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Wang X, Song X, Song Q, Wang J, Chen J. Recurrent retroperitoneal liposarcoma with multiple surgeries: a case report. Front Oncol 2024; 14:1363055. [PMID: 38764575 PMCID: PMC11102049 DOI: 10.3389/fonc.2024.1363055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 04/22/2024] [Indexed: 05/21/2024] Open
Abstract
Retroperitoneal liposarcoma (RPLPS) is a rare malignant tumor that is typically treated with surgical resection. However, RPLPS often has a high rate of local recurrence, making it crucial to explore new treatment options. In this report, we present the case of a middle-aged woman who experienced seven recurrences and underwent seven surgeries following the initial resection. Currently, the patient's condition remains stable after the eighth surgery. Although there have been numerous reports of RPLPS cases both domestically and internationally, instances of repeated recurrence like this are exceptionally rare. Therefore, we have gathered the patient's case data and conducted a retrospective analysis, incorporating relevant literature, to enhance the understanding of this disease among clinical practitioners.
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Affiliation(s)
- Xiao Wang
- Department of Gastrointestinal Surgery, Baotou Central Hospital, Baotou, Inner Mongolia, China
- Baotou Clinical Medical College, Inner Mongolia Medical University, Baotou, Inner Mongolia, China
| | - Xiaobiao Song
- Department of Gastrointestinal Surgery, Baotou Central Hospital, Baotou, Inner Mongolia, China
| | - Qiang Song
- Department of Gastrointestinal Surgery, Baotou Central Hospital, Baotou, Inner Mongolia, China
| | - Jijun Wang
- Department of Gastrointestinal Surgery, Baotou Central Hospital, Baotou, Inner Mongolia, China
| | - Junsheng Chen
- Department of Gastrointestinal Surgery, Baotou Central Hospital, Baotou, Inner Mongolia, China
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Zhang Q, Yang Y, You X, Ju Y, Zhang Q, Sun T, Liu W. Comprehensive genomic analysis of primary bone sarcomas reveals different genetic patterns compared with soft tissue sarcomas. Front Oncol 2023; 13:1173275. [PMID: 37546405 PMCID: PMC10401477 DOI: 10.3389/fonc.2023.1173275] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 07/03/2023] [Indexed: 08/08/2023] Open
Abstract
Introduction Sarcomas are classified into two types, bone sarcoma and soft tissue sarcoma (STS), which account for approximately 1% of adult solid malignancies and 20% of pediatric solid malignancies. There exist more than 50 subtypes within the two types of sarcoma. Each subtype is highly diverse and characterized by significant variations in morphology and phenotypes. Understanding tumor molecular genetics is helpful in improving the diagnostic accuracy of tumors that have been difficult to classify based on morphology alone or that have overlapping morphological features. The different molecular characteristics of bone sarcoma and STS in China remain poorly understood. Therefore, this study aimed to analyze genomic landscapes and actionable genomic alterations (GAs) as well as tumor mutational burden (TMB), microsatellite instability (MSI), and programmed death ligand-1 (PD-L1) expression among Chinese individuals diagnosed with primary bone sarcomas and STS. Methods This retrospective study included 145 patients with primary bone sarcomas (n = 75) and STS (n = 70), who were categorized based on the 2020 World Health Organization classification system. Results Patients diagnosed with bone sarcomas were significantly younger than those diagnosed with STS (p < 0.01). The top 10 frequently altered genes in bone sarcoma and STS were TP53, CDKN2A, CDKN2B, MAP3K1, LRP1B, MDM2, RB1, PTEN, MYC, and CDK4.The EWSR1 fusions exhibited statistically significant differences (p < 0.01) between primary bone sarcoma and STS in terms of their altered genes. Based on the actionable genes defined by OncoKB, actionable GAs was found in 30.7% (23/75) of the patients with bone sarcomas and 35.7% (25/70) of those with STS. There were 4.0% (3/75) patients with bone sarcoma and 4.3% (3/70) patients with STS exhibited high tumor mutational burden (TMB-H) (TMB ≥ 10). There was only one patient with STS exhibited MSI-L, while the remaining cases were microsatellite stable. The positive rate of PD-L1 expression was slightly higher in STS (35.2%) than in bone sarcoma (33.3%), however, this difference did not reach statistical significance. The expression of PD-L1 in STS patients was associated with a poorer prognosis (p = 0.007). Patients with STS had a better prognosis than those with bone sarcoma, but the observed difference did not attain statistical significance (p = 0.21). Amplification of MET and MYC genes were negatively correlated with clinical prognosis in bone tumors (p<0.01). Discussion In conclusion, bone sarcoma and STS have significantly different clinical and molecular characteristics, suggesting that it is vital to diagnose accurately for clinical treatment. Additionally, comprehensive genetic landscape can provide novel treatment perspectives for primary bone sarcoma and STS. Taking TMB, MSI, PD-L1 expression, and OncoKB definition together into consideration, there are still many patients who have the potential to respond to targeted therapy or immunotherapy.
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Affiliation(s)
- Qing Zhang
- Department of Orthopaedic Oncology, Beijing Ji Shui Tan Hospital, Peking University, Beijing, China
| | - Yongkun Yang
- Department of Orthopaedic Oncology, Beijing Ji Shui Tan Hospital, Peking University, Beijing, China
| | - Xia You
- The Medical Department, Jiangsu Simcere Diagnostics Co., Ltd, Nanjing, Jiangsu, China
- Nanjing Simcere Medical Laboratory Science Co., Ltd, Nanjing, Jiangsu, China
- The State Key Lab of Translational Medicine and Innovative Drug Development, Jiangsu Simcere Diagnostics Co., Ltd, Nanjing, Jiangsu, China
| | - Yongzhi Ju
- The Medical Department, Jiangsu Simcere Diagnostics Co., Ltd, Nanjing, Jiangsu, China
- Nanjing Simcere Medical Laboratory Science Co., Ltd, Nanjing, Jiangsu, China
- The State Key Lab of Translational Medicine and Innovative Drug Development, Jiangsu Simcere Diagnostics Co., Ltd, Nanjing, Jiangsu, China
| | - Qin Zhang
- The Medical Department, Jiangsu Simcere Diagnostics Co., Ltd, Nanjing, Jiangsu, China
- Nanjing Simcere Medical Laboratory Science Co., Ltd, Nanjing, Jiangsu, China
- The State Key Lab of Translational Medicine and Innovative Drug Development, Jiangsu Simcere Diagnostics Co., Ltd, Nanjing, Jiangsu, China
| | - Tingting Sun
- The Medical Department, Jiangsu Simcere Diagnostics Co., Ltd, Nanjing, Jiangsu, China
- Nanjing Simcere Medical Laboratory Science Co., Ltd, Nanjing, Jiangsu, China
- The State Key Lab of Translational Medicine and Innovative Drug Development, Jiangsu Simcere Diagnostics Co., Ltd, Nanjing, Jiangsu, China
| | - Weifeng Liu
- Department of Orthopaedic Oncology, Beijing Ji Shui Tan Hospital, Peking University, Beijing, China
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Álvarez Álvarez R, Manzano A, Agra Pujol C, Artigas Raventós V, Correa R, Cruz Jurado J, Fernandez JA, Garcia Del Muro X, Gonzalez JA, Hindi N, Lozano Lominchar P, Martínez-Trufero J, Méndez R, Muñoz M, Muñoz Casares C, Orbis Castellanos F, Orellana Fernandez R, Paniagua González M, Redondo A, Valverde Morales C, Asencio JM. Updated Review and Clinical Recommendations for the Diagnosis and Treatment of Patients with Retroperitoneal Sarcoma by the Spanish Sarcoma Research Group (GEIS). Cancers (Basel) 2023; 15:3194. [PMID: 37370803 DOI: 10.3390/cancers15123194] [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: 05/16/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
Soft tissue sarcomas (STS) are an uncommon and biologically heterogeneous group of tumors arising from mesenchymal cells. The incidence is estimated at five cases per 100,000 people per year. Retroperitoneal sarcomas (RPS) account for 10-15% of all STS, and their management depends on their anatomical characteristics and histotype. Due to their very low incidence, it is recommended that RPS be treated in reference centers and evaluated by an experienced multidisciplinary team (MDT). In Spain, the Spanish Group for Research in Sarcomas (GEIS) brings together experts from various specialties to promote research on sarcomas and improve treatment results. This paper summarizes the GEIS recommendations for the diagnosis, treatment, and follow-up of patients with RPS.
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Affiliation(s)
- Rosa Álvarez Álvarez
- Medical Oncology Department, Instituto de Investigacion Sanitaria Gregorio Marañon, Hospital Universitario Gregorio Marañon, 28007 Madrid, Spain
| | - Aránzazu Manzano
- Medical Oncology Department, Hospital Universitario Clínico San Carlos, 28040 Madrid, Spain
| | - Carolina Agra Pujol
- Pathology Department, Hospital Universitario Gregorio Marañon, Complutense University, 28007 Madrid, Spain
| | - Vicente Artigas Raventós
- Surgery Department, Hospital Universitario Sant Pau, Universidad Autonoma de Barcelona, 08035 Barcelona, Spain
| | - Raquel Correa
- Radiation Oncology Department, Hospital Virgen de la Victoria, 29010 Malaga, Spain
| | - Josefina Cruz Jurado
- Medical Oncology Department, Hospital Universitario Canarias, 38320 Santa Cruz de Tenerife, Spain
| | - Juan Angel Fernandez
- Sarcoma Multidisciplinary Unit, Surgery Department, Hospital Virgen de la Arrixaca, 30120 Murcia, Spain
| | - Xavier Garcia Del Muro
- Sarcoma Multidisciplinary Unit, Medical Oncology Department, Idibell, Instituto Catalan Oncología Hospitalet, 08908 Barcelona, Spain
| | - Jose Antonio Gonzalez
- Surgery Department, Hospital Universitario Sant Pau, Universidad Autonoma de Barcelona, 08035 Barcelona, Spain
| | - Nadia Hindi
- Medical Oncology Department, Fundacion Jimenez Diaz University Hospital, 28040 Madrid, Spain
- Medical Oncology Department, Hospital General de Villalba, 28400 Madrid, Spain
- Health Research Institute-Fundación Jiménez Díaz (IIS-FJD), Universidad Autónoma de Madrid (UAM), 28040 Madrid, Spain
| | - Pablo Lozano Lominchar
- Surgery Department, Hospital Universitario Gregorio Marañon, Complutense University, 28040 Madrid, Spain
| | | | - Ramiro Méndez
- Radiology Department, Hospital Universitario Clínico San Carlos, 28040 Madrid, Spain
| | - Mercedes Muñoz
- Radiation Oncology Department, Hospital Universitario Gregorio Marañon, Complutense University, 28007 Madrid, Spain
| | | | - Francisco Orbis Castellanos
- Sarcoma Multidisciplinary Unit, Surgery Department, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
| | | | - Miguel Paniagua González
- Radiology Department, Hospital Universitario Gregorio Marañon, Complutense University, 28007 Madrid, Spain
| | - Andres Redondo
- Medical Oncology Department, Hospital Universitario La Paz-IdiPAZ, 28046 Madrid, Spain
| | | | - Jose Manuel Asencio
- Surgery Department, Hospital Universitario Gregorio Marañon, Complutense University, 28040 Madrid, Spain
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Corn S, Nessim C, Roland CL, Gronchi A, Freeman C, Dumitra S. Data Dissemination of the Role of Neoadjuvant Radiation in Retroperitoneal Sarcoma: A CTOS and CSSO Survey. Curr Oncol 2023; 30:5807-5815. [PMID: 37366917 DOI: 10.3390/curroncol30060434] [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: 11/19/2022] [Revised: 05/23/2023] [Accepted: 06/12/2023] [Indexed: 06/28/2023] Open
Abstract
Consensus guidelines call for complete resection of retroperitoneal sarcoma with consideration of neoadjuvant radiation for curative-intent treatment. The 15-month delay from the initial presentation of an abstract to the final publication of the STRASS trial results assessing the impact of neoadjuvant radiation led to a dilemma of how patients should be managed in the interim. This study aims to (1) understand perspectives regarding neoadjuvant radiation for RPS during this period; and (2) assess the process of integrating data into practice. A survey was distributed to international organizations including all specialties treating RPS. Eighty clinicians responded, including surgical (60.5%), radiation (21.0%) and medical oncologists (18.5%). Low kappa correlation coefficients on a series of clinical scenarios querying individual recommendations before and after initial presentation as an abstract indicate considerable change. Over 62% of respondents identified a practice change; however, most also noted discomfort in adopting changes without a manuscript available. Of the 45 respondents indicating discomfort with practice changes without a full manuscript, 28 (62%) indicated that their practice changed in response to the abstract. There was substantial variability in recommendations for neoadjuvant radiation between the presentation of the abstract and the publication of trial results. The difference in the proportion of clinicians describing comfort with changing practice based on the presentation of the abstract versus those that had done so shows that indications for proper integration of data into practice are not clear. Endeavors to resolve this ambiguity and expedite availability of practice-changing data are warranted.
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Affiliation(s)
- Sarah Corn
- Department of Surgical Oncology, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
- Department of Surgery, University of Kansas School of Medicine, Wichita, KS 67214, USA
| | - Carolyn Nessim
- Department of Surgery, The Ottawa Hospital and Research Institute, University of Ottawa, Ottawa, ON K1H 8L6, Canada
| | - Christina L Roland
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale Dei Tumori, 20133 Milan, Italy
| | - Carolyn Freeman
- Department of Radiation Oncology, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Sinziana Dumitra
- Department of Surgical Oncology, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
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Cheng SH, Huang YS, Lee HH, Yen HH, Jhong YP, Chao TY. Case report and literature review: Conversion surgery for initially unresectable huge retroperitoneal liposarcoma after preoperative radiotherapy. Front Oncol 2023; 12:1096411. [PMID: 36686723 PMCID: PMC9852908 DOI: 10.3389/fonc.2022.1096411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 12/05/2022] [Indexed: 01/07/2023] Open
Abstract
Background Retroperitoneal liposarcoma (RPLS) is a rare malignancy that is notorious for recurrence. Surgical resection with clean margin is the current treatment of choice. However, owing to the large retroperitoneal space, RPLSs often grow to significant sizes before being diagnosed. Neoadjuvant and adjuvant therapies have potentials to improve long term treatment outcome. Case presentation A 55-year-old Han Chinese male presented to the general surgery department with a one-year history of abdominal fullness and a one-week history of palpable right inguinal mass. At first, he was diagnosed with incarcerated inguinal hernia. However, abdominal computer tomography (CT) and biopsy confirmed his final diagnosis to be retroperitoneal well-differentiated liposarcoma, cT2bN0M0, stage IIb. The tumor, which measured 44.5cm in maximum diameter, was too large for primary surgical resection. Neoadjuvant radiotherapy with 70 Gy in 35 fractions was delivered to the tumor, which shrunk the target volume from 6300 cc to 4800 cc, as observed in the middle of the radiotherapy course. The right testicular mass also received 70Gy/35Fx. Conversion surgery was performed after radiotherapy. Unfortunately, due to residual tumor, adjuvant chemotherapy consisting of AIM (ifosfamide, Mesna, and doxorubicin) and MAID (Mesna, doxorubincin, ifosfamide, and dacarbazine) regimens were administered sequentially. Afterward, debulking surgery was conducted, plus another 18 cycles of ifosfamide monotherapy when residual tumor was still seen on CT. Since the completion of ifosfamide chemotherapy, the patient has been cancer free with no evidence of tumor recurrence for more than 26 months. Conclusion Despite conflicting evidence in the literature, our case supports the use of high dose neoadjuvant radiotherapy and adjuvant chemotherapy in treating large, unresectable RPLSs. It also highlights the importance of using individualized, multidisciplinary approach in achieving cure for large, unresectable rare tumors.
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Affiliation(s)
- Sarah Hsin Cheng
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yen-Shuo Huang
- Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsin-Hua Lee
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan,Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan,Ph.D. Program in Environmental and Occupational Medicine, Kaohsiung Medical University and National Health Research Institutes, Kaohsiung, Taiwan,Department of Radiation Oncology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan,Center for Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan,*Correspondence: Hsin-Hua Lee,
| | - Heng-Hsuan Yen
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ying-Pei Jhong
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tzu-Yuan Chao
- Department of Radiation Oncology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan
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Istl AC, Gronchi A. Neoadjuvant Therapy for Primary Resectable Retroperitoneal Sarcomas-Looking Forward. Cancers (Basel) 2022; 14:cancers14071831. [PMID: 35406603 PMCID: PMC8998126 DOI: 10.3390/cancers14071831] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/23/2022] [Accepted: 03/26/2022] [Indexed: 01/25/2023] Open
Abstract
Simple Summary This review summarizes the current evidence around neoadjuvant radiotherapy and systemic therapy for retroperitoneal sarcoma (RPS). While surgery is the cornerstone of treatment for these tumors, data from prospective studies, retrospective studies, early phase trials, and—most recently—our first phase III randomized trial for RPS suggest there are clinical scenarios in which neoadjuvant therapy may provide benefit. This review evaluates the STRASS results in the setting of other recent studies, identifies active trials of interest, and suggests future directions of study in this field. The intersection of STRASS and STRASS2 is considered and a summary of current acceptable approaches to neoadjuvant therapy for RPS is provided. Abstract The cornerstone of therapy for primary retroperitoneal sarcomas (RPS) is complete surgical resection, best achieved by resecting the tumor en bloc with adherent structures even if not overtly infiltrated. Until recently, trials designed to elucidate the role of neoadjuvant radiation or chemotherapy for RPS have been unable to achieve sufficient enrollment. The completion of the STRASS trial, which explored neoadjuvant radiotherapy for primary resectable RPS, is a major milestone in RPS research, but has prompted further questions about histology-driven treatment paradigms for RPS. Though it was ultimately a negative trial with respect to its primary endpoint of abdominal recurrence-free survival, STRASS produced a signal that suggested improved abdominal recurrence-free survival with neoadjuvant radiotherapy (RT) for patients with liposarcoma (LPS). No effect was seen for leiomyosarcoma (LMS) or high-grade dedifferentiated (DD) LPS, consistent with recent literature suggesting LMS and high-grade DD-LPS have a predominant pattern of distant rather than local failure. These results, along with those from other recent studies conducted at the bench and the bedside, emphasize the importance of a histology-specific approach to RPS research. Recent evidence for patterns of distant failure in LMS and high-grade DD-LPS has prompted the initiation of STRASS2, a study of neoadjuvant chemotherapy for these histologies. As this study unfolds, evidence may emerge for novel systemic therapy options in specific sarcoma histotypes given the explosion in targeted and immunotherapeutic applications over the last decade. This article reviews current and recent evidence around neoadjuvant radiation and chemotherapy as well as avenues for future study to optimize these treatment approaches.
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Affiliation(s)
- Alexandra C. Istl
- Division of Surgical Oncology, Johns Hopkins Hospital, Baltimore, MD 21287, USA;
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy
- Correspondence:
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Griffiths TT, Arango MWF, Smith IM, Wade RG. The baseline neutrophil lymphocyte ratio predicts survival in soft-tissue sarcoma: A 17-year cohort study. J Plast Reconstr Aesthet Surg 2021; 75:1372-1379. [PMID: 34955395 DOI: 10.1016/j.bjps.2021.11.063] [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: 01/11/2021] [Revised: 07/07/2021] [Accepted: 11/12/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Abnormal ratios of peripheral blood cells, e.g. neutrophil-lymphocyte ratio (NLR), are strongly associated with poor outcomes in numerous cancers. In soft-tissue sarcoma (STS), the NLR has been studied in populations outside the UK although many have major methodological flaws, which represents the rationale for this study. METHODS Over 17 years old (2002-2019) adults with extremity STS were included. The baseline NLR (at the time of diagnosis) was calculated. The association between NLR, disease recurrence and survival was explored using cubic splines and a threshold of 3 selected, which is in keeping with the literature. Multivariable Cox regression was used to estimate overall survival, disease-free survival and recurrence with Hazard Ratios (HR) and 95% confidence intervals (CI). RESULTS Overall, 401 patients were included. The median follow-up was 3 years 8 months (interquartile range 1 years 7 months to 5 years 2 months). During surveillance 148 died (37%), of which 123 (76%) were attributable to sarcoma. At the time of diagnosis, an NLR≥3 was independently associated with worse overall survival (adjusted HR 1.44 [95% 1.01, 2.03]). However, the baseline NLR was not associated with the risk of recurrence (adjusted HR 0.98 [95% CI 0.62, 1.57]) or disease-free survival (adjusted HR 1.11 [95% CI 0.79, 1.56]). CONCLUSIONS At the time of diagnosis of STS, the NLR is strongly associated with survival and may serve as a cheap and readily available biomarker to personalise treatment plans for patients.
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Affiliation(s)
| | | | - Ian M Smith
- Academic Plastic Surgery Office, Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds LS1 3EX, UK
| | - Ryckie G Wade
- Faculty of Medicine and Health Sciences, University of Leeds, Leeds, UK; Academic Plastic Surgery Office, Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds LS1 3EX, UK.
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Saikia J, Rastogi S, Barwad A, Dhamija E, Pandey R, Bhoriwal S, Deo S, Kumar S. A systematic review of the current management approaches in leiomyosarcoma of inferior vena cava-Results from analysis of 118 cases. Asian Cardiovasc Thorac Ann 2021; 30:349-363. [PMID: 34672808 DOI: 10.1177/02184923211049911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Primary intravenous leiomyosarcomas are rare vascular tumors with aggressive disease biology. The diagnosis and management have been challenging as little data exist from large databases. METHODS A literature search was done to identify all cases of primary leiomyosarcomas in the last five years. Clinicopathological features and management strategies were evaluated. RESULTS The median age was 53 years, predominantly females (2.5:1), presenting as metastases in up to 12.1% cases. Most tumors were locally advanced with a median size of 10cm. Inferior vena cava involvement from renal veins to infrahepatic veins remains the most frequent site (57.1%cases) while nearly half (52.8%) proceeded for surgery without histological proof. Most patients could undergo upfront resection (88.0%) with few patients receiving neoadjuvant chemotherapy (4.3%) or neoadjuvant radiotherapy (2.2%). Significant multivisceral resections included right nephrectomy (41.3%), liver resection (25.7%) and left nephrectomy (2.2%). Most patients (91.8%) needed an inferior vena cava graft placement with remarkable microscopically negative margins (85.5% cases). Doxorubicin and ifosfamide were the most frequently used combination chemotherapy regimens in both pre and postoperative settings with partial responses. The median overall and disease free survival among operated patients was 60 months and 28 months respectively. In multivariate analysis large tumor, extensive inferior vena cava involvement, and need for adjuvant chemotherapy appeared significant predictors for overall survival. CONCLUSIONS Aggressive upfront surgical resection with clear margin remains the key for long-term survival. Doxorubicin-based regimens were preferred as neoadjuvant chemotherapy while adjuvant treatment with chemotherapy, radiotherapy, or both may be considered in high-risk patients.
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Affiliation(s)
- Jyoutishman Saikia
- Department of Surgical Oncology, DRBRA IRCH, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Rastogi
- Department of Medical Oncology, DRBRA IRCH, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Adarsh Barwad
- Department of Pathology, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Ekta Dhamija
- Department of Radiodiagnosis, DRBRA IRCH, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Rambha Pandey
- Department of Radiotherapy, DRBRA IRCH, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Bhoriwal
- Department of Surgical Oncology, DRBRA IRCH, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Suryanarayana Deo
- Department of Surgical Oncology, DRBRA IRCH, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Sunil Kumar
- Department of Surgical Oncology, DRBRA IRCH, 28730All India Institute of Medical Sciences, New Delhi, India
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Yokoyama Y, Nishida Y, Ikuta K, Nagino M. A case of retroperitoneal dedifferentiated liposarcoma successfully treated by neoadjuvant chemotherapy and subsequent surgery. Surg Case Rep 2020; 6:105. [PMID: 32448975 PMCID: PMC7246274 DOI: 10.1186/s40792-020-00865-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 05/07/2020] [Indexed: 12/25/2022] Open
Abstract
Background Retroperitoneal liposarcoma (RPLS) is the most commonly observed soft tissue sarcoma in the retroperitoneal space. Although the beneficial effect of chemotherapy for RPLS is controversial, there are some reports that have shown a considerable tumor-suppressive effect of chemotherapy in RPLS. We demonstrate a case of dedifferentiated RPLS, which was initially considered inoperable but was successfully treated by neoadjuvant chemotherapy and subsequent curative resection. Case presentation A 59-year-old female was referred to our hospital with a chief complaint of right lower quadrant abdominal pain. Abdominal computed tomography revealed a large retroperitoneal tumor with a maximum diameter of 11 cm. The tumor involved retroperitoneal major vasculatures, such as the right common iliac vein and artery, as well as the right psoas muscle and femoral nerve. The right ureter was also involved and obstructed by the tumor. A biopsy was performed through the retroperitoneal route, and the tumor was diagnosed as a dedifferentiated liposarcoma with the Fédération Nationale des Centres de Lutte Contre le Cancer grade 3. Because the tumor was highly invasive and complete resection was not feasible, we decided to administer neoadjuvant chemotherapy with doxorubicin and ifosfamide (AI). After completing 6 courses of AI, the tumor size was considerably reduced, and we decided to perform surgery with curative intent. Before laparotomy, femoro-femoral arterial bypass was performed to prepare for the right common iliac artery resection. Thereafter, the patient underwent laparotomy and tumor resection combined with right nephrectomy, resection of the right common iliac artery and vein, and resection of the right psoas muscle and femoral nerve. The postoperative course was uneventful, although the patient needed a walking brace to support her gait. The pathological findings indicated a 99% disappearance of tumor cells. The patient was healthy without any complaints after 1 year of surgery, and a follow-up CT scan revealed no tumor recurrence. Conclusions To the best of our knowledge, this is the first report that showed a nearly complete pathological response to AI in dedifferentiated RPLS, which was subsequently completely resected.
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Affiliation(s)
- Yukihiro Yokoyama
- Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
| | - Yoshihiro Nishida
- Department of Orthopedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Kunihiro Ikuta
- Department of Orthopedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Masato Nagino
- Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
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Gamboa AC, Gronchi A, Cardona K. Soft-tissue sarcoma in adults: An update on the current state of histiotype-specific management in an era of personalized medicine. CA Cancer J Clin 2020; 70:200-229. [PMID: 32275330 DOI: 10.3322/caac.21605] [Citation(s) in RCA: 253] [Impact Index Per Article: 63.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 02/11/2020] [Accepted: 02/12/2020] [Indexed: 12/13/2022] Open
Abstract
Soft-tissue sarcomas (STS) are rare tumors that account for 1% of all adult malignancies, with over 100 different histologic subtypes occurring predominately in the trunk, extremity, and retroperitoneum. This low incidence is further complicated by their variable presentation, behavior, and long-term outcomes, which emphasize the importance of centralized care in specialized centers with a multidisciplinary team approach. In the last decade, there has been an effort to improve the quality of care for patients with STS based on anatomic site and histology, and multiple ongoing clinical trials are focusing on tailoring therapy to histologic subtype. This report summarizes the latest evidence guiding the histiotype-specific management of extremity/truncal and retroperitoneal STS with regard to surgery, radiation, and chemotherapy.
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Affiliation(s)
- Adriana C Gamboa
- Division of Surgical Oncology, Department of Surgery, Emory University, Atlanta, Georgia
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Kenneth Cardona
- Division of Surgical Oncology, Winship Cancer Institute, Emory University Hospital Midtown, Atlanta, Georgia
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11
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Turner BT, Hampton L, Schiller D, Mack LA, Robertson-More C, Li H, Quan ML, Bouchard-Fortier A. Neoadjuvant radiotherapy followed by surgery compared with surgery alone in the treatment of retroperitoneal sarcoma: a population-based comparison. ACTA ACUST UNITED AC 2019; 26:e766-e772. [PMID: 31896947 DOI: 10.3747/co.26.5185] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Retroperitoneal sarcoma (rps) encompasses a heterogeneous group of malignancies with a high recurrence rate after resection. Neoadjuvant radiotherapy (nrt) is often used in the hope of sterilizing margins and decreasing local recurrence after excision. We set out to compare local recurrence-free survival (lrfs) and overall survival (os) in patients treated with or without nrt before resection. Methods Patients diagnosed with rps from February 1990 to October 2014 were identified in the Alberta Cancer Registry. Patients with complete gross resection of rps and no distant disease were included. Patient, tumour, treatment, and outcomes data were abstracted in a primary chart review. Baseline characteristics were compared using the Wilcoxon nonparametric test for continuous data and the Fisher exact test for dichotomous and categorical data. Survival was analyzed using Kaplan-Meier curves with log-rank test. Cox regression was performed to control for age, sex, tumour size, tumour grade, date of diagnosis, multivisceral resection, and intraoperative rupture. Results Resection alone was performed in 62 patients, and resection after nrt, in 40. Use of nrt was associated with multivisceral resection and negative microscopic margins. On univariate analysis, nrt was associated with superior median lrfs (89.3 months vs. 28.4 months, p = 0.04) and os (119.4 months vs. 75.9 months, p = 0.04). On multivariate analysis, nrt, younger age, and lower tumour grade predicted improved lrfs and os; sex, tumour size, date of diagnosis, multivisceral resection, and tumour rupture did not. Conclusions In this population-based study, nrt was associated with superior lrfs and os on both univariate and multivariate analysis. When feasible, nrt should be considered until a randomized controlled trial is completed.
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Affiliation(s)
- B T Turner
- Department of Surgery, University of Calgary, Calgary, AB
| | - L Hampton
- Cumming School of Medicine, Calgary, AB
| | - D Schiller
- Department of Surgery, Royal Alexandra Hospital, Edmonton, AB
| | - L A Mack
- Department of Surgery, University of Calgary, Calgary, AB
| | - C Robertson-More
- General Surgery Residency Program, University of Calgary, Calgary, AB
| | - H Li
- Departments of Oncology and Community Health Sciences, University of Calgary, Calgary, AB
| | - M L Quan
- Department of Surgery, University of Calgary, Calgary, AB.,Departments of Oncology and Community Health Sciences, University of Calgary, Calgary, AB
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12
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Wang GY, Lucas DR. Dedifferentiated Liposarcoma With Myofibroblastic Differentiation. Arch Pathol Lab Med 2019; 142:1159-1163. [PMID: 30281365 DOI: 10.5858/arpa.2018-0205-ra] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Liposarcoma is divided into myxoid, pleomorphic, well-differentiated, and dedifferentiated subtypes. Dedifferentiated liposarcoma displays the greatest histomorphologic diversity, including a subset with myofibroblastic differentiation that shares similarities with a spectrum of reactive, benign, and malignant soft tissue lesions. Misdiagnosis may lead to deleterious consequences, as dedifferentiated liposarcoma differs significantly in its prognosis and treatment from its mimics. OBJECTIVE.— To review the clinicopathologic, immunohistochemical, and molecular features of the myofibroblastic variant of dedifferentiated liposarcoma as well as the key distinguishing features from its mimics. DATA SOURCES.— Review of pertinent literature on major features and current understanding of dedifferentiated liposarcoma with myofibroblastic differentiation. CONCLUSIONS.— The myofibroblastic variant of dedifferentiated liposarcoma is an uncommon and underrecognized sarcoma with several important differential diagnoses, and likely represents the major subset of aggressive retroperitoneal tumors that may have been misdiagnosed as desmoid-type fibromatosis, inflammatory myofibroblastic tumor, or another type of sarcoma in the past.
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Affiliation(s)
| | - David R Lucas
- From the Department of Pathology, University of Michigan, Ann Arbor
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13
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Predictors of Disease-Free and Overall Survival in Retroperitoneal Sarcomas: A Modern 16-Year Multi-Institutional Study from the United States Sarcoma Collaboration (USSC). Sarcoma 2019; 2019:5395131. [PMID: 31281208 PMCID: PMC6589263 DOI: 10.1155/2019/5395131] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 03/18/2019] [Accepted: 04/03/2019] [Indexed: 01/08/2023] Open
Abstract
Background Retroperitoneal sarcomas (RPS) comprise approximately 15% of all soft-tissue sarcomas and frequently associated with significant morbidity and as little as 30% 5-year survival. Here, we provide a large, contemporary, and multi-institutional experience to determine which tumor, patient, and treatment characteristics are associated with long-term outcomes in RPS. Methods 571 patients with primary RPS were identified from the United States Sarcoma Collaboration (USSC). RPS patients who underwent resection from January 2000 to April 2016 were included with patient, tumor, and treatment-specific variables investigated as independent predictors of survival. Survival analyses for disease-free and overall survival were conducted using Kaplan–Meier and Cox proportional hazards model methods. Results The study cohort was 55% female, with a median age of 58.9 years (IQR: 48.6–70.0). The most common tumor histiotypes were liposarcoma (34%) and leiomyosarcoma (28%). Median follow-up was 30.6 months (IQR: 11.2–60.4). Median disease-free survival was 35.3 months (95% CI: 27.6–43.0), with multivariate predictors of poorer disease-free survival including higher grade tumors, nodal-positive disease, and multivisceral resection. Median overall survival was 81.6 months (95% CI: 66.3–96.8). Multivariate predictors of shorter overall survival included higher grade tumors, nodal-positive and multifocal disease, systemic chemotherapy, and grossly positive margins (R2) following resection. Conclusions The strongest predictors of disease-free and overall survival are tumor-specific characteristics, while surgical factors are less impactful. Nonsurgical therapies are not associated with improved outcomes despite persistent interest and utilization. Complete macroscopic resection (R0/R1) remains a persistent potentially modifiable risk factor associated with improved overall survival in patients with retroperitoneal sarcomas.
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14
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Xue M, Chen G, Dai J, Hu J. Development and Validation of a Prognostic Nomogram for Extremity Soft Tissue Leiomyosarcoma. Front Oncol 2019; 9:346. [PMID: 31119101 PMCID: PMC6504783 DOI: 10.3389/fonc.2019.00346] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 04/15/2019] [Indexed: 12/25/2022] Open
Abstract
Background: Extremity soft tissue leiomyosarcoma (LMS) is a rare disease with a poor prognosis. The aim of this study is to develop nomograms to predict the overall survival (OS) and cancer-specific survival (CSS) of patients with extremity soft tissue LMS. Methods: Based on the Surveillance, Epidemiology, and End Results (SEER) database, 1,528 cases of extremity soft tissue LMS diagnosed between 1983 and 2015 were included. Cox proportional hazards regression modeling was used to analyze prognosis and obtain independent predictors. The independent predictors were integrated to develop nomograms predicting 5- and 10-year OS and CSS. Nomogram performance was evaluated by a concordance index (C-index) and calibration plots using R software version 3.5.0. Results: Multivariate analysis revealed that age ≥60 years, high tumor grade, distant metastasis, tumor size ≥5 cm, and lack of surgery were significantly associated with decreased OS and CSS. These five predictors were used to construct nomograms for predicting 5- and 10-year OS and CSS. Internal and external calibration plots for the probability of 5- and 10-year OS and CSS showed excellent agreement between nomogram prediction and observed outcomes. The C-index values for internal validation of OS and CSS prediction were 0.776 (95% CI 0.752–0.801) and 0.835 (95% CI 0.810–0.860), respectively, whereas those for external validation were 0.748 (95% CI 0.721–0.775) and 0.814 (95% CI 0.785–0.843), respectively. Conclusions: The proposed nomogram is a reliable and robust tool for accurate prognostic prediction in patients with extremity soft tissue LMS.
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Affiliation(s)
- MingFeng Xue
- Department of Orthopaedics, The Second Hospital of Jiaxing, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Gang Chen
- Department of Orthopaedics, The Second Hospital of Jiaxing, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - JiaPing Dai
- Department of Orthopaedics, The Second Hospital of Jiaxing, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - JunYu Hu
- Department of Orthopaedics, The Second Hospital of Jiaxing, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
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15
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Ballesteros M, Montero N, López-Pousa A, Urrútia G, Solà I, Rada G, Pardo-Hernandez H, Bonfill X. Evidence mapping based on systematic reviews of therapeutic interventions for soft tissue sarcomas. Clin Transl Oncol 2019; 21:1398-1412. [PMID: 30875063 DOI: 10.1007/s12094-019-02069-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 02/22/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE Soft tissue sarcomas are a heterogeneous group of rare tumours of mesenchymal origin. Evidence mapping is one of the most didactic and friendly approaches to organise and summarise the range of research activity in broad topic fields. The objective of this evidence mapping is to identify, describe and organise the current available evidence about therapeutic interventions on soft tissues sarcomas. METHODS We followed the methodology of global evidence mapping. We performed a search of the PubMed, EMBASE, The Cochrane Library and Epistemonikos to identify systematic reviews (SRs) with or without meta-analyses published between 1990 and March 2016. Two independent literature reviewers assessed eligibility and extracted data. Methodological quality of the included systematic reviews was assessed using AMSTAR. We organised the results according to identified PICO questions and used tables and a bubble plot to display the results. RESULTS The map is based on 24 SRs that met eligibility criteria and included 66 individual studies. Three-quarters were either observational or uncontrolled clinical trials. The quality of the included SRs was in general moderate or high. We identified 64 PICO questions from them. The corresponding results mostly favoured the intervention arm. CONCLUSIONS This evidence mapping was built on the basis of SRs, which mostly included non-experimental studies and were qualified by the AMSTAR tool as of moderate quality. The evidence mapping created from PICO questions is a useful approach to describe complex and huge clinical topics through graphical media and orientate further research to fulfil the existing gaps. However, it is important to delimitate the steps of the evidence mapping in a pre-established protocol.
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Affiliation(s)
- M Ballesteros
- C/Sant Antoni Maria Claret, 167, Pavelló 18, Ground Floor, 08025, Barcelona, Spain.
| | - N Montero
- Centro de Investigación en Salud Pública y Epidemiología Clínica, Facultad de Ciencias de la Salud Eugenio Espejo, Universidad Tecnológica Equinoccial, Quito, Ecuador
| | - A López-Pousa
- Oncología Médica y Unidad de Curas Paliativas, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - G Urrútia
- Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - I Solà
- Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - G Rada
- Evidence Based Health Care Program, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - H Pardo-Hernandez
- Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - X Bonfill
- Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
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16
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Zhao R, Yu X, Feng Y, Wang J, Mao Y, Yin W, Zhang Z, Guo X, Ma S. The influence of anatomic location on outcomes in patients with localized primary soft tissue sarcoma. Jpn J Clin Oncol 2018; 48:799-805. [PMID: 30060202 DOI: 10.1093/jjco/hyy105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 07/08/2018] [Indexed: 11/14/2022] Open
Abstract
Background We hypothesized that survival varied significantly between retroperitoneal soft tissue sarcoma (STS) and extremity/trunk STS. This study explored the reasons for the different outcomes and identified patient characteristics for survival. Methods This retrospective study identified 213 consecutive patients with localized primary STS from January 2002 to July 2013, including 47 retroperitoneal STS (22.1%) and 166 extremity/trunk STS (77.9%). Local failure-free survival (LFFS), distant metastasis-free survival (DMFS) and overall survival (OS) were constructed by the Kaplan-Meier method. Univariate Cox proportional hazards regression models were fit to assess the ability of patient characteristics to predict survival. Results At presentation, patients with retroperitoneal STS had larger tumor size (median size 18 cm vs. 6 cm; P < 0.001) and positive margin (21.3% vs. 8.4%; P = 0.014), and less often received radiotherapy (2.1% vs. 45.8%; P < 0.001). The median follow-up time for the entire population was 68 months (range, 5-127 months). Local recurrence was more frequent in patients with retroperitoneal STS compared with patients with extremity/trunk STS (53.2% vs. 28.3%; P = 0.001). LFFS and OS were lower in patients with retroperitoneal STS than extremity/trunk STS, with 5-year LFFS (50% vs. 74.3%; P < 0.001) and 5-year OS (65.4% vs. 77.5%; P = 0.017), respectively. Conclusion Retroperitoneal STS was associated with significantly worse survival compared with extremity/trunk STS. Larger tumor size, more patients with positive margin and fewer patients received radiotherapy in retroperitoneal group may result in worse survival compared with extremity/trunk disease.
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Affiliation(s)
- Ruping Zhao
- Department of Radiation Oncology, The Affiliated Hangzhou Hospital of Nanjing Medical University, Hangzhou First People's Hospital, Hangzhou, Zhejiang.,Department of Radiation Oncology, Hangzhou Cancer Hospital, Nanjing Medical University, Hangzhou, Zhejiang
| | - Xiaoli Yu
- Department of Radiation Oncology, Cancer Hospital of Fudan University, Xuhui, Shanghai.,Department of Oncology, Shanghai Medical College of Fudan University, Xuhui, Shanghai
| | - Yan Feng
- Department of Radiation Oncology, Cancer Hospital of Fudan University, Xuhui, Shanghai.,Department of Oncology, Shanghai Medical College of Fudan University, Xuhui, Shanghai
| | - Jian Wang
- Department of Pathology, Cancer Hospital of Fudan University, Xuhui, Shanghai.,Department of Oncology, Shanghai Medical College of Fudan University, Xuhui, Shanghai, China
| | - Yanjiao Mao
- Department of Radiation Oncology, Hangzhou Cancer Hospital, Nanjing Medical University, Hangzhou, Zhejiang
| | - Wei Yin
- Department of Radiation Oncology, Hangzhou Cancer Hospital, Nanjing Medical University, Hangzhou, Zhejiang
| | - Zhen Zhang
- Department of Radiation Oncology, Cancer Hospital of Fudan University, Xuhui, Shanghai.,Department of Oncology, Shanghai Medical College of Fudan University, Xuhui, Shanghai
| | - Xiaomao Guo
- Department of Radiation Oncology, Cancer Hospital of Fudan University, Xuhui, Shanghai.,Department of Oncology, Shanghai Medical College of Fudan University, Xuhui, Shanghai
| | - Shenglin Ma
- Department of Radiation Oncology, The Affiliated Hangzhou Hospital of Nanjing Medical University, Hangzhou First People's Hospital, Hangzhou, Zhejiang
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17
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Aggressive Surgical Approach for Treatment of Primary and Recurrent Retroperitoneal Soft Tissue Sarcoma. Indian J Surg 2018; 80:154-162. [PMID: 29915482 DOI: 10.1007/s12262-018-1722-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 01/15/2018] [Indexed: 01/14/2023] Open
Abstract
To analyze treatment and survival in a series of resected patients with primary or recurrent retroperitoneal sarcoma (RPS) treated and prospectively followed at a single institution. Between July 1994 and December 2015, 89 patients (36 M, 53 F; mean age 60 years, range 25-79) were evaluated. For the purpose of analysis, complete resection was defined as removal of gross tumor with histologically confirmed clear resection margins. Eighty-three out of the 89 patients (93%), 46 of whom affected by primary RPS, and 37 by recurrent RPS, underwent surgical exploration. Sixty-two had a grossly and microscopically complete resection. Fifty-three out of 83 patients (64%) underwent removal of contiguous intra-abdominal organs. Preoperative mortality was nil and significant preoperative complications occurred in six cases only (7%). High-grade tumor pointed out to be a significant variable for a worse survival in all 83 patients amenable to undergo surgical resection (57% 5 years survival for low grade vs 14% for high grade; P = 0.0004). Among completely resected patients, only histologic grade clearly affected disease-free survival (72% 5 years survival for low grade vs 50% for high grade; P = 0.04), while the role of preoperative blood transfusions (67% 5 years survival for non-transfused patients vs 29% for transfused patients; P = 0.05) has to be evaluated in connection to patient complexity. Histological grade and recurrence are the most valuable prognostic predictors; in this clinical subset, an aggressive surgical approach in both primary and recurrent RPS is associated with a best long-term survival and disease-free survival.
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Berger NG, Silva JP, Mogal H, Clarke CN, Bedi M, Charlson J, Christians KK, Tsai S, Gamblin TC. Overall survival after resection of retroperitoneal sarcoma at academic cancer centers versus community cancer centers: An analysis of the National Cancer Data Base. Surgery 2017; 163:318-323. [PMID: 28943041 DOI: 10.1016/j.surg.2017.07.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 06/20/2017] [Accepted: 07/06/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Operative resection remains the definitive curative therapy for retroperitoneal sarcoma. Data published recently show a correlation between improved outcomes for complex oncologic operations and treatment at academic centers. For large retroperitoneal sarcomas, operative resection can be complex and require multidisciplinary care. We hypothesized that survival rates vary between type of treating center for patients undergoing resection for retroperitoneal sarcoma. METHODS Patients with stage I to III nonmetastatic retroperitoneal sarcomas who underwent operative resection were identified from the National Cancer Database during the years 2004-2013. Treating centers were categorized as academic cancer centers or community cancer centers. Overall survival was analyzed by log-rank test and graphed using Kaplan-Meier method. RESULTS A total of 2,762 patients were identified. A majority of patients (59.4%, n = 1,642) underwent resection at an academic cancer centers. Median age at diagnosis was 63 years old. Neoadjuvant radiotherapy was more common at academic cancer centers, while adjuvant radiotherapy was more common at community cancer centers. Improved overall survival was seen at academic cancer centers across all stages compared with community cancer centers (P = .014) but, after multivariable Cox regression analysis, was not a significant independent predictor of survival (hazard ratio = 0.91, 95% confidence interval, 0.79-1.04, P = .171). Academic cancer centers exhibited a greater rate of R0 resection (55.9% vs 47.0%, P < .001) and a lesser odds of positive margins (odds ratio 0.83, 95% confidence interval, 0.69-0.99, P = .044) after multivariable logistic regression. CONCLUSION Resection for retroperitoneal sarcoma performed at academic cancer centers was an independent predictor of margin-negative resection but was not a statistically significant factor for survival. This observation suggests that site of care may contribute to some aspect of improved oncologic resection for retroperitoneal sarcoma.
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Affiliation(s)
- Nicholas G Berger
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Jack P Silva
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Harveshp Mogal
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Callisia N Clarke
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Manpreet Bedi
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - John Charlson
- Section of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Kathleen K Christians
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Susan Tsai
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - T Clark Gamblin
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.
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Albertsmeier M, Rauch A, Roeder F, Hasenhütl S, Pratschke S, Kirschneck M, Gronchi A, Jebsen NL, Cassier PA, Sargos P, Belka C, Lindner LH, Werner J, Angele MK. External Beam Radiation Therapy for Resectable Soft Tissue Sarcoma: A Systematic Review and Meta-Analysis. Ann Surg Oncol 2017; 25:754-767. [PMID: 28895107 DOI: 10.1245/s10434-017-6081-2] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Indexed: 12/22/2022]
Abstract
PURPOSE The aim of this study was to evaluate the role of preoperative and postoperative external beam radiation therapy (EBRT) in the treatment of resectable soft tissue sarcomas (STSs) of different tumor locations. METHODS A systematic literature search was performed to identify studies investigating the effects of EBRT (versus no EBRT) on local recurrence (LR) and overall survival (OS) or comparing different EBRT sequences. Random effects meta-analyses were calculated and presented as cumulative odds ratios (ORs). RESULTS Sixteen studies (n = 3958 patients) comparing EBRT versus no EBRT, including one randomized controlled trial (RCT) in extremity sarcoma, were analyzed. EBRT appeared to reduce LR in both retroperitoneal tumors (OR 0.47, p < 0.0001) and other locations (OR 0.49, p = 0.001). OS was improved by EBRT in retroperitoneal STSs (OR 0.37, p < 0.0001) but not in other tumor locations. Eleven studies (n = 2140), including one RCT, compared preoperative and postoperative radiotherapy. LR was less frequent following preoperative EBRT in retroperitoneal STSs (OR 0.03, p = 0.02), as well as in other tumor locations (OR 0.67, p = 0.01), while wound complications in extremity sarcoma were more frequent following preoperative EBRT (OR 2.92, p < 0.0001). Several studies included in this meta-analysis bear a high risk of bias and no RCT has been published for retroperitoneal STS. CONCLUSIONS This meta-analysis supports the use of EBRT for local tumor control in patients with resectable STSs. Based on a small number of non-randomized studies, a positive effect on OS may exist in the subgroup of retroperitoneal STSs.
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Affiliation(s)
- Markus Albertsmeier
- Department of General, Visceral and Transplantation Surgery, Ludwig Maximilian University Hospital, Marchioninistr. 15, 81377, Munich, Germany
| | - Alexandra Rauch
- Department of Medical Informatics, Biometry and Epidemiology-IBE, Research Unit for Biopsychosocial Health, Chair for Public Health and Health Care Research, Ludwig Maximilian University, Munich, Germany.,Furtwangen University, Furtwangen, Germany
| | - Falk Roeder
- Department of Radiation Oncology, Ludwig Maximilian University Hospital, Ludwig-Maximilians-University, Munich, Germany.,Department of Molecular Radiation Oncology, German Cancer Research Center, Heidelberg, Germany
| | - Sandro Hasenhütl
- Department of General, Visceral and Transplantation Surgery, Ludwig Maximilian University Hospital, Marchioninistr. 15, 81377, Munich, Germany
| | - Sebastian Pratschke
- Department of General, Visceral and Transplantation Surgery, Ludwig Maximilian University Hospital, Marchioninistr. 15, 81377, Munich, Germany
| | - Michaela Kirschneck
- Department of Medical Informatics, Biometry and Epidemiology-IBE, Research Unit for Biopsychosocial Health, Chair for Public Health and Health Care Research, Ludwig Maximilian University, Munich, Germany
| | - Alessandro Gronchi
- Sarcoma Service, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Nina L Jebsen
- Department of Oncology, Musculo-Skeletal Tumour Service, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | - Paul Sargos
- Department of Radiotherapy, Institut Bergonié, Bordeaux, France
| | - Claus Belka
- Department of Radiation Oncology, Ludwig Maximilian University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Lars H Lindner
- Department of Medical Oncology, Ludwig Maximilian University Hospital, Munich, Germany
| | - Jens Werner
- Department of General, Visceral and Transplantation Surgery, Ludwig Maximilian University Hospital, Marchioninistr. 15, 81377, Munich, Germany
| | - Martin K Angele
- Department of General, Visceral and Transplantation Surgery, Ludwig Maximilian University Hospital, Marchioninistr. 15, 81377, Munich, Germany.
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Abstract
INTRODUCTION The purpose of this article was established by the external genitalia group CCAFU recommandations for diagnosis, treatment and monitoring of retroperitoneal sarcomas, intended for urologists. MATERIAL AND METHODS The multidisciplinary working group has updated the 2013 guidelines, based on an exhaustive review of the literature on PubMed, valued references, level of evidence, to assign grades of recommendation. RESULTS From a clinical suspicion evoking a RPS, computed tomography thoraco abdominal and pelvic is the gold standard. MRI is useful for surgical planning. Before the biopsy confirmation, the inclusion of the file in the French sarcoma pathology reference network should be the rule. The biopsy under scanner performed by retroperitoneal approach is recommended and should be achieve before any therapeutic management of a suspicious retroperitoneal solid mass. Treatment is primarily surgical with the main objective resection in healthy margins (R0) obtained by a technically challenging compartmental resection surgery. Instead of radiation therapy and chemotherapy within a multimodal treatment (neo adjuvant or adjuvant) is discussed based on the evolving risks and opportunities excision. The relapse rate is related to tumor grade and surgical margin. The final prognosis is closely related to the quality of initial management and the volume of cases handled by the center. CONCLUSION The RPS has a poor prognosis. The quality of the initial management directly impacts the disease-free survival and overall survival. The multidisciplinary management coordinated within a referent care network of sarcoma pathology is an imperative necessity. © 2016 Elsevier Masson SAS. All rights reserved.
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(Neo)adjuvant treatment in localised soft tissue sarcoma: The unsolved affair. Eur J Cancer 2016; 70:1-11. [PMID: 27866094 DOI: 10.1016/j.ejca.2016.09.030] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 09/21/2016] [Accepted: 09/26/2016] [Indexed: 01/21/2023]
Abstract
Soft tissue sarcomas (STS) are rare and heterogeneous tumours. A correct definition of STS is imperative from the very beginning of disease management, to guide the diagnostic and imaging work-up, and help to establish the prognosis on which the therapeutic strategy will be based. Over the last few years, many efforts have been made to identify characteristics that could predict disease behaviour and to enrich the therapeutic armamentarium against the advanced disease, that is still characterised by poor prognosis. Surgery remains the milestone of treatment for localised STS, whereas many uncertainties regarding the role of adjuvant and neoadjuvant treatment persist. Some controlled evidence is available, but often conflicting and insufficient to make chemotherapy (CT) a standard practice and, currently, a common and shared strategy does not exist. The biggest question concerns the prospective identification of the subgroup of patients who would benefit the most from (neo)adjuvant therapies. In light of the growing understanding of different biologies and sensitivities of the various sarcoma subtypes, the value of histology in the selection of peri-operative treatments is one of the most intriguing topics under discussion. In this perspective, a new generation of neoadjuvant trials have been planned and are currently ongoing. The aim of this review was to rekindle interest in the long-standing topic of (neo)adjuvant CT in localised STS, providing an update on its role in sarcomas' management and highlighting future directions and consequential factors needed to further improve outcomes in this disease.
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Molina G, Hull MA, Chen YL, DeLaney TF, De Amorim Bernstein K, Choy E, Cote G, Harmon DC, Mullen JT, Haynes AB. Preoperative radiation therapy combined with radical surgical resection is associated with a lower rate of local recurrence when treating unifocal, primary retroperitoneal liposarcoma. J Surg Oncol 2016; 114:814-820. [PMID: 27634478 DOI: 10.1002/jso.24427] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 08/15/2016] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND OBJECTIVES Local recurrence (LR) is the primary cause of death in patients with retroperitoneal liposarcoma (RP-LPS). The purpose of this study was to evaluate if the addition of preoperative radiation therapy (XRT) to radical resection for RP-LPS at a single institution was associated with improved LR. METHODS This retrospective analysis included patients with unifocal, primary RP-LPS who underwent complete R0/R1 resection at a single institution between 1991 and 2013. Multiple patient, tumor, and surgeon characteristics were tested to evaluate their association to LR (recurrence in the retroperitoneal space). We used competing risk hazards regression to evaluate the effect of preoperative XRT on the probability of LR. RESULTS There were 41 patients with liposarcoma histology whose tumors included entirely well-differentiated (N = 13), de-differentiated components (n = 26), myxoid (n = 1), and NOS (n = 1). Preoperative XRT was significantly associated with a lower probability of LR (HR 0.11, 95%CI 0.01-0.91, P = 0.04) and a higher 5-year local recurrence-free survival (95.6%, 95%CI 72.4-99.4%, vs. 75.0%, 95%CI 40.8-91.2%; P = 0.0213), but not with 5-year distant recurrence-free survival or disease-specific survival. CONCLUSIONS Preoperative XRT combined with complete R0/R1 resection for unifocal, primary RP-LPS was associated with improved LR and it should be considered in the multimodality treatment of RP-LPS. J. Surg. Oncol. 2016;114:814-820. © 2016 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- George Molina
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Melissa A Hull
- Division of Surgical Oncology, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Yen-Lin Chen
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Thomas F DeLaney
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Edwin Choy
- Division of Hematology and Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Gregory Cote
- Division of Hematology and Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - David C Harmon
- Division of Hematology and Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - John T Mullen
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Alex B Haynes
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
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Yang J, Zhao Y, Zheng CH, Wang Q, Pang XY, Wang T, Ma JJ. Huge retroperitoneal liposarcoma with renal involvement requires nephrectomy: A case report and literature review. Mol Clin Oncol 2016; 5:607-609. [PMID: 27900096 DOI: 10.3892/mco.2016.1017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 08/10/2016] [Indexed: 11/06/2022] Open
Abstract
A 60-year-old female visited Guihang Guiyang Hospital (Guiyang, China). She presented with abdominal pain in the right side for the previous 2-months, with a touchable mass identified for the previous 1-month. Computed tomography with magnetic resonance imaging revealed a huge mass in the right abdomen. The diagnosis of well-differentiated retroperitoneal liposarcoma with renal involvement was made. During surgery, the tumor was removed, including the fatty renal capsule; however, the kidney was preserved. It is currently debatable whether resection of adjacent organs is required to obtain the negative margins. Conventional viewpoints advise that multi-organ resection is required in order to obtain the negative-margin. However, even if an R0 resection is achieved, the local recurrence rate remains markedly high. Additionally, the complications of organ resection have more impact on patients. Radiotherapy and chemotherapy are an important adjuvant method for these patients. In conclusion, retroperitoneal liposarcoma is a rare disease with a high rate of recurrence. Complete resection is the predominant treatment; however, combined resection of adjacent organs must be considered.
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Affiliation(s)
- Jun Yang
- Department of General Surgery, Guihang Guiyang Hospital, Guiyang, Guizhou 550009, P.R. China
| | - Yue Zhao
- Department of General Surgery, Guihang Guiyang Hospital, Guiyang, Guizhou 550009, P.R. China
| | - Chun Hua Zheng
- Department of General Surgery, Guihang Guiyang Hospital, Guiyang, Guizhou 550009, P.R. China
| | - Qian Wang
- Department of General Surgery, Guihang Guiyang Hospital, Guiyang, Guizhou 550009, P.R. China
| | - Xue Yu Pang
- Department of General Surgery, Guihang Guiyang Hospital, Guiyang, Guizhou 550009, P.R. China
| | - Tian Wang
- Department of General Surgery, Guihang Guiyang Hospital, Guiyang, Guizhou 550009, P.R. China
| | - Jiao Jiao Ma
- Department of General Surgery, Guihang Guiyang Hospital, Guiyang, Guizhou 550009, P.R. China
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