano
- Department of Translational Molecular Pathology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Michael Nakazawa
- Department of Sarcoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA (R.B.); (M.A.Z.)
| | - Andrew J. Bishop
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (A.J.B.); (A.F.)
| | - Ahsan Farooqi
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (A.J.B.); (A.F.)
| | - Devarati Mitra
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (A.J.B.); (A.F.)
| | - Beverly Ashleigh Guadagnolo
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (A.J.B.); (A.F.)
| | - Robert Benjamin
- Department of Sarcoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA (R.B.); (M.A.Z.)
| | - Shreyaskumar Patel
- Department of Sarcoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA (R.B.); (M.A.Z.)
| | - Vinod Ravi
- Department of Sarcoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA (R.B.); (M.A.Z.)
| | - Dejka M. Araujo
- Department of Sarcoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA (R.B.); (M.A.Z.)
| | - Andrew Livingston
- Department of Sarcoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA (R.B.); (M.A.Z.)
| | - Maria A. Zarzour
- Department of Sarcoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA (R.B.); (M.A.Z.)
| | - Anthony P. Conley
- Department of Sarcoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA (R.B.); (M.A.Z.)
| | - Ravin Ratan
- Department of Sarcoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA (R.B.); (M.A.Z.)
| | - Neeta Somaiah
- Department of Sarcoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA (R.B.); (M.A.Z.)
| | - Alexander J. Lazar
- Department of Translational Molecular Pathology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Department of Genomic Medicine, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Christina Roland
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (C.R.)
| | - Emily Z. Keung
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (C.R.)
| | - Elise F. Nassif Haddad
- Department of Sarcoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA (R.B.); (M.A.Z.)
- Department of Investigational Cancer Therapeutics, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| |
Collapse
|
4
|
Osaki J, Noguchi R, Yanagihara K, Ono T, Adachi Y, Iwata S, Toda Y, Sekita T, Kobayashi E, Kojima N, Yoshida A, Kawai A, Kondo T. Establishment and characterization of NCC-ASPS2-C1: a novel patient-derived cell line of alveolar soft part sarcoma. Hum Cell 2024; 37:865-873. [PMID: 38478355 DOI: 10.1007/s13577-024-01039-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 01/29/2024] [Indexed: 04/15/2024]
Abstract
Alveolar soft part sarcoma (ASPS) is a rare mesenchymal tumor characterized by rearrangement of the ASPSCR1 and TFE3 genes and a histologically distinctive pseudoalveolar pattern. ASPS progresses slowly, but is prone to late metastasis. As ASPS is refractory to conventional chemotherapy, the only curative treatment is complete surgical resection. The prognosis of advanced and metastatic cases is poor, highlighting the need for preclinical research to develop appropriate treatment options. However, ASPS is extremely rare, accounting for < 1% of all soft tissue sarcomas, and only one patient-derived ASPS cell line is available from public cell banks worldwide for research. This study reports the establishment of a novel ASPS cell line derived from the primary tumor tissue of an ASPS patient, named NCC-ASPS2-C1. This cell line retains the ASPSCR1-TFE3 fusion gene, which is characteristic of ASPS. The characterization of this cell line revealed stable growth, spheroid formation, and invasive properties. By screening a drug library using NCC-ASPS2-C1, we identified several drugs that inhibited the proliferation of ASPS cells. In conclusion, the establishment of NCC-ASPS2-C1 provides a valuable resource for advancing ASPS research and developing novel treatments for this challenging disease.
Collapse
Affiliation(s)
- Julia Osaki
- Division of Rare Cancer Research, National Cancer Center Research Institute, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Rei Noguchi
- Division of Rare Cancer Research, National Cancer Center Research Institute, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Kazuyoshi Yanagihara
- Division of Rare Cancer Research, National Cancer Center Research Institute, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Takuya Ono
- Division of Rare Cancer Research, National Cancer Center Research Institute, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Yuki Adachi
- Division of Rare Cancer Research, National Cancer Center Research Institute, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Shuhei Iwata
- Division of Rare Cancer Research, National Cancer Center Research Institute, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Yu Toda
- Department of Musculoskeletal Oncology and Rehabilitation Medicine, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Tetsuya Sekita
- Department of Musculoskeletal Oncology and Rehabilitation Medicine, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Eisuke Kobayashi
- Department of Musculoskeletal Oncology and Rehabilitation Medicine, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Naoki Kojima
- Department of Diagnostic Pathology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Akihiko Yoshida
- Department of Diagnostic Pathology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Akira Kawai
- Department of Musculoskeletal Oncology and Rehabilitation Medicine, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Tadashi Kondo
- Division of Rare Cancer Research, National Cancer Center Research Institute, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan.
| |
Collapse
|
5
|
Borghi A, Gronchi A. Extremity and Truncal Soft Tissue Sarcoma: Risk Assessment and Multidisciplinary Management. Semin Radiat Oncol 2024; 34:147-163. [PMID: 38508780 DOI: 10.1016/j.semradonc.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
Extremity and truncal soft tissue sarcomas are a heterogeneous group of rare cancers that arise from mesenchymal tissues. Hence, the adoption of tailored risk assessment and prognostication tools plays a crucial role in optimizing the decision-making for which of the many possible treatment strategies to select. Management of these tumors requires a multidisciplinary strategy, which has seen significant development in recent decades. Surgery has emerged as the primary treatment approach, with the main goal of achieving microscopic negative tumor margins. To reduce the likelihood of local recurrence, loco-regional treatments such as radiation therapy and isolated limb perfusion are often added to the treatment regimen in combination with surgery. This approach also enables surgeons to perform limb-sparing surgery, particularly in cases where a positive tumor margin is expected. Chemotherapy may also provide a further benefit in decreasing the probability of local recurrence or reducing distant metastasis in selected patients. Selecting the optimal treatment strategy for these rare tumors is best accomplished by an experienced multi-disciplinary team.
Collapse
Affiliation(s)
- Alessandra Borghi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy..
| |
Collapse
|
6
|
Yuan J, Zhang X, Zhang S, Yu S. A Modification of the American Joint Committee on Cancer Nomogram for Undifferentiated Sarcoma With External Validation and Risk Stratification. Am Surg 2024; 90:762-769. [PMID: 37905507 DOI: 10.1177/00031348231211035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
BACKGROUND The aim of this study is to establish a model to predict the overall survival (OS) and stratify the risk of postoperative patients with undifferentiated sarcoma. METHODS A total of 452 postoperative patients with undifferentiated sarcoma in the trunk and extremity from the Surveillance, Epidemiology, and End Results database were enrolled as the training cohort. We collected a group of 163 undifferentiated sarcoma patients from our center as the external validation cohort. Cox proportional hazards regression model was used to screen survival-associated factors for the construction of the nomogram. Concordance-indexes (C-indexes), calibration curves, and receiver operating characteristics (ROCs) curves were applied for the discrimination and calibration of the nomogram. The cutoff value of nomogram-based total points was applied to stratify the risk of patients. RESULTS A nomogram was developed incorporating four independent factors: age, tumor site, eighth AJCC stage, and radiotherapy. The nomogram showed good prognostic accuracy and excellent agreement in the training and validation cohort, with C-indexes of .701 (95% confidence interval [CI]: .683-.719) and .700 (95% CI: 0.659-.741), respectively. Furthermore, we identified the best cutoff value of nomogram total points (103.2) as the predicted risk and divided the patients into a high-risk group and a low-risk group. Significant differences in OS between the two groups were indicated in the training cohort and external validation cohort, showing the appreciable clinical validity and clinical utility of the nomogram (P < .001). CONCLUSION This nomogram provides an insightful and applicable tool for individual evaluations and the distinguishment of risk for patients with undifferentiated sarcoma.
Collapse
Affiliation(s)
- Jin Yuan
- Department of Orthopedics, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xinxin Zhang
- Department of Orthopedics, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shuguang Zhang
- Center for Thyroid and Breast Surgery, Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Shengji Yu
- Department of Orthopedics, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
7
|
Huchet N, Penel N, Bonvalot S, Thariat J, Ducimetière F, Giraud A, Toulmonde M, Le Cesne A, Blay JY, Bellera C. Handling missing covariates in observational studies: an illustration with the assessment of prognostic factors of survival outcomes in soft-tissue or visceral sarcomas in irradiated fields (SIF). Ther Adv Med Oncol 2024; 16:17588359231220999. [PMID: 38249328 PMCID: PMC10798078 DOI: 10.1177/17588359231220999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/29/2023] [Indexed: 01/23/2024] Open
Abstract
Background Missing covariates are common in observational research and can lead to bias and loss of statistical power. Limited data regarding prognostic factors of survival outcomes of sarcomas in irradiated fields (SIF) are available. Because of the long lag time between irradiation of first cancer and scarcity of SIF, missing data are a critical issue when analyzing long-term outcomes. We assessed prognostic factors of overall (OS), progression-free (PFS), and metastatic-progression-free (MPFS) survivals in SIF using three methods to account for missing covariates. Methods We relied on the NETSARC French Sarcoma Group database, Cox (OS/PFS), and competitive hazards (MPFS) survival models. Covariates investigated were age, sex, histological subtype, tumor size, depth and grade, metastasis, surgery, surgical resection, surgeon's expertise, imaging, and neo-adjuvant treatment. We first applied multiple imputation (MI): observed data were used to estimate the missing covariate. With the missing-data modality approach, a category missing was created for qualitative variables. With the complete-case (CC) approach, analysis was restricted to patients without missing covariates. Results CC subjects (N = 167; 33%) presented more often with soft-tissue sarcoma (versus visceral sarcoma) and grade I-II tumors as compared to the 504 eligible cases. With MI (N = 504), factors associated with the worst outcome included metastasis (p = 0.04) and R1/R2 resection (p < 0.001) for OS; higher grade/non-gradable tumors (p = 0.002) and R1/R2 resection (p < 0.001) for PFS; and metastasis (p = 0.01) for M-PFS. The 'missing-data modality' approach (N = 504) led to different associations, including significance reached due to variables with the modality 'missing'. The CC analysis led to different results and reduced precision. Conclusion The CC population was not representative of the eligible population, introducing bias, in addition to worst precision. The 'missing-data modality method' results in biased estimates in non-randomized studies, as outcomes may be related to variables with missing values. Appropriate statistical methods for missing covariates, for example, MI, should therefore be considered.
Collapse
Affiliation(s)
- Noémie Huchet
- INSERM CIC1401, Clinical and Epidemiological Research Unit, Institut Bergonié, Comprehensive Cancer Center, Bordeaux, France
| | - Nicolas Penel
- Department of Medical Oncology, Centre Oscar Lambret, Lille, France
- Lille University, Lille, France
| | - Sylvie Bonvalot
- Surgery Department, Institut Curie, Comprehensive Cancer Center, Paris, France
| | - Juliette Thariat
- Centre François Baclesse, Comprehensive Cancer Center, Caen, France
- Laboratoire de physique Corpusculaire IN2P3/ENSICAEN/CNRS UMR 6534, Normandie Université, Caen France
| | - Françoise Ducimetière
- Department of Medical Oncology, Centre Léon Bérard, Comprehensive Cancer Center, Lyon, France
| | - Antoine Giraud
- INSERM CIC1401, Clinical and Epidemiological Research Unit, Institut Bergonié, Comprehensive Cancer Center, Bordeaux, France
| | - Maud Toulmonde
- Department of Medical Oncology, Institut Bergonié, Comprehensive Cancer Center, Bordeaux, France
| | - Axel Le Cesne
- Department of Medical Oncology, Gustave Roussy Cancer Campus, Comprehensive Cancer Center, Villejuif, France
| | - Jean-Yves Blay
- Department of Medical Oncology, Centre Léon Bérard, Comprehensive Cancer Center, Lyon, France
| | - Carine Bellera
- INSERM CIC1401, Clinical and Epidemiological Research Unit, Institut Bergonié, Comprehensive Cancer Center, 229 Cours de l'Argonne, Bordeaux 33076, France
- Univ. Bordeaux, INSERM, Bordeaux Population Health Research Center, Epicene team, UMR 1219, Bordeaux, France
| |
Collapse
|
8
|
Kim S, Bae H, Kim HS. Dedifferentiated Leiomyosarcoma of the Uterine Corpus with Heterologous Component: Clinicopathological Analysis of Five Consecutive Cases from a Single Institution and Comprehensive Literature Review. Diagnostics (Basel) 2024; 14:160. [PMID: 38248037 PMCID: PMC10814992 DOI: 10.3390/diagnostics14020160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/04/2024] [Accepted: 01/08/2024] [Indexed: 01/23/2024] Open
Abstract
Dedifferentiation is a very rare phenomenon in uterine leiomyosarcoma (LMS). The aim of this study was to comprehensively analyze the clinicopathological characteristics of uterine dedifferentiated LMS (DDLMS). We reviewed electronic medical records and pathology slides from five patients with uterine DDLMS and performed immunostaining. The mean age of the patients was 56 years. Two patients presented with abdominal discomfort, while in three cases the uterine tumors were detected on routine medical examination. The mean size of the tumors was 17.0 cm. Four patients underwent hysterectomy. The initial stages were distributed as IB (2/5), IIIC (2/5), and IVC (1/5). Post-operative concurrent chemoradiation therapy, radiation therapy, and chemotherapy were administered in one, one, and two patients, respectively. Despite post-operative treatment, three patients developed metastatic recurrences in the abdominal and pelvic organs. Recurrence-free survival time ranged between 4 and 30 months. Histologically, the differentiated areas demonstrated the classic morphology of malignant smooth muscle differentiation, whereas the dedifferentiated areas resembled undifferentiated pleomorphic sarcoma and were characterized by large pleomorphic tumor cells admixed with haphazardly arranged atypical cells with marked nuclear pleomorphism. All cases also exhibited heterologous components, including chondrosarcoma (CSA; 3/5) and rhabdomyosarcoma (2/5). In two cases, the heterologous components were initially detected in primary tumors. In three cases, the primary tumors did not exhibit any dedifferentiated or heterologous components. Instead, more than half of the recurrent tumors consisted of heterologous components. Three cases showed a sharp demarcation between the LMS and CSA components, while in two cases the dedifferentiated area imperceptibly merged with the differentiated component. Immunostaining revealed that the dedifferentiated components exhibited a lack of desmin immunoreactivity in three of the four examined cases. A subset of uterine LMS represents various amounts and types of dedifferentiation and heterologous components in both primary and recurrent tumors. Routine recognition of DDLMS and distinction from its mimickers are required for accurate diagnosis and further characterization of these rare tumors.
Collapse
Affiliation(s)
- Suyeon Kim
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea;
| | - Hyunsik Bae
- Pathology Center, Seegene Medical Foundation, Seoul 04805, Republic of Korea
| | - Hyun-Soo Kim
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea;
| |
Collapse
|
9
|
Blay JY, Tlemsani C, Toulmonde M, Italiano A, Rios M, Bompas E, Valentin T, Duffaud F, Le Nail LR, Watson S, Firmin N, Dubray-Longeras P, Ropars M, Perrin C, Hervieu A, Lebbe C, Saada-Bouzid E, Soibinet P, Fiorenza F, Bertucci F, Boudou P, Vaz G, Bonvalot S, Honoré C, Marec-Berard P, Minard V, Cleirec M, Biau D, Meeus P, Babinet A, Dumaine V, Carriere S, Fau M, Decanter G, Gouin F, Ngo C, Le Loarer F, Karanian M, Meurgey A, Dufresne A, Brahmi M, Chemin-Airiau C, Ducimetiere F, Penel N, Le Cesne A. Sclerosing Epithelioid Fibrosarcoma (SEF) versus Low Grade Fibromyxoid Sarcoma (LGFMS): Presentation and outcome in the nationwide NETSARC+ series of 330 patients over 13 years. Eur J Cancer 2024; 196:113454. [PMID: 38008029 DOI: 10.1016/j.ejca.2023.113454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/08/2023] [Indexed: 11/28/2023]
Abstract
Sclerosing Epithelioid Fibrosarcoma (SEF) and Low Grade Fibromyxoid Sarcoma (LGFMS) are ultrarare sarcomas sharing common translocations whose natural history are not well known. We report on the nationwide exhaustive series of 330 patients with SEF or LGFMS in NETSARC+ since 2010. PATIENTS AND METHODS NETSARC (netsarc.org) is a network of 26 reference sarcoma centers with specialized multidisciplinary tumor boards (MDTB). Since 2010, (i) pathological review has been mandatory for sarcoma,and (ii) tumour/patients' characteristics have been collected in the NETSARC+ nationwide database. The characteristics of patients with SEF and LGFMS and their outcome are compared. RESULTS 35/73 (48%) and 125/257(49%) of patients with SEF and LGFMS were female. More visceral, bone and trunk primary sites were observed in SEF (p < 0.001). 30% of SEF vs 4% of LGFMS patients had metastasis at diagnosis (p < 0.0001). Median size of the primary tumor was 51 mm (range 10-90) for LGFMS vs 80 (20-320) for SEF (p < 0.001). Median age for LGFMS patients was 12 years younger than that of SEF patients (43 [range 4-98] vs 55 [range 10-91], p < 0.001). Neoadjuvant treatment was more often given to SEF (16% vs 9%, p = 0.05). More patients with LGFMS were operated first in reference centers (51% vs 26%, p < 0.001). The R0 rate on the operative specimen was 41% in LGFMS vs 16% in SEF (p < 0.001). Median event-free survival (EFS) of patients with SEF and LGFMS were 32 vs 136 months (p < 0.0001). The median overall survival (OS) was not reached. Fifty-months OS was 93% vs 81% for LGFMS vs SEF (p = 0.05). Median OS was 77 months after first relapse, similar for SEF and LGFMS. In multivariate analysis, age, tumor size, metastasis at diagnosis were independent prognostic factors for OS in LGFMS. CONCLUSIONS Although sharing close molecular alterations, SEF and LGFMS have a different natural history, clinical presentation and outcome, with a higher risk of metastatic relapse in SEF. Survival after relapse is longer than with other sarcomas, and similar for SEF and LGFMS.
Collapse
Affiliation(s)
- J Y Blay
- Centre Léon Bérard & Université Claude Bernard, Lyon, France.
| | | | - M Toulmonde
- Departement of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - A Italiano
- Departement of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - M Rios
- Institut Cancerologie Lorraine, Centre Alexis Vautrin, Nancy, France
| | - E Bompas
- Department of Medical Oncology, Institut de Cancerologie Ouest Nantes, France
| | - T Valentin
- Institut Claudius Regaud & Institut Universitaire de Cancerologie, Oncopole, Toulouse, France
| | - F Duffaud
- La Timone University Hospital, Marseille, France
| | | | - S Watson
- Dept of Medical Oncology, Institut Curie & INSERM U830, Institut Curie Research Center, Paris, France
| | - N Firmin
- Institut de Cancérologie de Montpellier, Montpellier, France
| | | | - M Ropars
- Eugene Marquis Comprehensive Cancer Center, France
| | | | - A Hervieu
- Centre George Francois Leclerc, Dijon, France
| | - C Lebbe
- Centre Georges François Leclerc, Dijon, France
| | - E Saada-Bouzid
- Dermato-Oncology Unit, Saint Louis Hospital, Paris, France
| | | | | | - F Bertucci
- Institut Paoli-Calmettes, Marseille, France
| | | | - G Vaz
- Centre Léon Bérard & Université Claude Bernard, Lyon, France
| | | | - C Honoré
- Gustave Roussy Cancer Campus, Villejuif, France
| | - P Marec-Berard
- Centre Léon Bérard & Université Claude Bernard, Lyon, France
| | - V Minard
- Gustave Roussy Cancer Campus, Villejuif, France
| | | | - D Biau
- Hopital Cochin, Paris, France
| | - P Meeus
- Centre Léon Bérard & Université Claude Bernard, Lyon, France
| | | | | | - S Carriere
- Institut de Cancérologie de Montpellier, Montpellier, France
| | - M Fau
- Departement of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - G Decanter
- Univ. Lille, CHU Lille, ULR 2694 - Metrics: Evaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France; Department of Medical Oncology, Centre Oscar Lambret, Lille, France
| | - F Gouin
- Centre Léon Bérard & Université Claude Bernard, Lyon, France
| | - C Ngo
- Departement of Medical Oncology, Institut Bergonié, Bordeaux, France
| | | | - M Karanian
- Centre Léon Bérard & Université Claude Bernard, Lyon, France
| | - A Meurgey
- Centre Léon Bérard & Université Claude Bernard, Lyon, France
| | - A Dufresne
- Centre Léon Bérard & Université Claude Bernard, Lyon, France
| | - M Brahmi
- Centre Léon Bérard & Université Claude Bernard, Lyon, France
| | - C Chemin-Airiau
- Centre Léon Bérard & Université Claude Bernard, Lyon, France
| | - F Ducimetiere
- Centre Léon Bérard & Université Claude Bernard, Lyon, France.
| | - N Penel
- Univ. Lille, CHU Lille, ULR 2694 - Metrics: Evaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France; Department of Medical Oncology, Centre Oscar Lambret, Lille, France
| | | |
Collapse
|
10
|
Li F, Li C, Guo W, Meng X. A world-wide systematic review of the primary leiomyosarcoma of inferior vena cava. Asian J Surg 2023; 46:5983-5984. [PMID: 37723036 DOI: 10.1016/j.asjsur.2023.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/06/2023] [Indexed: 09/20/2023] Open
Affiliation(s)
- Feng Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong Province, China; Department of Pancreatic Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Chengqing Li
- Department of Pancreatic Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Wenyi Guo
- Department of Pancreatic Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Xue Meng
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong Province, China.
| |
Collapse
|
11
|
Tokumoto H, Akita S, Kosaka K, Kubota Y, Mitsukawa N. Do the Histological Differences of Soft Tissue Sarcomas Affect the Rate of Skin Defect Reconstruction? Ann Plast Surg 2023; 91:585-589. [PMID: 37638837 DOI: 10.1097/sap.0000000000003680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
BACKGROUND In soft tissue sarcoma (STS) resection, flap reconstruction and/or skin grafting is frequently required. However, it is not clear whether the histological difference affects the rate of reconstruction. The present study aimed to investigate it. METHODS This study compared in 5 classifications (105 adipocytic tumors, 102 fibroblastic tumors, 39 muscle tumors, 31 peripheral nerve sheath tumors, and 178 tumors of uncertain differentiation). In addition, the reconstruction rates of detailed tumor sites were compared. The median and case number (percentage) were calculated. RESULTS Tumor size (adipocytic 112 mm vs fibroblastic 79 mm, muscle 72 mm, nerve 90 mm, uncertain 74 mm, P < 0.0001 in all comparisons), histological low-grade rates (adipocytic 43.8% vs uncertain 3.9%, P < 0.0001; fibroblastic 46.1% vs muscle 15.4%, P = 0.003; fibroblastic vs uncertain, P < 0.0001; nerve 19.4% vs uncertain, P = 0.003) and reconstruction rates (adipocytic 5.7% vs fibroblastic 42.2%, muscle 33.3%, nerve 32.3%, uncertain 25.8%, P < 0.0001 in all comparisons) were significantly different. In the region of lower extremity, the regions of thigh [adipocytic 1/62 (1.6%) vs fibroblastic 7/32 (21.9%), P = 0.002], and lower leg [adipocytic 1/16 (6.3%) vs fibroblastic 11/19 (57.9%), P = 0.002] were significantly different. CONCLUSIONS In adipocytic tumors, the tumor size was significantly large; however, the skin defect reconstruction rate was significantly lower than that of the other STS. Histologically, the reconstruction rate of STS derived from superficial tissue increases, whereas the reconstruction rate derived from deep tissue such as adipocytic tumor decreases.
Collapse
Affiliation(s)
- Hideki Tokumoto
- From the Department of Plastic and Reconstructive Surgery, Chiba Cancer Center Hospital
| | - Shinsuke Akita
- Department of Plastic, Reconstructive and Aesthetic Surgery, Chiba University, Faculty of Medicine, Chiba, Japan
| | - Kentaro Kosaka
- Department of Plastic, Reconstructive and Aesthetic Surgery, Chiba University, Faculty of Medicine, Chiba, Japan
| | - Yoshitaka Kubota
- Department of Plastic, Reconstructive and Aesthetic Surgery, Chiba University, Faculty of Medicine, Chiba, Japan
| | - Nobuyuki Mitsukawa
- Department of Plastic, Reconstructive and Aesthetic Surgery, Chiba University, Faculty of Medicine, Chiba, Japan
| |
Collapse
|
12
|
Blay JY, Piperno-Neumann S, Watson S, Dufresne A, Valentin T, Duffaud F, Toulmonde M, Italiano A, Bertucci F, Tlemsani C, Firmin N, Bompas E, Perrin C, Ropars M, Saada-Bouzid E, Dubray-Longeras P, Hervieu A, Lebbe C, Gantzer J, Chaigneau L, Fiorenza F, Rios M, Isambert N, Soibinet P, Boudou-Roquette P, Verret B, Ferron G, Ryckewaert T, Lebellec L, Brahmi M, Gouin F, Meeus P, Vaz G, Le Loarer F, Karanian M, De Pinieux G, Ducimetiere F, Chemin C, Morelle M, Le Cesne A, Penel N. Epithelioid hemangio-endothelioma (EHE) in NETSARC: The nationwide series of 267 patients over 12 years. Eur J Cancer 2023; 192:113262. [PMID: 37625241 DOI: 10.1016/j.ejca.2023.113262] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/07/2023] [Accepted: 07/24/2023] [Indexed: 08/27/2023]
Abstract
EPITHELIOID HEMANGIOENDOTHELIOMA A NATIONWIDE STUDY: Epithelioid hemangioendothelioma (EHE) is an ultrarare sarcoma whose natural history and treatment is not well defined. We report on the presentation and outcome of 267 patients with EHE in the NETSARC+ network since 2010 in France. PATIENTS AND METHODS NETSARC (netsarc.org) is a network of 26 reference sarcoma centres with specialised multidisciplinary tumour boards (MDTB), funded by the French National Cancer Institute (NCI), Institut National du Cancer (INCA). Since 2010, presentation to an MDTB and second pathological review are mandatory for sarcoma patients. Patients' characteristics are collected in a nationwide database regularly monitored with stable incidence since 2013. The characteristics of patients with EHE at diagnosis are presented as well as progression-free survival (PFS), overall survival (OS), and outcome under treatment. RESULTS Two hundred and sixty-seven patients with EHE were included in the NETSARC+ database since 2010. Median age in the series was 51 (range 10-90) years, 58% were women. Median tumour size was 37 mm (4-220). Forty-eight percent, 42%, and 10% were visceral, soft parts, or bone primaries. The most frequent sites were liver (28%), lung (13%). 40% were reported to have systemic (i.e. multifocal or metastatic disease) at diagnosis. With a median follow-up of 20 months, OS and PFS rates at 24 months were 82% and 67%, with 10-year projected OS and PFS of 62% and 21% respectively. Male and M+ patients at diagnosis had a significantly worse OS, but not PFS. Local treatment was associated with a favourable survival in localised but not in patients with advanced stage at diagnosis. For 23 patients receiving medical treatment, PFS and OS were 50.2% and 33.2% at 60 months were respectively. CONCLUSIONS EHE is a frequently metastatic sarcoma at diagnosis with a unique natural history. This study shows in a nationwide series over 12 years that most patients progressed but are still alive at 10 years, both in localised and metastatic stages.
Collapse
Affiliation(s)
- J Y Blay
- Department of Medical oncology, Centre Léon Bérard and Université Claude Bernard, Lyon, France.
| | - S Piperno-Neumann
- Department of Medical Oncology, Institut Curie and INSERM U830, Institut Curie Research Center, Paris, France
| | - S Watson
- Department of Medical Oncology, Institut Curie and INSERM U830, Institut Curie Research Center, Paris, France
| | - A Dufresne
- Department of Medical oncology, Centre Léon Bérard and Université Claude Bernard, Lyon, France
| | - T Valentin
- Department of Medical oncology, Institut Claudius Regaud and Institut Universitaire de Cancerologie, Oncopole, Toulouse, France
| | - F Duffaud
- Department of Medical oncology, La Timone University Hospital, Marseille, France
| | - M Toulmonde
- Departement of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - A Italiano
- Departement of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - F Bertucci
- Department of Medical oncology, Institut Paoli-Calmettes, Marseille, France
| | - C Tlemsani
- Department of Medical oncology, Hôpital Cochin-Saint-Vincent de Paul, Paris, France
| | - N Firmin
- Department of Medical oncology, Institut de Cancérologie de Montpellier, Montpellier, France
| | - E Bompas
- Department of Medical Oncology, Institut de Cancerologie Ouest, Nantes, France
| | - C Perrin
- Department of Medical oncology, Eugene Marquis Comprehensive Cancer Center and CHU, Rennes, France
| | - M Ropars
- Department of Medical oncology, Eugene Marquis Comprehensive Cancer Center and CHU, Rennes, France
| | - E Saada-Bouzid
- Department of Medical oncology, Centre Antoine-Lacassagne, Nice, France
| | - P Dubray-Longeras
- Department of Medical oncology, Centre Georges François Leclerc, Dijon, France
| | - A Hervieu
- Department of Medical oncology, Centre Jean Perrin/ERTICa EA 4677, Clermont-Ferrand, France
| | - C Lebbe
- Department of Medical oncology, Oncology Unit, Saint Louis Hospital, Paris, France
| | - J Gantzer
- Department of Medicine, ICANS, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - L Chaigneau
- Department of Medical oncology, CHU Besancon, Besançon, France
| | - F Fiorenza
- Department of Medical oncology, CHU Limoges, Limoges, France
| | - M Rios
- Department of Medical oncology, Institut Cancerologie Lorraine, Centre Alexis Vautrin, Nancy, France
| | - N Isambert
- Department of Medical oncology, CHU, Poitiers, France
| | - P Soibinet
- Department of Medical oncology, Institut J Godinot Reims, Reims, France
| | - P Boudou-Roquette
- Department of Medical oncology, Hôpital Cochin-Saint-Vincent de Paul, Paris, France
| | - B Verret
- Department of Medical oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - G Ferron
- Department of Medical oncology, Institut Claudius Regaud and Institut Universitaire de Cancerologie, Oncopole, Toulouse, France
| | - T Ryckewaert
- Department of Medical oncology, Centre Oscar Lambret, and Université de Lille ULR 2694, Lille, France
| | - L Lebellec
- Department of Medical oncology, Centre Oscar Lambret, and Université de Lille ULR 2694, Lille, France
| | - M Brahmi
- Department of Medical oncology, Centre Léon Bérard and Université Claude Bernard, Lyon, France
| | - F Gouin
- Department of Medical oncology, Centre Léon Bérard and Université Claude Bernard, Lyon, France
| | - P Meeus
- Department of Medical oncology, Centre Léon Bérard and Université Claude Bernard, Lyon, France
| | - G Vaz
- Department of Medical oncology, Centre Léon Bérard and Université Claude Bernard, Lyon, France
| | - F Le Loarer
- Departement of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - M Karanian
- Department of Medical oncology, Centre Léon Bérard and Université Claude Bernard, Lyon, France
| | - G De Pinieux
- Department of Medical oncology, CHU Tours, Tours, France
| | - F Ducimetiere
- Department of Medical oncology, Centre Léon Bérard and Université Claude Bernard, Lyon, France
| | - C Chemin
- Department of Medical oncology, Centre Léon Bérard and Université Claude Bernard, Lyon, France
| | - M Morelle
- Department of Medical oncology, Centre Léon Bérard and Université Claude Bernard, Lyon, France
| | - A Le Cesne
- Department of Medical oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - N Penel
- Department of Medical oncology, Centre Oscar Lambret, and Université de Lille ULR 2694, Lille, France
| |
Collapse
|
13
|
Gatt R, Casingena L, Pisani D, Agius R, Cassar N. Undifferentiated pleomorphic sarcoma of the spleen: a case report and literature review. Surg Case Rep 2023; 9:166. [PMID: 37726565 PMCID: PMC10509087 DOI: 10.1186/s40792-023-01734-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/21/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Undifferentiated pleomorphic sarcoma is an uncommon sarcoma and its presence in the spleen is even rarer, with only a handful of cases reported in English literature. It is typically only diagnosed following histological analysis. Its rarity also means that there is little consensus over ideal management. CASE PRESENTATION This report presents a case of a 40-year-old Caucasian male who was found to have a splenic mass after presenting with non-specific abdominal pain and generalized malaise. Numerous imaging modalities were used which demonstrated a large partially solid and partially cystic lesion in spleen with no evidence of metastasis. As core biopsies were undiagnostic, he was planned for a diagnostic and therapeutic splenectomy. However, despite magnetic resonance imaging 11 days prior to his operation showed no evidence of liver metastasis, a massive splenic tumour with hepatic metastases was identified intraoperatively. An open splenectomy, distal pancreatectomy and liver metastasectomy was hence carried out. Histological analysis confirmed liver metastasis secondary to a splenic undifferentiated pleomorphic sarcoma. The patient recovered well and was discharged home. He presented again three weeks after his operation with lower back pain, abdominal pain and fever. Computed tomography demonstrated extensive recurrent disease burden in the peritoneum and liver. The patient passed away a month after surgery. CONCLUSION Splenic undifferentiated pleomorphic sarcoma is a rare tumour which may pose a significant diagnostic challenge on both clinical and histopathological grounds. Following diagnosis and treatment, its aggressive nature often results in a poor prognosis. Current literature fails to delineate any superior management strategy to increase survival.
Collapse
|
14
|
Jakob J, Andreou D, Bedke J, Denschlag D, Dürr HR, Frese S, Gösling T, Graeter T, Grünwald V, Grützmann R, Hoffmann J, Juhasz-Boess I, Kasper B, Kogosov V, Knoefel WT, Lehner B, Lehnhardt M, Lindner LH, Matthies C, Sehouli J, Ugurel S, Hohenberger P. Ten recommendations for sarcoma surgery: consensus of the surgical societies based on the German S3 guideline "Adult Soft Tissue Sarcomas". Langenbecks Arch Surg 2023; 408:272. [PMID: 37430129 PMCID: PMC10333354 DOI: 10.1007/s00423-023-03002-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 06/25/2023] [Indexed: 07/12/2023]
Abstract
PURPOSE The evidence-based (S3) guideline "Adult Soft Tissue Sarcomas" (AWMF Registry No. 032/044OL) published by the German Guideline Program in Oncology (GGPO) covers all aspects of sarcoma treatment with 229 recommendations. Representatives of all medical specialties involved in sarcoma treatment contributed to the guideline. This paper compiles the most important recommendations for surgeons selected by delegates from the surgical societies. METHODS A Delphi process was used. Delegates from the surgical societies involved in guideline process selected the 15 recommendations that were most important to them. Votes for similar recommendations were tallied. From the resulting ranked list, the 10 most frequently voted recommendations were selected and confirmed by consensus in the next step. RESULTS The statement "Resection of primary soft tissue sarcomas of the extremities should be performed as a wide resection. The goal is an R0 resection" was selected as the most important term. The next highest ranked recommendations were the need for a preoperative biopsy, performing preoperative MRI imaging with contrast, and discussing all cases before surgery in a multidisciplinary sarcoma committee. CONCLUSION The evidence-based guideline "Adult Soft Tissue Sarcomas" is a milestone to improve the care of sarcoma patients in Germany. The selection of the top ten recommendations by surgeons for surgeons has the potential to improve the dissemination and acceptance of the guideline and thus improve the overall outcome of sarcoma patients.
Collapse
Affiliation(s)
- Jens Jakob
- Sarcoma Unit, Department of Surgery and Mannheim Cancer Center, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, D-68135, Mannheim, Germany.
| | - Dimosthenis Andreou
- Department of Orthopedics and Trauma, Medical University of Graz, Graz, Austria
| | - Jens Bedke
- Department of Urology, Klinikum Stuttgart, Stuttgart, Germany
| | - Dominik Denschlag
- Department of Gynecology, Hochtaunus-Kliniken gGmbH, Bad Homburg, Germany
| | - Hans Roland Dürr
- Orthopaedic Oncology, Department of Orthopaedics and Trauma Surgery, LMU Klinikum, University Hospital, LMU Munich, Munich, Germany
| | | | - Thomas Gösling
- Department of Trauma and Orthopedic Surgery, Clinical Center Braunschweig, Braunschweig, Germany
| | - Thomas Graeter
- Thoracic Surgery, SLK-Lungenklinik Lowenstein, Lowenstein, Germany
| | - Viktor Grünwald
- Clinic for Urology, Clinic for Medical Oncology, University Hospital Essen, Essen, Germany
| | - Robert Grützmann
- Department of Surgery, Comprehensive Cancer Center, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Bavaria, Germany
| | - Jürgen Hoffmann
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Ingolf Juhasz-Boess
- Department of Gynecology, Obstetrics and Reproductive Medicine, University of Freiburg Faculty of Medicine, Freiburg im Breisgau, Germany
| | - Bernd Kasper
- Sarcoma Unit, Mannheim Cancer Center (MCC), Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany
| | - Vlada Kogosov
- Comprehensive Cancer Center Göttingen G-CCC, University Medical Center Göttingen, Georg August University, Göttingen, Germany
- CCC-N (Comprehensive Cancer Center Lower Saxony), Göttingen, Germany
| | - Wolfram Trudo Knoefel
- Department of Surgery, Heinrich-Heine-University and University Hospital Duesseldorf, Duesseldorf, Germany
| | - Burkhard Lehner
- Department of Orthopaedics, Section Orthopedic Oncology and Septic Orthopedic Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Marcus Lehnhardt
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Lars H Lindner
- Department of Medicine III, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Cordula Matthies
- Department of Neurosurgery, University Hospital and Julius-Maximilians-University, Wuerzburg, Germany
| | - Jalid Sehouli
- Department of Gynecology with Center for Oncological Surgery, Charité Comprehensive Cancer Center, University Medicine Berlin, Berlin, Germany
| | - Selma Ugurel
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Peter Hohenberger
- Division of Surgical Oncology and Thoracic Surgery, Department of Surgery, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| |
Collapse
|
15
|
Michot A, Lagarde P, Lesluyes T, Darbo E, Neuville A, Baud J, Perot G, Bonomo I, Maire M, Michot M, Coindre JM, Le Loarer F, Chibon F. Analysis of the Peritumoral Tissue Unveils Cellular Changes Associated with a High Risk of Recurrence. Cancers (Basel) 2023; 15:3450. [PMID: 37444560 DOI: 10.3390/cancers15133450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/22/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND The management of soft-tissue sarcoma (STS) relies on a multidisciplinary approach involving specialized oncological surgery combined with other adjuvant therapies to achieve optimal local disease control. Purpose and Results: Genomic and transcriptomic pseudocapsules of 20 prospective sarcomas were analyzed and revealed to be correlated with a higher risk of recurrence after surgery. CONCLUSIONS A peritumoral environment that has been remodeled and infiltrated by M2 macrophages, and is less expressive of healthy tissue, would pose a significant risk of relapse and require more aggressive treatment strategies.
Collapse
Affiliation(s)
- Audrey Michot
- Bordeaux Institute of Oncology, BRIC U1312, INSERM, 33000 Bordeaux, France
- Institut Bergonié, Centre de Lutte Contre le Cancer de Bordeaux, 33076 Bordeaux, France
- Department of Biopathology, Bergonié Institute, Université Victor Segalen Site Carreire, Bordeaux 2, 33076 Bordeaux, France
| | - Pauline Lagarde
- Institut Bergonié, Centre de Lutte Contre le Cancer de Bordeaux, 33076 Bordeaux, France
- Department of Biopathology, Bergonié Institute, Université Victor Segalen Site Carreire, Bordeaux 2, 33076 Bordeaux, France
| | - Tom Lesluyes
- Institut Bergonié, Centre de Lutte Contre le Cancer de Bordeaux, 33076 Bordeaux, France
| | - Elodie Darbo
- Bordeaux Institute of Oncology, BRIC U1312, INSERM, 33000 Bordeaux, France
- Department of Biopathology, Bergonié Institute, Université Victor Segalen Site Carreire, Bordeaux 2, 33076 Bordeaux, France
| | - Agnès Neuville
- Institut Bergonié, Centre de Lutte Contre le Cancer de Bordeaux, 33076 Bordeaux, France
| | - Jessica Baud
- Bordeaux Institute of Oncology, BRIC U1312, INSERM, 33000 Bordeaux, France
| | - Gaëlle Perot
- OncoSarc, INSERM U1037, Cancer Research Center in Toulouse (CRCT), 31000 Toulouse, France
- Department of Pathology, Institut Claudius Régaud, IUCT-Oncopole, 31000 Toulouse, France
| | - Iris Bonomo
- Institut Bergonié, Centre de Lutte Contre le Cancer de Bordeaux, 33076 Bordeaux, France
| | - Mathilde Maire
- Institut Bergonié, Centre de Lutte Contre le Cancer de Bordeaux, 33076 Bordeaux, France
| | - Maxime Michot
- Institut Bergonié, Centre de Lutte Contre le Cancer de Bordeaux, 33076 Bordeaux, France
| | - Jean-Michel Coindre
- Institut Bergonié, Centre de Lutte Contre le Cancer de Bordeaux, 33076 Bordeaux, France
- Department of Biopathology, Bergonié Institute, Université Victor Segalen Site Carreire, Bordeaux 2, 33076 Bordeaux, France
| | - François Le Loarer
- Bordeaux Institute of Oncology, BRIC U1312, INSERM, 33000 Bordeaux, France
- Institut Bergonié, Centre de Lutte Contre le Cancer de Bordeaux, 33076 Bordeaux, France
- Department of Biopathology, Bergonié Institute, Université Victor Segalen Site Carreire, Bordeaux 2, 33076 Bordeaux, France
| | - Frédéric Chibon
- OncoSarc, INSERM U1037, Cancer Research Center in Toulouse (CRCT), 31000 Toulouse, France
- Department of Pathology, Institut Claudius Régaud, IUCT-Oncopole, 31000 Toulouse, France
| |
Collapse
|
16
|
Graves L, Jeck WR, Grilley-Olson JE. A League of Its Own? Established and Emerging Therapies in Undifferentiated Pleomorphic Sarcoma. Curr Treat Options Oncol 2023; 24:212-228. [PMID: 36729198 DOI: 10.1007/s11864-023-01054-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2022] [Indexed: 02/03/2023]
Abstract
OPINION STATEMENT Over the last decade in soft tissue sarcoma (STS) research, the shifting landscape towards more precise subtype classification and the increasing study of novel therapeutic strategies has prompted a need to highlight current knowledge of effective subtype specific therapies. Undifferentiated pleomorphic sarcoma (UPS), formerly known as malignant fibrous histiocytoma (MFH), is among the most common subtypes of STS arising in the trunk or extremities of adults. Administration of systemic chemotherapy is the primary management in locally advanced and metastatic UPS. While anthracycline-based chemotherapy continues to be standard of care in this setting, outcomes in locally advanced or metastatic UPS remain poor. Recent studies highlight the unique characteristics of UPS that may contribute to its greater sensitivity to immune checkpoint inhibition (ICI) compared to other STS subtypes. With the promise of benefit from novel therapies, including ICI or ICI plus chemotherapy, for a subset of patients with UPS comes the need to identify biomarkers predictive of response to therapy. Ongoing and future clinical trials should place strong emphasis on correlative biomarker studies to learn more about the unique biology of UPS and to identify patients for whom ICI-based therapy will be effective.
Collapse
Affiliation(s)
- Laurie Graves
- Division of Pediatric Hematology & Oncology, Duke University, Hanes House, Room 378, DUMC Box 102382, 315 Trent Drive, Durham, NC, 27710, USA.
| | - William R Jeck
- Department of Pathology, Duke University, Durham, NC, 27710, USA
- Duke Cancer Institute, Durham, NC, 27710, USA
| | - Juneko E Grilley-Olson
- Duke Cancer Institute, Durham, NC, 27710, USA
- Division of Medical Oncology, Duke University, Durham, NC, 27710, USA
| |
Collapse
|
17
|
Abnormal growth of a pleomorphic leiomyosarcoma originating from the mesenteric vein associated with poor outcome after curative-intent resection: a case report. Surg Case Rep 2022; 8:147. [PMID: 35909190 PMCID: PMC9339445 DOI: 10.1186/s40792-022-01497-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 07/15/2022] [Indexed: 11/10/2022] Open
Abstract
Background A leiomyosarcoma (LMS) is a rare tumor that mainly originates from the urinary tract and digestive system; however, non-visceral organ-derived patterns are rare. Herein, we report that a vessel-derived pleomorphic LMS (PLMS) originating from the mesenteric vein has a poor prognosis even after curative-intent surgery. Case presentation The patient was a 41-year-old woman with no relevant medical history. The patient presented with abdominal pain and an abnormal bulge on the left lower abdomen. Magnetic resonance imaging revealed a large tumor occupying the left abdomen. Enhanced computed tomography revealed a bulky tumor with a maximum size of 13 × 13 cm with impending rupture, and a small amount of ascites was detected around the tumor. As the tumor directly invaded the small intestine and descending colon, left hemicolectomy and partial resection of the small intestine were performed. The patient was discharged on postoperative day 10, without any complications. On histopathological analysis, the tumor was diagnosed as a vessel-derived LMS with a pleomorphic pattern. The patient died due to disseminated intravascular coagulation because generalized peritonitis was induced by the super-early recurrence of the tumor 2 months after the surgery. Conclusions Regardless of curative-intent surgery for a vessel-derived PLMS, super-early local recurrence and distant metastasis were observed. A vessel-derived PLMS requires further investigation to determine its characteristics and therapeutic strategies to improve long-term prognosis.
Collapse
|
18
|
Sharma NK, Okakpu U, Murthy J, Wei LM, Lopez-Solis R, Schmidt C, Badhwar V, Marsh JW. Case report: Surgical resection of a retro-hepatic leiomyosarcoma involving atrial reconstruction, cardiopulmonary bypass, ex vivo tumor resection, and liver re-implantation. Front Surg 2022; 9:1037312. [PMID: 36420407 PMCID: PMC9676270 DOI: 10.3389/fsurg.2022.1037312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 10/10/2022] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION Leiomyosarcomas (LMS) involving the inferior vena cava (IVC) is a clinically rare entity, accounting for approximately 0.5% of all adult sarcomas. CASE PRESENTATION A 67-year-old male presented to the emergency department with mild back and lower abdominal pain. During the workup, a computed tomography scan without contrast showed an area of decreased attenuation within the liver adjacent to the intrahepatic IVC. Magnetic resonance imaging confirmed the involvement of the retro-hepatic IVC; biopsy confirmed the diagnosis of LMS. Given the location of the involvement of the retro-hepatic IVC, liver explantation was deemed necessary for adequate tumor resection. The superior extension of the tumor toward the heart necessitated Cardio-Pulmonary (CPB). The patient successfully underwent a complex surgical procedure involving liver explantation with ex vivo back-table resection of the retro-hepatic LMS, replacement of the retro-hepatic vena cava with a ringed Gore-Tex graft, liver re-implantation, and hepatic vein-atrial reconstruction under cardiopulmonary bypass. There were no intraoperative or post-op complications. DISCUSSION The role of vascular reconstruction of the IVC varies depending on the level and extent of the tumor, with options ranging from primary repair, ligation, or reconstruction dictated. Surgical resection with negative margins remains the treatment of choice due to the lack of efficacy of adjuvant therapies. Importantly, liver explantation offers a chance for complete surgical resection and reconstruction. Similarly, the complex nature of the tumor necessitated a pioneering approach involving direct hepato-atrial venous anastomosis. CONCLUSION To the best of our knowledge, this is the first reported case in which the hepatic veins were anastomosed directly to the right atrium while also replacing the native vena cava with a separate graft.
Collapse
Affiliation(s)
- Neel K. Sharma
- Department of Surgery, West Virginia University, Morgantown, WV, United States
| | - Uchenna Okakpu
- School of Medicine, West Virginia University, Morgantown, WV, United States
| | - Jeevan Murthy
- School of Medicine, West Virginia University, Morgantown, WV, United States
| | - Lawrence M. Wei
- Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV, United States
| | - Roberto Lopez-Solis
- Department of Surgery, West Virginia University, Morgantown, WV, United States
| | - Carl Schmidt
- Department of Surgery, West Virginia University, Morgantown, WV, United States
| | - Vinay Badhwar
- Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV, United States
| | - J. Wallis Marsh
- Department of Surgery, West Virginia University, Morgantown, WV, United States
| |
Collapse
|
19
|
MARTÍN ROMÁN L, FERNÁNDEZ MARTÍNEZ M, PROSPERI A, LOZANO P, VÁSQUEZ W, PALENCIA N, GONZÁLEZ BAYÓN L. Multimodal approach of leiomyosarcoma of the inferior vena cava: case report and literature review of main points of controversy. Chirurgia (Bucur) 2022. [DOI: 10.23736/s0394-9508.21.05373-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
20
|
Yang Y, Beeraka NM, Liu J, Zuo X, Wang X, Li T, Fan R. Comparative Combinatorial Implications and Theranostics of Immunotherapy in the Impediment of Alveolar Soft Part Sarcoma. Curr Pharm Des 2022; 28:3404-3412. [PMID: 36154597 DOI: 10.2174/1381612828666220921151750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/21/2022] [Accepted: 08/10/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs), specifically programmed cell death receptor- 1/ligand 1 (PD-1/L1) inhibitors, have shown potential pharmacological efficacy in several cancers. Nonetheless, data pertinent to their therapeutic efficacy in alveolar soft-part sarcoma (ASPS) are limited. OBJECTIVE The retrospective aspects of ICIs (anti-PD1/PD-L1 blockers) to target ASPS are comparatively analyzed for clinical outcomes with other targeted immunotherapy modalities. METHODS We have conducted a systematic review without statistical analysis or comprehensive meta-analysis by collecting the articles published between 1952 and Sep 10th, 2020, by searching the following words: alveolar soft part sarcoma and immunotherapy including immune checkpoint, immune checkpoint inhibitors, and PD-1, PD-L1. We performed a pooled analysis of case reports, conferences, clinical trials, and other research reports pertinent to the efficacy of a PD-1 or PD-L1 antagonist in patients diagnosed with metastatic ASPS. RESULTS The effective studies include 10 case reports, 2 conference reports, 5 clinical trials, and 2 additional research reports. A total of 110 patients were reported to be enrolled in the pooled analysis; among them, 87 (78.38%) received a PD-1/PD-L1 antagonist. For patients who received anti-PD-1/PD-L1as monotherapy, their clinical response rates (CRR) were 63.22% whereas those who received targeted therapy and immunotherapy had a CRR of 78.95% (15/19). In the patients treated with double immunotherapy, their CRR was 100% (4/4). Tumor mutational burden and mismatch repair status have significant implications for predicting the ASPS prognosis. CONCLUSION Alveolar soft-part sarcoma patients with distant metastases can exhibit better clinical outcomes with immunotherapy, particularly toripalimab, atezolizumab, and axitinib combinatorial regimen with pembrolizumab. In addition, this review describes the therapeutic implications to guide personalized medicine depending on the expression patterns of PD-1/PD-L1 during the immunotherapy with ASPS.
Collapse
Affiliation(s)
- Ya Yang
- Department of Radiation Therapy, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Narasimha M Beeraka
- Department of Radiation Therapy, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.,Department of Human Anatomy, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), 8/2 Trubetskaya str., Moscow, 119991, Russia.,Department of Pharmaceutical Chemistry, JSS Academy of Higher Education and Research (JSS AHER), JSS College of Pharmacy, Mysuru, Karnataka, India
| | - Junqi Liu
- Department of Radiation Therapy, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Xiaoxiao Zuo
- Department of Radiation Therapy, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Xin Wang
- Department of Radiation Therapy, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Tingxuan Li
- Department of Radiation Therapy, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Ruitai Fan
- Department of Radiation Therapy, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| |
Collapse
|
21
|
Lazcano R, Barreto CM, Salazar R, Carapeto F, Traweek RS, Leung CH, Gite S, Mehta J, Ingram DR, Wani KM, Vu KAT, Parra ER, Lu W, Zhou J, Witt RG, Cope B, Thirasastr P, Lin HY, Scally CP, Conley AP, Ratan R, Livingston JA, Zarzour AM, Ludwig J, Araujo D, Ravi V, Patel S, Benjamin R, Wargo J, Wistuba II, Somaiah N, Roland CL, Keung EZ, Solis L, Wang WL, Lazar AJ, Nassif EF. The immune landscape of undifferentiated pleomorphic sarcoma. Front Oncol 2022; 12:1008484. [PMID: 36313661 PMCID: PMC9597628 DOI: 10.3389/fonc.2022.1008484] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 09/19/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Undifferentiated pleomorphic sarcoma (UPS) can be associated with a relatively dense immune infiltration. Immune checkpoint inhibitors (anti-PD1, anti-PDL1, and anti-CTLA4) are effective in 20% of UPS patients. We characterize the immune microenvironment of UPS and its association with oncologic outcomes. Material and methods Surgically resected UPS samples were stained by immunohistochemistry (IHC) for the following: tumor-associated immune cells (CD3, CD8, CD163, CD20), immune checkpoints (stimulatory: OX40, ICOS; inhibitory: PD-L1, LAG3, IDO1, PD1), and the adenosine pathway (CD73, CD39). Sections were reviewed for the presence of lymphoid aggregates (LA). Clinical data were retrospectively obtained for all samples. The Wilcoxon rank-sum and Kruskal-Wallis tests were used to compare distributions. Correlations between biomarkers were measured by Spearman correlation. Univariate and multivariate Cox models were used to identify biomarkers associated with overall survival (OS) and disease-free survival (DFS). Unsupervised clustering was performed, and Kaplan-Meier curves and log-rank tests used for comparison of OS and DFS between immune clusters. Results Samples analyzed (n=105) included 46 primary tumors, 34 local recurrences, and 25 metastases. LA were found in 23% (n=10/43), 17% (n=4/24), and 30% (n=7/23) of primary, recurrent, and metastatic samples, respectively. In primary UPS, CD73 expression was significantly higher after preoperative radiation therapy (p=0.009). CD39 expression was significantly correlated with PD1 expression (primary: p=0.002, recurrent: p=0.004, metastatic: p=0.001), PD-L1 expression (primary: p=0.009), and CD3+ cell densities (primary: p=0.016, recurrent: p=0.043, metastatic: p=0.028). In recurrent tumors, there was a strong correlation between CD39 and CD73 (p=0.015), and both were also correlated with CD163+ cell densities (CD39 p=0.013; CD73 p<0.001). In multivariate analyses, higher densities of CD3+ and CD8+ cells (Cox Hazard Ratio [HR]=0.33; p=0.010) were independently associated with OS (CD3+, HR=0.19, p<0.001; CD8+, HR= 0.33, p=0.010) and DFS (CD3+, HR=0.34, p=0.018; CD8+, HR=0.34, p= 0.014). Unsupervised clustering of IHC values revealed three immunologically distinct clusters: immune high, intermediate, and low. In primary tumors, these clusters were significantly associated with OS (log-rank p<0.0001) and DFS (p<0.001). Conclusion We identified three immunologically distinct clusters of UPS Associated with OS and DFS. Our data support further investigations of combination anti-PD-1/PD-L1 and adenosine pathway inhibitors in UPS.
Collapse
Affiliation(s)
- Rossana Lazcano
- Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Carmelia M. Barreto
- Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ruth Salazar
- Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Fernando Carapeto
- Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Raymond S. Traweek
- Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Cheuk H. Leung
- Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Swati Gite
- Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jay Mehta
- Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Davis R. Ingram
- Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Khalida M. Wani
- Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Kim-Anh T. Vu
- Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Edwin R. Parra
- Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Wei Lu
- Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jianling Zhou
- Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Russell G. Witt
- Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Brandon Cope
- Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Prapassorn Thirasastr
- Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Heather Y. Lin
- Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Christopher P. Scally
- Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Anthony P. Conley
- Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ravin Ratan
- Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - J. Andrew Livingston
- Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Alexandra M. Zarzour
- Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Joseph Ludwig
- Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Dejka Araujo
- Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Vinod Ravi
- Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Shreyaskumar Patel
- Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Robert Benjamin
- Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jennifer Wargo
- Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ignacio I. Wistuba
- Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- Division of Pathology and Laboratory Medicine, The University of Texas, MD Anderson Cancer Center, Houston, TX, United States
| | - Neeta Somaiah
- Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Christina L. Roland
- Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Emily Z. Keung
- Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Luisa Solis
- Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Wei-Lien Wang
- Division of Pathology and Laboratory Medicine, The University of Texas, MD Anderson Cancer Center, Houston, TX, United States
| | - Alexander J. Lazar
- Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- Division of Pathology and Laboratory Medicine, The University of Texas, MD Anderson Cancer Center, Houston, TX, United States
- Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Elise F. Nassif
- Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- *Correspondence: Elise F. Nassif,
| |
Collapse
|
22
|
Fujiwara T, Nakata E, Kunisada T, Ozaki T, Kawai A. Alveolar soft part sarcoma: progress toward improvement in survival? A population-based study. BMC Cancer 2022; 22:891. [PMID: 35971085 PMCID: PMC9377116 DOI: 10.1186/s12885-022-09968-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 08/01/2022] [Indexed: 11/18/2022] Open
Abstract
Background Alveolar soft part sarcoma (ASPS) is a rare histological subtype of soft-tissue sarcoma, which remains refractory to conventional cytotoxic chemotherapy. We aimed to characterize ASPS and investigate whether the oncological outcome has improved over the past decade. Methods One hundred and twenty patients with newly diagnosed ASPS from 2006 to 2017, identified from the Bone and Soft-Tissue Tumor Registry in Japan, were analyzed retrospectively. Results The study cohort comprised 34 (28%) patients with localized ASPS and 86 (72%) with metastatic disease at presentation. The 5-year disease-specific survival (DSS) was 68% for all patients and 86% and 62% for localized and metastatic disease, respectively (p = 0.019). Metastasis at presentation was the only adverse prognostic factor for DSS (hazard ratio [HR]: 7.65; p = 0.048). Patients who were > 25 years (80%; p = 0.023), had deep-seated tumors (75%; p = 0.002), and tumors > 5 cm (5–10 cm, 81%; > 10 cm, 81%; p < 0.001) were more likely to have metastases at presentation. In patients with localized ASPS, adjuvant chemotherapy or radiotherapy did not affect survival, and 13 patients (45%) developed distant metastases in the lung (n = 12, 92%) and brain (n = 2, 15%). In patients with metastatic ASPS (lung, n = 85 [99%]; bone, n = 12 [14%]; and brain n = 9 [11%]), surgery for the primary or metastatic site did not affect survival. Prolonged survival was seen in patients who received pazopanib treatment (p = 0.045), but not in those who received doxorubicin-based cytotoxic chemotherapy. Overall, improved DSS for metastatic ASPS has been observed since 2012 (5-year DSS, from 58 to 65%) when pazopanib was approved for advanced diseases, although without a statistically significant difference (p = 0.117). Conclusion The national study confirmed a unique feature of ASPS with frequent metastasis to the lung and brain but an indolent clinical course. An overall trend toward prolonged survival after the introduction of targeted therapy encourages continuous efforts to develop novel therapeutic options for this therapeutically resistant soft-tissue sarcoma.
Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09968-5.
Collapse
Affiliation(s)
- Tomohiro Fujiwara
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, Japan.
| | - Eiji Nakata
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, Japan
| | - Toshiyuki Kunisada
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, Japan
| | - Akira Kawai
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan
| |
Collapse
|
23
|
Boye K, Lobmaier I, Kobbeltvedt MR, Thorkildsen J, Taksdal I, Bjerkehagen B, Bruland ØS, Zaikova O, Sundby Hall K, Hompland I. Real-world evidence on perioperative chemotherapy in localized soft tissue sarcoma of the extremities and trunk wall; a population-based study. Acta Oncol 2022; 61:793-800. [PMID: 35698755 DOI: 10.1080/0284186x.2022.2082259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Data from the real-world setting on perioperative chemotherapy in high-risk, localized soft tissue sarcoma (STS) is limited. Real-world data (RWD) includes data derived from patients treated outside clinical trials and often captures long-term follow-up not recorded in clinical trials. The aim of this study was to provide population-based, real-world evidence on perioperative chemotherapy in localized STS. MATERIAL AND METHODS Adult patients with localized STS in the extremities or trunk wall treated at Oslo University Hospital, Oslo, Norway from 1998 to 2017 were included in the study. Data were extracted from a prospectively maintained database, supplemented by retrospective review of medical records. RESULTS The total study cohort included 806 patients, of whom 154 (19%) received perioperative chemotherapy. A regimen with anthracycline and ifosfamide was given in 141 of 154 cases (92%). During long-term follow-up two patients developed secondary malignancies, cardiac toxicity was registered in 11 patients (7%) and renal toxicity in 12 patients (8%). Seventy-one of 154 patients (46%) were treated outside of clinical trials and constituted the RWD cohort. The median age at surgery was slightly lower and there were more synovial sarcomas and fewer myxofibrosarcomas in the RWD cohort. No difference in chemotherapy dose intensity was observed. The estimated 5-year metastasis-free survival (MFS) in all patients receiving perioperative chemotherapy was 58%. In the RWD cohort 5-year MFS was 53% and in the clinical study cohort 61% (HR 1.24; 95% CI 0.77-2.00). CONCLUSION Long-term outcome after perioperative chemotherapy was comparable for patients treated in routine clinical practice to those in clinical trials. Secondary malignancy and cardiac toxicity were observed. The risk of serious late side effects should be included in the decision process on perioperative chemotherapy.
Collapse
Affiliation(s)
- Kjetil Boye
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | | | | | | | | | - Bodil Bjerkehagen
- Department of Pathology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Øyvind S Bruland
- Department of Oncology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Olga Zaikova
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | | | - Ivar Hompland
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
24
|
"Malignant Mesenchymoma" Revisited: A Clinicopathologic Study of Leiomyosarcomas With Osteosarcomatous Differentiation. Am J Surg Pathol 2022; 46:1430-1435. [PMID: 35687345 DOI: 10.1097/pas.0000000000001928] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Leiomyosarcoma (LMS) is the most common sarcoma in adults. Rarely, LMS dedifferentiates into an undifferentiated sarcoma. Very few cases of LMS with heterologous osteosarcomatous differentiation (OS) have been reported. The purpose of this study was to evaluate the clinicopathologic features of LMS with OS. Of 5570 LMS cases diagnosed from 2006 to 2022, 15 cases (0.2%) of LMS with OS were identified, affecting 13 females and 2 males; ages ranged from 32 to 66 years (median: 53 y). Ten tumors arose in the uterus, 2 in the retroperitoneum, and 1 each in the mesentery, mediastinum, and rectum. Primary tumors ranged from 7 to 20 cm (mean: 16 cm). The LMS components showed conventional spindle cell morphology in most cases; 3 cases showed marked pleomorphism; 3 cases contained an epithelioid component; and 1 case showed myxoid features. In 5 cases OS was identified in the primary tumor, whereas in 10 cases OS was first detected in metastases. One metastatic and 2 primary LMS showed both OS and chondrosarcomatous differentiation. Prominent osteoclastic giant cells were seen in the OS components in 11 cases. Mitotic activity ranged from 17 to 61/10 HPF with tumor necrosis in 10 cases. Twelve patients developed metastases; sites included lungs, diaphragm, kidney, adrenal glands, colon, small intestine, liver, bone, and pancreas. At last follow-up, 8 patients had died of disease, and 4 patients were alive with metastases. The interval between OS and death ranged from 3 weeks to 18 months (median: 6.5 mo). Development of OS in LMS is exceptionally rare. This form of heterologous differentiation may occur in both primary tumors and metastases. LMS with OS is highly aggressive with poor outcomes. Awareness of this phenomenon is important to avoid misdiagnosis as osteosarcoma.
Collapse
|
25
|
Li Y, Liu Y, Qu Y, Chen X, Qu X, Ye Y, Du X, Cheng Y, Xu M, Zhang H. Case Report: Two Cases of Soft-Tissue Sarcomas: High TMB as a Potential Predictive Biomarker for Anlotinib Combined With Toripalimab Therapy. Front Immunol 2022; 13:832593. [PMID: 35603147 PMCID: PMC9120574 DOI: 10.3389/fimmu.2022.832593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 04/11/2022] [Indexed: 11/30/2022] Open
Abstract
Soft-tissue sarcomas (STS), with over 100 different histologic subtypes, are rare tumors that account for 1% of all adult malignancies. Immune checkpoint inhibitors (ICIs) display certain benefits in some subtypes, especially in undifferentiated pleomorphic sarcoma (UPS), alveolar soft part sarcoma (ASPS), and leiomyosarcoma (LMS). However, efficacy is difficult to predict. High tumor mutational burden (TMB-H) and programmed death-ligand 1 (PD-L1) expression are the strongest features associated with the efficacy of immunotherapy, although they are rarely found in STS patients. Until now, whether or not PD-L1 expression and TMB are related to the efficacy of immunotherapy has not been determined. In this study, we report data obtained from two STS patients, one ASPS and one UPS with a high TMB, that benefited from anlotinib combined with toripalimab following resistance to anlotinib monotherapy. A 26 year-old female patient was diagnosed with ASPS. PD-L1 was negative. Next generation sequencing (NSG) revealed ASPSCR1-TFE3 fusion and TMB-H. Following eight months of anlotinib monotherapy, the patient’s disease progressed but continued to benefit from subsequent use of anlotinib combined with toripalimab for 19 months. Another 63 year-old male patient was diagnosed with UPS. PD-L1 was positive and NGS revealed TMB-H. Following 19 months of anlotinib monotherapy, the patient’s disease progressed but continued to benefit from subsequent use of anlotinib combined with toripalimab. DFS is 23 months to follow-up time. The results presented are the first to report the relationship between TMB and the efficacy of immunotherapy in STS. Based on our results, we hypothesis that anlotinib combined with toripalimab is effective for the treatment of some advanced ASPS or UPS. TMB may be a potential predictive biomarker for ICI treatment and deserves additional study.
Collapse
Affiliation(s)
- Yong Li
- Department of Oncology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- *Correspondence: Yong Li, ; Haibo Zhang,
| | - Yihong Liu
- Department of Oncology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Yanchun Qu
- Department of Oncology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Xian Chen
- Department of Oncology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Xin Qu
- Department of Oncology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Yongsong Ye
- Department of Oncology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Xiaohua Du
- Department of Pathology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Ying Cheng
- Department of Medical, Shanghai OrigiMed Co., Ltd, Shanghai, China
| | - Mian Xu
- Department of Medical, Shanghai OrigiMed Co., Ltd, Shanghai, China
| | - Haibo Zhang
- Department of Oncology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- *Correspondence: Yong Li, ; Haibo Zhang,
| |
Collapse
|
26
|
Clinicopathological Assessment of Cancer/Testis Antigens NY-ESO-1 and MAGE-A4 in Highly Aggressive Soft Tissue Sarcomas. Diagnostics (Basel) 2022; 12:diagnostics12030733. [PMID: 35328286 PMCID: PMC8946957 DOI: 10.3390/diagnostics12030733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/04/2022] [Accepted: 03/16/2022] [Indexed: 11/17/2022] Open
Abstract
We aimed to investigate the clinical significance of the expression of NY-ESO-1 and MAGE-A4 in soft tissue sarcoma (STS). Immunostaining for NY-ESO-1, MAGE-A4, and Ki67 was performed using pathological specimens harvested from 10 undifferentiated pleomorphic sarcoma (UPS), nine myxofibrosarcoma (MFS), and three malignant peripheral nerve sheath tumor (MPNST) patients treated at our hospital. We examined the correlation of NY-ESO-1 and MAGE-A4 expression levels with tumor size, histological grade, and SUVmax values. Positive cell rates of various markers were also compared between patients in remission and those who were not in remission. The rates of cases positive for NY-ESO, MAGE-A4, and Ki67 were 50%, 63.6%, and 90.9%, respectively. The average rates of cells positive for NY-ESO, MAGE-A4, and Ki67 in all STS types were 18.2%, 39.4%, and 16.8%, respectively. A positive correlation was observed between rates of cells positive for NY-ESO-1 and MAGE-A4 and between NY-ESO-1 and MAGE-A4 expression levels and clinical features. There was no significant difference in the positive cell rate of NY-ESO-1 or MAGE-A4 between remission and non-remission cases. Our results suggest that NY-ESO-1 and MAGE-A4 expression may be useful for the diagnosis and prognostication of UPS, MFS, and MPNST.
Collapse
|
27
|
Goel M, Mohan A, Patkar S, Gala K, Shetty N, Kulkarni S, Dhareshwar J. Leiomyosarcoma of inferior vena cava (IVC): do we really need to reconstruct IVC post resection? Single institution experience. Langenbecks Arch Surg 2022; 407:1209-1216. [PMID: 35022833 DOI: 10.1007/s00423-021-02408-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 12/08/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Inferior vena cava (IVC) leiomyosarcomas (LMS) are a rare group of retroperitoneal tumors. R0 surgical resection is the only curative modality of treatment. IVC resection for retroperitoneal sarcoma is a complex surgery with no definitive guidelines for reconstruction. METHODS Retrospective review of all patients who underwent surgical resection of primary leiomyosarcoma of the IVC requiring resection from 2010 to 2020 at our tertiary care center was performed. RESULTS Among 24 patients who required IVC resection for LMS, only 7 (29%) required reconstruction of IVC. According to Clavien-Dindo classification, there was one grade 3 or more morbidity and 1 post-operative mortality. Seventeen patients underwent R0 resection whereas 7 patients had R1 resection on final histopathology. At a median follow-up of 25 months (range 8-91 months), the median OS was 40 months with median DFS of 28 months. Two patients presented with local recurrence while 13 patients developed systemic recurrence on follow-up. CONCLUSION Careful preoperative multidisciplinary planning can make IVC resection without reconstruction feasible with acceptable perioperative morbidity, mortality, and oncological outcomes for IVC LMS.
Collapse
Affiliation(s)
- Mahesh Goel
- GI & HPB Service, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Marg, Parel, Mumbai, 400 012, India
| | - Anand Mohan
- GI & HPB Service, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Marg, Parel, Mumbai, 400 012, India
| | - Shraddha Patkar
- GI & HPB Service, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Marg, Parel, Mumbai, 400 012, India.
| | - Kunal Gala
- Department of Interventional Radiology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Nitin Shetty
- Department of Interventional Radiology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Suyash Kulkarni
- Department of Interventional Radiology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Jayesh Dhareshwar
- Department of Vascular Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| |
Collapse
|
28
|
Zhou M, Javadi C, Charville GW, Bui NQ, Harris EJ, Poultsides GA, Norton JA, Visser B, Lee B, Dua MM, Ganjoo KN. Surgical resection of leiomyosarcoma of the inferior vena cava: A case series and literature review. Surg Oncol 2021; 39:101670. [PMID: 34710646 DOI: 10.1016/j.suronc.2021.101670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/21/2021] [Accepted: 10/19/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVES We review our institution's experience in treating leiomyosarcomas involving the inferior vena cava, and we offer guidance on the management. METHODS A text-based search was performed to identify all patients who underwent surgical resection between January 2002 and October 2020. Clinicopathologic data, intraoperative variables, and outcomes were extracted from chart review. RESULTS Twelve of 16 patients (75%) had localized disease; the remaining had limited metastatic disease. Seven of 16 patients (44%) received neoadjuvant chemotherapy or radiation; three patients had partial responses, and four patients had stable disease using RECIST 1.1 criteria. IVC reconstruction was performed in 14 of 16 patients (88%); IVC was ligated for the remaining two patients. Half of all patients had R0 resection on final pathology; the remaining had R1 resections. Progression-free survival (PFS) and overall survival (OS) were not statistically different between patients with R0 and R1 resection. Median PFS was 1.8 years (95% CI 0.89 - not reached); median OS was 6.5 years (1.8 - not reached). Only one patient (6%) experienced local disease recurrence; 4 of 16 patients (25%) experienced disease recurrence distally without local recurrence. CONCLUSIONS Resection of IVC leiomyosarcomas at a sarcoma referral center with experience in vascular reconstruction can lead to many years of recurrence-free survival. Surgical resection should be offered to patients with a low volume of metastatic disease to reduce local complications from the primary tumor, many of which exert significant mass effect on surrounding organs. For patients with metastatic disease or large, high-risk tumors, neoadjuvant chemotherapy can provide a biologic test of disease stability prior to resection.
Collapse
Affiliation(s)
- Maggie Zhou
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Greg W Charville
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Nam Q Bui
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - E John Harris
- Department of Surgery, Stanford University Hospital, Stanford, CA, USA
| | | | - Jeffrey A Norton
- Department of Surgery, Stanford University Hospital, Stanford, CA, USA
| | - Brendan Visser
- Department of Surgery, Stanford University Hospital, Stanford, CA, USA
| | - Byrne Lee
- Department of Surgery, Stanford University Hospital, Stanford, CA, USA
| | - Monica M Dua
- Department of Surgery, Stanford University Hospital, Stanford, CA, USA
| | - Kristen N Ganjoo
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
| |
Collapse
|
29
|
High Prevalence of 5T4/Trophoblast Glycoprotein in Soft Tissue Sarcomas. Cancers (Basel) 2021; 13:cancers13194841. [PMID: 34638324 PMCID: PMC8508483 DOI: 10.3390/cancers13194841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/17/2021] [Accepted: 09/22/2021] [Indexed: 11/16/2022] Open
Abstract
The expression of 5T4/trophoblast glycoprotein was evaluated in several histological subtypes of soft tissue sarcoma (STS) to determine whether the prevalence and level of expression of this membrane-associated glycoprotein is sufficient for use in targeted therapies. Tumor tissue microarrays containing cores from different histological subtypes of STS were stained using a standardized immunohistochemical staining method to detect 5T4; the level of staining was assessed using a semi-quantitative scoring method. No 5T4 staining was seen in the angiosarcomas and liposarcomas investigated in this study. 5T4 staining in the other STS subtypes was seen in more than 50% of cases, warranting further investigation into whether this antigen could evoke an anti-tumor immune response or can be used as target for the delivery of more potent toxins through antibody drug conjugates.
Collapse
|
30
|
Miallot R, Galland F, Millet V, Blay JY, Naquet P. Metabolic landscapes in sarcomas. J Hematol Oncol 2021; 14:114. [PMID: 34294128 PMCID: PMC8296645 DOI: 10.1186/s13045-021-01125-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 07/08/2021] [Indexed: 12/15/2022] Open
Abstract
Metabolic rewiring offers novel therapeutic opportunities in cancer. Until recently, there was scant information regarding soft tissue sarcomas, due to their heterogeneous tissue origin, histological definition and underlying genetic history. Novel large-scale genomic and metabolomics approaches are now helping stratify their physiopathology. In this review, we show how various genetic alterations skew activation pathways and orient metabolic rewiring in sarcomas. We provide an update on the contribution of newly described mechanisms of metabolic regulation. We underscore mechanisms that are relevant to sarcomagenesis or shared with other cancers. We then discuss how diverse metabolic landscapes condition the tumor microenvironment, anti-sarcoma immune responses and prognosis. Finally, we review current attempts to control sarcoma growth using metabolite-targeting drugs.
Collapse
Affiliation(s)
- Richard Miallot
- Centre National de la Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale, Centre d'Immunologie de Marseille Luminy, Aix Marseille Univ, Marseille, France.
| | - Franck Galland
- Centre National de la Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale, Centre d'Immunologie de Marseille Luminy, Aix Marseille Univ, Marseille, France
| | - Virginie Millet
- Centre National de la Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale, Centre d'Immunologie de Marseille Luminy, Aix Marseille Univ, Marseille, France
| | - Jean-Yves Blay
- Centre Léon Bérard, Lyon 1, Lyon Recherche Innovation contre le Cancer, Université Claude Bernard, Lyon, France
| | - Philippe Naquet
- Centre National de la Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale, Centre d'Immunologie de Marseille Luminy, Aix Marseille Univ, Marseille, France.
| |
Collapse
|
31
|
Hashimoto K, Nishimura S, Ito T, Akagi M. Characterization of PD-1/PD-L1 immune checkpoint expression in soft tissue sarcomas. Eur J Histochem 2021; 65. [PMID: 34218652 PMCID: PMC8273625 DOI: 10.4081/ejh.2021.3203] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 06/25/2021] [Indexed: 02/08/2023] Open
Abstract
Inhibitors of the programmed death-1/programmed death-ligand 1 (PD-1/PD-L1) immune checkpoint system are used for treating various malignancies. However, evidence on their use in soft tissue sarcomas (STS) is limited. This study aimed to retrospectively investigate the relationship between the expression of PD-1/PD-L1 and related antigens in STS, and their association with clinical characteristics. Immunostaining for CD4, CD8, PD-1, PD-L1, IL-2, and IFN-γ was performed using pathological specimens harvested at the time of biopsy from 10 patients with undifferentiated pleomorphic sarcoma (UPS), nine with myxofibrosarcoma (MFS), and three with malignant peripheral nerve sheath tumor (MPNST) who were treated at our hospital. Subsequently, the positive immunostaining cell rates were calculated. We also examined the correlation between each immune positive cell rate and age, tissue grade, size, and maximum standardized uptake (SUV-max) values. The 3-year event-free survival (EFS) and overall survival (OS) rates were compared between the positive and negative groups (positive rate >10%; negative <10%) for various immune stains. The positive rates were also compared between the presence and absence of events groups. There was positive staining for the immune checkpoint molecules in every STS type except for PD-1 in MPNST. CD4, CD8, and PD-1 stained lymphocytes in close proximity to the tumor in adjacent tissue sections. A positive correlation was observed between the positive cell rates of each immune component including inflammatory cytokines such as IL-2 and IFN-γ. Additionally, the clinical features positively correlated with the positive PD-1/PD-L1 expression rates. No significant differences in the 3-EFS and OS rates were observed between the PD-1/PD-L1 positive and negative groups. Our results suggest that an inducible immune checkpoint mechanism may be involved in UPS, MFS, and MPNST.
Collapse
Affiliation(s)
- Kazuhiko Hashimoto
- Department of Orthopedic Surgery, Kindai University Hospital, Osaka-Sayama City, Osaka.
| | - Shunji Nishimura
- Department of Orthopedic Surgery, Kindai University Hospital, Osaka-Sayama City, Osaka.
| | - Tomohiko Ito
- Department of Orthopedic Surgery, Kindai University Hospital, Osaka-Sayama City, Osaka.
| | - Masao Akagi
- Department of Orthopedic Surgery, Kindai University Hospital, Osaka-Sayama City, Osaka.
| |
Collapse
|
32
|
Gaignard E, Bergeat D, Robin F, Corbière L, Rayar M, Meunier B. Inferior Vena Cava Leiomyosarcoma: What Method of Reconstruction for Which Type of Resection? World J Surg 2021; 44:3537-3544. [PMID: 32445073 DOI: 10.1007/s00268-020-05602-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Inferior vena cava leiomyosarcoma (IVCL) is a rare tumor with a poor prognosis, and its surgical resection remains a challenge. To date, surgery is the only potentially curative treatment for IVCL with a 5-year survival rate of 55%. The main challenge is to combine oncological surgery with clear margins and vascular reconstruction of the inferior vena cava (IVC). In this review, we discuss the different approaches to vascular reconstruction after IVCL resection, using a prosthetic or autologous patch, direct suture or simple ligation without IVC reconstruction. The reconstruction of IVC depends of tumor location and its extension. We recommend no reconstruction if venous collaterality is well-established. When vascular reconstruction is required, we prefer prosthetic PTFE graft. These patients should be referred to high-volume centers with a multidisciplinary team of sarcoma surgeons with cardiothoracic, vascular and hepatic specialties.
Collapse
Affiliation(s)
- Elodie Gaignard
- Service de Chirurgie hépatobiliaire Et Digestive, CHU Rennes, 2 Rue Henri le Guilloux, 35000, Rennes, France.
- Université de Rennes, 35000, Rennes, France.
| | - Damien Bergeat
- Service de Chirurgie hépatobiliaire Et Digestive, CHU Rennes, 2 Rue Henri le Guilloux, 35000, Rennes, France
- Université de Rennes, 35000, Rennes, France
- UMR Inserm 1241, NuMeCan, Nutrition Metabolisme Et Cancer, 35000, Rennes, France
| | - Fabien Robin
- Service de Chirurgie hépatobiliaire Et Digestive, CHU Rennes, 2 Rue Henri le Guilloux, 35000, Rennes, France
- Université de Rennes, 35000, Rennes, France
- UMR Inserm 1241, NuMeCan, Nutrition Metabolisme Et Cancer, 35000, Rennes, France
| | - Lisa Corbière
- Service de Chirurgie hépatobiliaire Et Digestive, CHU Rennes, 2 Rue Henri le Guilloux, 35000, Rennes, France
- Université de Rennes, 35000, Rennes, France
| | - Michel Rayar
- Service de Chirurgie hépatobiliaire Et Digestive, CHU Rennes, 2 Rue Henri le Guilloux, 35000, Rennes, France
- Université de Rennes, 35000, Rennes, France
| | - Bernard Meunier
- Service de Chirurgie hépatobiliaire Et Digestive, CHU Rennes, 2 Rue Henri le Guilloux, 35000, Rennes, France
- Université de Rennes, 35000, Rennes, France
| |
Collapse
|
33
|
Guérin J, Laizet Y, Le Texier V, Chanas L, Rance B, Koeppel F, Lion F, Gourgou S, Martin AL, Tejeda M, Toulmonde M, Cox S, Hess E, Rousseau-Tsangaris M, Jouhet V, Saintigny P. OSIRIS: A Minimum Data Set for Data Sharing and Interoperability in Oncology. JCO Clin Cancer Inform 2021; 5:256-265. [PMID: 33720747 PMCID: PMC8140800 DOI: 10.1200/cci.20.00094] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 11/30/2020] [Accepted: 01/19/2021] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Many institutions throughout the world have launched precision medicine initiatives in oncology, and a large amount of clinical and genomic data is being produced. Although there have been attempts at data sharing with the community, initiatives are still limited. In this context, a French task force composed of Integrated Cancer Research Sites (SIRICs), comprehensive cancer centers from the Unicancer network (one of Europe's largest cancer research organization), and university hospitals launched an initiative to improve and accelerate retrospective and prospective clinical and genomic data sharing in oncology. MATERIALS AND METHODS For 5 years, the OSIRIS group has worked on structuring data and identifying technical solutions for collecting and sharing them. The group used a multidisciplinary approach that included weekly scientific and technical meetings over several months to foster a national consensus on a minimal data set. RESULTS The resulting OSIRIS set and event-based data model, which is able to capture the disease course, was built with 67 clinical and 65 omics items. The group made it compatible with the HL7 Fast Healthcare Interoperability Resources (FHIR) format to maximize interoperability. The OSIRIS set was reviewed, approved by a National Plan Strategic Committee, and freely released to the community. A proof-of-concept study was carried out to put the OSIRIS set and Common Data Model into practice using a cohort of 300 patients. CONCLUSION Using a national and bottom-up approach, the OSIRIS group has defined a model including a minimal set of clinical and genomic data that can be used to accelerate data sharing produced in oncology. The model relies on clear and formally defined terminologies and, as such, may also benefit the larger international community.
Collapse
Affiliation(s)
- Julien Guérin
- Direction des Données, Institut Curie, Paris, France
| | - Yec'han Laizet
- Bioinformatics and AI Unit, Institut Bergonié, Bordeaux, France
- INSERM U1218—ACTION Unit, Bordeaux, France
| | - Vincent Le Texier
- Synergie Lyon Cancer, Platform of Bioinformatics Gilles Thomas, Centre Léon Bérard, Lyon, France
| | - Laetitia Chanas
- Direction des Données, Institut Curie, Paris, France
- Institut Curie, PSL Research University, INSERM U900, Paris, France
- CBIO-Centre for Computational Biology, MINES ParisTech, PSL Research University, Paris, France
| | - Bastien Rance
- INSERM, Centre de Recherche des Cordeliers, UMRS 1138, Paris Descartes, Sorbonne Paris Cité University, Paris, France
- Hôpital Européen Georges Pompidou, AP-HP, Université Paris Descartes, Paris, France
| | - Florence Koeppel
- Direction de la Recherche, Gustave Roussy Cancer Campus, Villejuif, France
| | - François Lion
- Direction de la Transformation Numérique et des Systèmes d'Information, Gustave Roussy Cancer Campus, Villejuif, France
| | - Sophie Gourgou
- Institut du cancer de Montpellier, Univ Montpellier, Montpellier, France
| | | | - Manuel Tejeda
- Pôle Data—DSIO, Institut Paoli-Calmettes, Marseille, France
| | - Maud Toulmonde
- Department of Medical Oncology, Institut Bergonie, Bordeaux, Aquitaine, France
| | - Stéphanie Cox
- Department of Translational Research and Innovation, Centre Léon Bérard, Lyon, France
| | - Elisabeth Hess
- Direction de la Recherche Biomédicale, Centre de Recherche, Institut Curie, Paris, France
| | | | - Vianney Jouhet
- Service d'Information Médicale—IAM Unit, Pôle de Santé Publique, CHU de Bordeaux, Bordeaux, France
- INSERM, Bordeaux Population Health, UMR 1219—ERIAS Unit, Bordeaux University, Bordeaux, France
| | - Pierre Saintigny
- Department of Translational Research and Innovation, Centre Léon Bérard, Lyon, France
- Univ Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Cancer Research Center of Lyon, Lyon, France
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| |
Collapse
|
34
|
Cao S, Li J, Zhang J, Li H. Development and validation of a prognostic nomogram for predicting the overall survival of myxofibrosarcoma patients: a large population-based study. Transl Cancer Res 2021; 10:923-937. [PMID: 35116421 PMCID: PMC8798403 DOI: 10.21037/tcr-20-2588] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 12/04/2020] [Indexed: 12/13/2022]
Abstract
Background Although some studies have explored prognostic factors of myxofibrosarcoma (MFS), the sample sizes were small, generally fewer than 100 patients. There is still no effective prognostic model for MFS patients based on a large population and comprehensive factors. The present study was designed to establish and validate a large population-based, clinically relevant prognostic nomogram for predicting 3- and 5-year overall survival (OS) in patients with MFS. Methods We identified patients with MFS (ICD-O-3 code: 8811/3) who were diagnosed between 2004 and 2015 from the Surveillance, Epidemiology, and End Results database and separated them into training and validation cohorts (7:3 ratio). Survival was described using the Kaplan-Meier method. Univariate and multivariate Cox regression analyses were used to identify prognostic factors of survival. An individual nomogram was established to predict OS at 3 and 5 years in MFS patients. The discriminative ability and predictive accuracy of the nomogram were compared to those of the traditional American Joint Committee on Cancer (AJCC) staging system in the training and validation cohorts. Finally, MFS patients were divided into two subgroups based on the prognostic index (PI) score of the nomogram, and the survival outcomes of the subgroups were compared. Results A total of 1,270 patients were included. Age at diagnosis, total number of in situ or malignant tumors, tumor size, tumor site, tumor extension, AJCC stage, surgical status, chemotherapy, and radiotherapy were the independent predictors of survival and were included in the nomogram. The nomogram had C-indexes of 0.806 in the training cohort and 0.783 in the validation cohort, which were greater than those of the sixth edition of the AJCC staging system (training cohort, 0.669 and validation cohort, 0.674). Decision curve analysis (DCA) revealed that the nomogram was useful with high clinical net benefits. Survival outcomes were significantly different between the different risk subgroups (P<0.001). Conclusions A novel nomogram based on a large population was constructed to evaluate survival outcomes for MFS. Its predictive efficacy was markedly superior than that of the traditional sixth edition of the AJCC staging system.
Collapse
Affiliation(s)
- Shuai Cao
- Department of Orthopedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jie Li
- Department of Orthopedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jun Zhang
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Haopeng Li
- Department of Orthopedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| |
Collapse
|
35
|
Age-related differences of oncological outcomes in primary extremity soft tissue sarcoma: a multistate model including 6260 patients. Eur J Cancer 2020; 141:128-136. [PMID: 33137588 DOI: 10.1016/j.ejca.2020.09.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/06/2020] [Accepted: 09/25/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE No studies extensively compared the young adults (YA, 18-39 years), middle-aged (40-69 years), and elderly (≥70 years) population with primary high-grade extremity soft tissue sarcoma (eSTS). This study aimed to determine whether the known effect of age on overall survival (OS) and disease progression can be explained by differences in tumour characteristics and treatment protocol among the YA, middle-aged and elderly population in patients with primary high-grade eSTS treated with curative intent. METHODS In this retrospective multicentre study, inclusion criteria were patients with primary high-grade eSTS of 18 years and older, surgically treated with curative intent between 2000 and 2016. Cox proportional hazard models and a multistate model were used to determine the association of age on OS and disease progression. RESULTS A total of 6260 patients were included in this study. YA presented more often after 'whoops'-surgery or for reresection due to residual disease, and with more deep-seated tumours. Elderly patients presented more often with grade III and larger (≥10 cm) tumours. After adjustment for the imbalance in tumour and treatment characteristics the hazard ratio for OS of the middle-aged population is 1.47 (95% confidence interval [CI]: 1.23-1.76) and 3.13 (95% CI: 2.59-3.78) in the elderly population, compared with YA. DISCUSSION The effect of age on OS could only partially be explained by the imbalance in the tumour characteristics and treatment variables. The threefold higher risk of elderly could, at least partially, be explained by a higher other-cause mortality. The results might also be explained by a different tumour behaviour or suboptimal treatment in elderly compared with the younger population.
Collapse
|
36
|
Nakayama R, Mori T, Okita Y, Shiraishi Y, Endo M. A multidisciplinary approach to soft-tissue sarcoma of the extremities. Expert Rev Anticancer Ther 2020; 20:893-900. [PMID: 32820961 DOI: 10.1080/14737140.2020.1814150] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Soft-tissue sarcoma (STS) denotes a group of rare and highly heterogeneous malignant tumors of mesenchymal origin. Accurate histological diagnosis is critical for selecting appropriate treatment. Complete tumor resection is the primary treatment for STS, and the efficacies of radiotherapy and chemotherapy have been tested in the adjuvant setting to improve oncological outcomes. Because most STS lesions arise in the extremities, preserving limb function and managing limb impairment after radical local treatment represent significant challenges. AREAS COVERED This article reviews the current front-line treatments for patients with extremity STS and discusses the multidisciplinary team-based efforts needed to improve oncological outcomes and survivorship. EXPERT OPINION Given the rarity, variety, and complexity of STS, a multidisciplinary approach involving experts in various disciplines is vital for improving outcomes in patients ranging from diagnosis to survivorship. A major challenge is building a sustainable system in each region permitting all patients with extremity STS to be treated at high-volume centers with multidisciplinary teams dedicated to this rare and complex disease.
Collapse
Affiliation(s)
- Robert Nakayama
- Department of Orthopaedic Surgery, Keio University School of Medicine , Tokyo, Japan
| | - Tomoaki Mori
- Department of Orthopaedic Surgery, Keio University School of Medicine , Tokyo, Japan
| | - Yusuke Okita
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital , Tokyo, Japan
| | - Yutaka Shiraishi
- Department of Radiology, Keio University School of Medicine , Tokyo, Japan
| | - Makoto Endo
- Department of Orthopaedic Surgery, Kyushu University , Fukuoka, Japan
| |
Collapse
|
37
|
Novel therapeutic options for alveolar soft part sarcoma: antiangiogenic therapy, immunotherapy and beyond. Curr Opin Oncol 2020; 32:295-300. [PMID: 32541316 DOI: 10.1097/cco.0000000000000652] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Alveolar soft part sarcoma (ASPS) represent 0.5% of sarcomas, defining a rarest among rare malignancies. It affects young adults, displaying slow-growing mass of the thigh, head and neck, and trunk. Although quite indolent, a majority of cases displays an advanced disease with lung bone or central nervous system metastasis. Complete surgery is the cornerstone of localized ASPS, and advanced diseases poorly respond to chemotherapy. Here discuss recent progress in molecular characterization of ASPS and future prospects of therapeutic approaches. RECENT FINDINGS ASPS is characterized by a specific oncogenic translocation ASPSCR1-TFE3 that induce hepatocyte growth factor receptor (MET) overexpression, angiogenesis, and immunosuppression in the tumor microenvironment. These specific biological features have encouraged the successful exploration of MET inhibitors, antiangiogenic drugs, and immunotherapy. We reviewed the main tracks of ASPS biology and recent insights from targeted therapies is ASPS mainly driven tyrosine kinase inhibitors (especially antiangiogenics), immune-checkpoint inhibitors, and their combinations. SUMMARY Overall, antiangiogenics and anti Programmed cell death 1/Programmed cell death ligand 1 therapies showed a significant activity in ASPS that warrants additional investigation through randomized trials to validate those results and through ancillary biological studies to better understand resistance mechanisms and biomarkers of response.
Collapse
|
38
|
Abstract
PURPOSE OF REVIEW Development of immune therapy in sarcoma faces the rarity and heterogeneity of the disease. This review analyses the data available from published clinical trials, and the new clinical strategies under assessment, developed in parallel to the exploration of biological mechanisms underlying the efficacy of immune therapy. RECENT FINDINGS Published data of four clinical trials assessing the efficacy of immune therapy in metastatic bone and soft-tissue sarcoma and associated translational programs are available. Response rate and progression-free survival with single-agent immune check point blockade in unselected sarcoma are low. No biomarkers of efficacy have been identified so far. To increase the efficacy of such treatments, combination of immune check point blockade with chemotherapy, radiotherapy or targeted therapy is currently assessed. Signal of specific sensibility of some histological subtypes is explored. Adoptive cell therapy or vaccine seems particularly promising in translocation-associated sarcoma. SUMMARY Characterization of immune environment, mechanism of action of combined regimen and identification of biomarkers will be key steps to build the next clinical trials to improve the efficacy of such strategy.
Collapse
|
39
|
Sayitoglu EC, Georgoudaki AM, Chrobok M, Ozkazanc D, Josey BJ, Arif M, Kusser K, Hartman M, Chinn TM, Potens R, Pamukcu C, Krueger R, Zhang C, Mardinoglu A, Alici E, Temple HT, Sutlu T, Duru AD. Boosting Natural Killer Cell-Mediated Targeting of Sarcoma Through DNAM-1 and NKG2D. Front Immunol 2020; 11:40. [PMID: 32082316 PMCID: PMC7001093 DOI: 10.3389/fimmu.2020.00040] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 01/08/2020] [Indexed: 12/16/2022] Open
Abstract
Sarcomas are malignancies of mesenchymal origin that occur in bone and soft tissues. Many are chemo- and radiotherapy resistant, thus conventional treatments fail to increase overall survival. Natural Killer (NK) cells exert anti-tumor activity upon detection of a complex array of tumor ligands, but this has not been thoroughly explored in the context of sarcoma immunotherapy. In this study, we investigated the NK cell receptor/ligand immune profile of primary human sarcoma explants. Analysis of tumors from 32 sarcoma patients identified the proliferative marker PCNA and DNAM-1 ligands CD112 and/or CD155 as commonly expressed antigens that could be efficiently targeted by genetically modified (GM) NK cells. Despite the strong expression of CD112 and CD155 on sarcoma cells, characterization of freshly dissociated sarcomas revealed a general decrease in tumor-infiltrating NK cells compared to the periphery, suggesting a defect in the endogenous NK cell response. We also applied a functional screening approach to identify relevant NK cell receptor/ligand interactions that induce efficient anti-tumor responses using a panel NK-92 cell lines GM to over-express 12 different activating receptors. Using GM NK-92 cells against primary sarcoma explants (n = 12) revealed that DNAM-1 over-expression on NK-92 cells led to efficient degranulation against all tested explants (n = 12). Additionally, NKG2D over-expression showed enhanced responses against 10 out of 12 explants. These results show that DNAM-1+ or NKG2D+ GM NK-92 cells may be an efficient approach in targeting sarcomas. The degranulation capacity of GM NK-92 cell lines was also tested against various established tumor cell lines, including neuroblastoma, Schwannoma, melanoma, myeloma, leukemia, prostate, pancreatic, colon, and lung cancer. Enhanced degranulation of DNAM-1+ or NKG2D+ GM NK-92 cells was observed against the majority of tumor cell lines tested. In conclusion, DNAM-1 or NKG2D over-expression elicited a dynamic increase in NK cell degranulation against all sarcoma explants and cancer cell lines tested, including those that failed to induce a notable response in WT NK-92 cells. These results support the broad therapeutic potential of DNAM-1+ or NKG2D+ GM NK-92 cells and GM human NK cells for the treatment of sarcomas and other malignancies.
Collapse
Affiliation(s)
- Ece Canan Sayitoglu
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States.,NSU Cell Therapy Institute, Nova Southeastern University, Fort Lauderdale, FL, United States
| | - Anna-Maria Georgoudaki
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States.,NSU Cell Therapy Institute, Nova Southeastern University, Fort Lauderdale, FL, United States.,Center for Hematology and Regenerative Medicine, Karolinska University Hospital Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Michael Chrobok
- Center for Hematology and Regenerative Medicine, Karolinska University Hospital Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Didem Ozkazanc
- Faculty of Engineering and Natural Sciences, Sabanci University, Istanbul, Turkey
| | - Benjamin J Josey
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States.,NSU Cell Therapy Institute, Nova Southeastern University, Fort Lauderdale, FL, United States
| | - Muhammad Arif
- Science for Life Laboratory, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Kim Kusser
- Translational Research and Economic Development, Nova Southeastern University, Fort Lauderdale, FL, United States
| | - Michelle Hartman
- Translational Research and Economic Development, Nova Southeastern University, Fort Lauderdale, FL, United States
| | - Tamara M Chinn
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States
| | - Renee Potens
- NSU Cell Therapy Institute, Nova Southeastern University, Fort Lauderdale, FL, United States
| | - Cevriye Pamukcu
- Faculty of Engineering and Natural Sciences, Sabanci University, Istanbul, Turkey
| | - Robin Krueger
- Translational Research and Economic Development, Nova Southeastern University, Fort Lauderdale, FL, United States
| | - Cheng Zhang
- Faculty of Dentistry, Oral & Craniofacial Sciences, Centre for Host-Microbiome Interactions, King's College London, London, United Kingdom
| | - Adil Mardinoglu
- Science for Life Laboratory, KTH Royal Institute of Technology, Stockholm, Sweden.,Faculty of Dentistry, Oral & Craniofacial Sciences, Centre for Host-Microbiome Interactions, King's College London, London, United Kingdom
| | - Evren Alici
- Center for Hematology and Regenerative Medicine, Karolinska University Hospital Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Harry Thomas Temple
- Department of Surgery, Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States
| | - Tolga Sutlu
- Department of Molecular Biology and Genetics, Bogaziçi University, Istanbul, Turkey
| | - Adil Doganay Duru
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States.,NSU Cell Therapy Institute, Nova Southeastern University, Fort Lauderdale, FL, United States.,Science for Life Laboratory, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
40
|
A double-blind placebo-controlled randomized phase II trial assessing the activity and safety of regorafenib in non-adipocytic sarcoma patients previously treated with both chemotherapy and pazopanib. Eur J Cancer 2020; 126:45-55. [PMID: 31918233 DOI: 10.1016/j.ejca.2019.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 11/22/2019] [Accepted: 12/01/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Metastatic soft tissue sarcomas (STSs) management remains an unmet medical need. We assessed the activity and safety of regorafenib in patients with metastatic non-adipocytic STS who were previously treated with both chemotherapy and pazopanib. PATIENTS AND METHODS This double-blind, placebo-controlled, multicenter comparative randomized phase II trial included patients with histologically proven advanced and inoperable STS. Patients receiving placebo were offered optional cross-over for centrally confirmed disease progression. Primary end-point was centrally reviewed Response Evaluation Criteria in Solid Tumours-based progression-free survival (PFS), analysed on the intent-to-treat data set. In total, 24 events were required for 90% power, hazard ratio (HR) = 0.33 (median PFS, 3.6 versus 1.2 months), and 1-sided α = 0.1 (ClinicalTrials.gov, NCT01900743). RESULTS From December 2015 to October 2017, 37 patients were randomized; 18 to regorafenib and 19 to placebo. Thirteen patients assigned to placebo switched to regorafenib after progression. Median follow-up was 27.2 months (95% confidence interval [CI]: 24.4-not reached). We observed a significant PFS benefit of regorafenib compared with placebo (adjusted HR = 0.33; 95% CI: 0.15-0.74; p = 0.0007 median PFS = 2.1 versus 1.1 months, respectively), and a large and nearly significant overall survival (OS) benefit despite the cross-over (adjusted HR = 0.49; 95% CI: 0.23-1.06; p = 0.007; median OS = 17.8 versus 8.2 months). Before cross-over, the most common grade III or higher adverse events were lymphopenia (5 versus 1, respectively), diarrhoea (4 versus 0), dyspnoea (3 versus 1), skin toxicity (3 versus 0), arterial hypertension (2 versus 0), and increased transaminases (2 versus 0). CONCLUSION The present study demonstrated a meaningful clinical anti-tumour activity with regorafenib in heavily pre-treated patients with non-adipocytic STS.
Collapse
|
41
|
Leiomyosarcoma: Prognostic outline of a rare head and neck malignancy. Oral Oncol 2019; 95:100-105. [PMID: 31345375 DOI: 10.1016/j.oraloncology.2019.06.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/29/2019] [Accepted: 06/07/2019] [Indexed: 11/23/2022]
Abstract
Soft tissue sarcomas (STS) are mesenchymal malignant neoplasms with a broad spectrum of biologic behaviour. Most STS show predilection for extremities with rarity in head and neck. Leiomyosarcoma (LMS) is an extremely rare STS in head and neck due to the paucity of smooth muscles in this anatomical region. Owing to its rarity, diagnosis of LMS is often delayed or is often misdiagnosed. Our study aimed to evaluate clinico-demographic factors determining clinical course of primary head-neck LMS. Further, we also assessed cases of secondary head-neck LMS and LMS due to other causes to compare their clinical outcome with primary head-neck LMS. In primary LMS cases, intraoral LMS showed slightly better prognosis than extraoral LMS. Survival analysis revealed that prognosis of primary LMS was significantly better than secondary LMS. No significant difference in survival was seen between primary LMS and LMS due to other causes. These observations indicate that site of origin appears to determine the clinical behaviour of LMS. Results showed that size, recurrence and metastasis are important prognostic variables. Though large tumor size was associated with poor prognosis, tumor aggressiveness may not be directly proportional to its size. Surgical management with or without adjuvant therapy was associated with favourable outcome. As several factors are associated with prognostic outcome of head-neck LMS, multimodality therapy approach after careful analysis of various prognostic variables in each case on an individual basis is essential.
Collapse
|
42
|
Iannessi A, Bertrand AS, Peyrottes I, Thyss A, Machiavello JC, Liberatore M. One-bloc percutaneous large biopsy of soft-tissue tumours: feasibility study and possible indications. Clin Radiol 2019; 74:649.e11-649.e17. [PMID: 31178068 DOI: 10.1016/j.crad.2019.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 05/02/2019] [Indexed: 11/26/2022]
Abstract
AIM To report the early results of the Intact lesion excision system (LES) regarding feasibility, tolerance and efficiency in obtaining soft-tissue tumour samples under ultrasound guidance. MATERIALS AND METHODS The feasibility and tolerance of Intact LES procedures under ultrasound guidance were studied prospectively in 15 patients. The procedure was performed on an outpatient basis under local anaesthesia by a single interventional radiologist with 6 years of experience and lasted around 30 min. RESULTS The feasibility of the Intact LES for soft-tissue masses was good except when lesions were hard and calcified. Tolerance was good, with median pain experienced during the procedure evaluated at 4.5/10 (SD 2.2) and median post-procedural pain at day 1 evaluated at 1.8/10 (SD 2.5). No major complications were observed; however, for vascularised lesions, one case of acute wound bleeding and two post-procedural haematomas led to delayed pain. CONCLUSION Percutaneous biopsy of suspected soft-tissue sarcoma using the LES device under ultrasound guidance is well tolerated and feasible. After a first non-contributing core biopsy, and especially, in the case of lipomatous lesions, it is a valuable option to consider, as is surgical incision biopsy.
Collapse
Affiliation(s)
- A Iannessi
- Interventional and Diagnostic Imaging Department, Cancer Center Antoine Lacassagne, 33 Avenue de Valombrose, 06100 Nice, France.
| | - A S Bertrand
- Interventional and Diagnostic Imaging Department, Cancer Center Antoine Lacassagne, 33 Avenue de Valombrose, 06100 Nice, France
| | - I Peyrottes
- Pathology Department, Cancer Center Antoine Lacassagne, 33 Avenue de Valombrose, 06100 Nice, France
| | - A Thyss
- Oncology Department, Cancer Center Antoine Lacassagne, 33 Avenue de Valombrose, 06100 Nice, France
| | - J C Machiavello
- Visceral Surgery Department, Cancer Center Antoine Lacassagne, 33 Avenue de Valombrose, 06100 Nice, France
| | - M Liberatore
- Diagnostic Imaging Department, Princess Grace Hospital, 1 Avenue Pasteur, 98012 Monaco
| |
Collapse
|
43
|
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
| |
Collapse
|
44
|
Carvalho SD, Pissaloux D, Crombé A, Coindre JM, Le Loarer F. Pleomorphic Sarcomas: The State of the Art. Surg Pathol Clin 2019; 12:63-105. [PMID: 30709449 DOI: 10.1016/j.path.2018.10.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This article focuses on pleomorphic sarcomas, which are malignant mesenchymal tumors with complex genetic background at the root of their morphologic pleomorphism. They are poorly differentiated tumors that may retain different lines of differentiation, sometimes correlating with clinicopathological or prognostic features. Accurate diagnosis in this group of tumors relies on adequate sampling due to their heterogeneity and assessment with both microscopy and large panels of immunohistochemistry. Molecular analyses have a limited role in their diagnosis as opposed to translocation-related sarcomas but may provide theranostic and important prognostic information in the future.
Collapse
Affiliation(s)
- Sofia Daniela Carvalho
- Department of Pathology, Hospital de Braga, Sete Fontes-Sao Victor, 4710-243 Braga, Portugal; Department of Pathology, Institut Bergonié, 276 cours de l'Argonne, 33000, Bordeaux, France
| | - Daniel Pissaloux
- Department of Pathology, Centre Leon Berard, Promenade Lea Bullukian, 69376 Lyon, France
| | - Amandine Crombé
- Department of Radiology, Institut Bergonié, 276 cours de l'Argonne, 33000, Bordeaux, France
| | - Jean-Michel Coindre
- Department of Pathology, Institut Bergonié, 276 cours de l'Argonne, 33000, Bordeaux, France; University of Bordeaux, Talence, France
| | - François Le Loarer
- Department of Pathology, Hospital de Braga, Sete Fontes-Sao Victor, 4710-243 Braga, Portugal; University of Bordeaux, Talence, France.
| |
Collapse
|
45
|
Boughzala-Bennadji R, Stoeckle E, Le Péchoux C, Méeus P, Honoré C, Attal J, Duffaud F, De Pinieux G, Bompas E, Thariat J, Leroux A, Bertucci F, Isambert N, Delcambre C, Blay JY, Sunyach MP, Coindre JM, Sargos P, Penel N, Bonvalot S. Localized Myxofibrosarcomas: Roles of Surgical Margins and Adjuvant Radiation Therapy. Int J Radiat Oncol Biol Phys 2018; 102:399-406. [DOI: 10.1016/j.ijrobp.2018.05.055] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 05/17/2018] [Accepted: 05/20/2018] [Indexed: 11/16/2022]
|