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Zhang A, Yuan X, Jiang S, Xu D, Huang C, Tang JY, Gao Y. Outcomes of children with clear cell sarcoma of kidney following NWTS strategies in Shanghai China (2003-2021). PLoS One 2024; 19:e0306863. [PMID: 38980838 PMCID: PMC11233012 DOI: 10.1371/journal.pone.0306863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 06/24/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND Although clear cell sarcoma of kidney (CCSK) is rare, it is the second most common renal tumor in children after Wilms' tumor. NWTS and SIOP are two major groups which had made tremendous efforts on renal tumors, but the strategies are different, for NWTS follows the upfront surgery principle providing definite pathology and the SIOP follows the upfront chemotherapy principle, each has its own advantages. Here we aimed to evaluate the outcomes of CCSK in China following NWTS strategies to analyze the prognostic factors. METHODS For this multicenter retrospective study, a total of 54 patients were enrolled from three children's hospitals, between April 2003 and December 2021. Treatment comprised upfront radical nephrectomy, followed by radiotherapy and intensive chemotherapy. Clinical records were regularly updated. Prognostic factors and survival rates were evaluated. RESULTS The 54 enrolled patients had a median age of 37 months (range, 4 months to 11.4 years). The stage distribution was 16% stage I (n = 9), 30% stage II (n = 16), 39% stage III (n = 21), and 15% stage IV (n = 8). Among stage IV, metastasis sites included the lung (n = 6), bone (n = 1), and intra-orbital/cervical lymph node (n = 1). After a median follow-up of 5.6 years, the 5-year event-free survival (EFS) was 82.4±5.4%, and overall survival was 88.1±4.6%. The EFS was 100% for stage I, 93.8 ±6.1% for stage II, 71.1±10.0% for stage III, and 68.6±18.6% for stage IV. Univariate analysis revealed that staging (III/IV), tumor rupture, and inferior vena cava tumor thrombus were inferior prognostic factors. Multivariate analysis revealed that tumor rupture was independent poor prognostic factor (P = 0.01, HR 5.9). Among relapsed patients, relapse occurred a median of 11 months after diagnosis (range, 4-41 months), and 50% (4/8) achieved a second complete remission after multiple treatment. None of the six lung metastasis patients received lung RT, only one patient developed a relapse and was salvaged by RT after relapse. CONCLUSIONS Tumor rupture was independent poor prognostic factor. Upfront surgery of NWTS strategies can make a definite pathology diagnosis, but how to reduce tumor rupture during surgery is important especially in developing countries. The outcomes of patients with stage I-III CCSK in China were comparable to findings in other developed countries. Better outcomes were achieved in stage IV CCSK by using an intensive chemotherapy regimen including carboplatin, which require further confirmation by AREN0321. Lung RT may be safely omitted in selected patients who achieve a compete radiographic response after 6 weeks of systemic treatment (including surgery). Treatment should be encouraged even in CCSK cases with metastasis and relapse.
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Affiliation(s)
- Anan Zhang
- Department of Hematology and Oncology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaojun Yuan
- Department of Pediatric Hematology and Oncology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shayi Jiang
- Department of Hematology and Oncology, Children's Hospital of Shanghai, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dongqing Xu
- Department of Pediatric Hematology and Oncology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Can Huang
- Department of Hematology and Oncology, Children's Hospital of Shanghai, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Yan Tang
- Department of Hematology and Oncology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yijin Gao
- Department of Hematology and Oncology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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2
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Benedetti DJ, Renfro LA, Tfirn I, Daw NC, Kalapurakal JA, Ehrlich PF, Khanna G, Perlman E, Warwick A, Gow KW, Paulino AC, Seibel NL, Grundy P, Fernandez CV, Geller JI, Mullen EA, Dome JS. Treatment and outcomes of clear cell sarcoma of the kidney: A report from the Children's Oncology Group studies AREN0321 and AREN03B2. Cancer 2024; 130:2361-2371. [PMID: 38396300 PMCID: PMC11162327 DOI: 10.1002/cncr.35266] [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: 11/17/2023] [Revised: 01/18/2024] [Accepted: 01/30/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND On the fifth National Wilms Tumor Study, treatment for clear cell sarcoma of the kidney (CCSK) included combined vincristine, doxorubicin, cyclophosphamide, and etoposide (regimen I) plus radiation therapy (RT), yielding 5-year event-free survival (EFS) rates of 100%, 88%, 73%, and 29% for patients who had with stage I, II, III, and IV disease, respectively. In the Children's Oncology Group study AREN0321 of risk-adapted therapy, RT was omitted for stage I disease if lymph nodes were sampled, and carboplatin was added for stage IV disease (regimen UH-1). Patients who had stage II/III disease received regimen I with RT. METHODS Four-year EFS was analyzed for patients enrolled on AREN0321 and on those enrolled on AREN03B2 who received AREN0321 stage-appropriate chemotherapy. RESULTS Eighty-two patients with CCSK enrolled on AREN0321, 50 enrolled on AREN03B2 only. The 4-year EFS rate was 82.7% (95% confidence interval [CI], 74.8%-91.4%) for AREN0321 and 89.6% (95% CI, 81.3%-98.7%) for AREN03B2 only (p = .28). When combining studies, the 4-year EFS rates for patients who had stage I (n = 10), II (n = 47), III (n = 65), and IV (n = 10) disease were 90% (95% CI, 73.2%-100.0%), 93.4% (95% CI, 86.4%-100.0%), 82.8% (95% CI, 74.1%-92.6%), and 58.3% (95% CI, 34%-100.0%), respectively. There were no local recurrences among seven patients with stage I disease who were treated without RT. One stage I recurrence occurred in the brain, which was the most common site of relapse overall. Among patients with local stage III tumors, neither initial procedure type, margin status, nor lymph node involvement were prognostic. CONCLUSIONS Patients with stage I CCSK had excellent outcomes without local recurrences when treated without RT. Patients with stage IV disease appeared to benefit from a carboplatin-containing regimen, although their outcomes remained unsatisfactory. Further research is needed to improve outcomes for patients with advanced-stage disease (ClinicalTrials.gov identifiers NCT00335556 and NCT00898365).
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Affiliation(s)
- Daniel J Benedetti
- Division of Hematology/Oncology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lindsay A Renfro
- Division of Biostatistics, University of Southern California, Los Angeles, California, USA
- Children's Oncology Group, Monrovia, California, USA
| | - Ian Tfirn
- Children's Oncology Group, Monrovia, California, USA
| | - Najat C Daw
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - John A Kalapurakal
- Department of Radiation Oncology, Northwestern University, Chicago, Illinois, USA
| | - Peter F Ehrlich
- Section of Pediatric Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Geetika Khanna
- Department of Radiology and Imaging Sciences, Emory University, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Elizabeth Perlman
- Department of Pathology and Laboratory Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Anne Warwick
- Department of Pediatrics, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, Maryland, USA
| | - Kenneth W Gow
- Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
| | - Arnold C Paulino
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nita L Seibel
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Paul Grundy
- Division of Immunology, Hematology, Oncology, Palliative Care, and Environmental Interactions, University of Alberta, Edmonton, Alberta, Canada
| | - Conrad V Fernandez
- Division of Pediatric Hematology/Oncology, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - James I Geller
- Division of Oncology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Elizabeth A Mullen
- Department of Pediatric Hematology/Oncology, Dana-Farber Cancer Institute/Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jeffrey S Dome
- Division of Oncology and Department of Pediatrics, Children's National Hospital and the George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
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Dorwal P, Abou-Seif C, Ng J, Super L, Chan Y, Rathi V. Clear Cell Sarcoma of the Kidney (CCSK) With BCOR-CCNB3 Fusion: A Rare Case Report With a Brief Review of the Literature. Pediatr Dev Pathol 2022; 26:149-152. [PMID: 36533315 DOI: 10.1177/10935266221124377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Pediatric renal tumors are a rare entity and majority of these tumors are accounted for by Wilms tumor. The second most common renal tumor is clear cell sarcoma of the kidney (CSSK). Most of the CSSK have either BCOR-internal tandem duplication (ITD) or YWHAE-NUTM2B/E fusion. The sarcomas with BCOR-CCNB3 fusion are well documented in soft tissue and bone tumors, but are extremely rare in the pediatric renal setting. We are reporting an extremely rare case of pediatric clear cell sarcoma of the kidney (CSSK) with BCOR-CCNB3 fusion, which was a diagnostic challenge on morphological grounds. A final diagnosis could only be reached after multiple reviews and NGS based RNA fusion testing. We have also performed a brief review of literature which revealed eight (8) other cases of this rare entity.
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Affiliation(s)
- Pranav Dorwal
- Department of Anatomical Pathology, Monash Health, Clayton, VIC, Australia.,Department of Diagnostic Genomics, Monash Health, Clayton, VIC, Australia.,School of Clinical Sciences, Faculty of Medicine, Nursing and Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - Claire Abou-Seif
- Department of Anatomical Pathology, Monash Health, Clayton, VIC, Australia
| | - Jessica Ng
- Department of Anatomical Pathology, The Royal Children's Hospital, Parkville, VIC, Australia
| | - Leanne Super
- Department of Paediatrics, Monash Children's Hospital, Clayton, VIC, Australia.,Department of Paediatrics, Monash University, Clayton, VIC, Australia
| | - Yuen Chan
- Department of Anatomical Pathology, Monash Health, Clayton, VIC, Australia
| | - Vivek Rathi
- Department of Diagnostic Genomics, Monash Health, Clayton, VIC, Australia.,School of Clinical Sciences, Faculty of Medicine, Nursing and Clinical Sciences, Monash University, Clayton, VIC, Australia
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Liu NQ, Cao WH, Wang X, Chen J, Nie J. Cyclin genes as potential novel prognostic biomarkers and therapeutic targets in breast cancer. Oncol Lett 2022; 24:374. [PMID: 36238849 PMCID: PMC9494629 DOI: 10.3892/ol.2022.13494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 08/15/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Nian-Qiu Liu
- Department of Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Center, Kunming, Yunnan 650000, P.R. China
| | - Wei-Han Cao
- Department of Ultrasound, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650000, P.R. China
| | - Xing Wang
- Department of Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Center, Kunming, Yunnan 650000, P.R. China
| | - Junyao Chen
- Department of Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Center, Kunming, Yunnan 650000, P.R. China
| | - Jianyun Nie
- Department of Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Center, Kunming, Yunnan 650000, P.R. China
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Whittle SB, Fetzko S, Roy A, Venkatramani R. Soft Tissue and Visceral Organ Sarcomas With BCOR Alterations. J Pediatr Hematol Oncol 2022; 44:195-200. [PMID: 35537005 PMCID: PMC10026688 DOI: 10.1097/mph.0000000000002480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/06/2022] [Indexed: 11/26/2022]
Abstract
Sarcomas with BCOR alteration are a heterogenous group characterized by changes including internal tandem duplications (ITDs) and recurring fusions with CCNB3, ZC3H7B, and other rare partners. With widespread genomic testing, these alterations are now associated with histologies such as Ewing-like sarcoma (BCOR::CCNB3), high-grade endometrial stromal sarcoma (ZC3H7B::BCOR), and clear cell sarcoma of kidney (BCOR-ITD). BCOR altered sarcomas of soft tissues and organs were identified through PubMed using keywords "Sarcoma (AND) BCOR" from 2005 through October 2021. Summary statistics and outcome data were calculated using STATA v12.1. Forty-one publications described 190 patients with BCOR altered soft tissue or organ sarcomas. BCOR-ITD was most common, followed by BCOR::CCNB3, ZC3H7B::BCOR. BCOR-ITD tumors occurred mainly in infants, BCOR::CCNB3 commonly occurred in adolescent young adults, and ZC3H7B::BCOR only in adults. The most common site for BCOR::CCNB3 fused tumors was extremity, BCOR-ITD kidney and ZC3H7B::BCOR uterus. Metastasis was rare in patients with BCOR::CCNB3. While most underwent resection and chemotherapy, few received radiation. Median follow-up of survivors was 24 months. Five year overall survival for patients with BCOR::CCNB3 fusions was 68% (95% confidence interval [CI]: 46%-83%). Patients with BCOR-ITD and ZC3H7B::BCOR had worse prognoses with 5 years overall survival of 35% (95% CI: 15%-56%) and 41% (95% CI: 11%-71%), respectively, demonstrating need for collaborative efforts identifying optimal treatments to improve outcomes.
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Affiliation(s)
- Sarah B. Whittle
- Department of Pediatrics, Texas Children’s Hospital, Houston, TX
- Texas Children’s Cancer and Hematology Centers, Texas Children’s Hospital, Houston, TX
| | - Stephanie Fetzko
- Department of Pediatrics, Texas Children’s Hospital, Houston, TX
- Texas Children’s Cancer and Hematology Centers, Texas Children’s Hospital, Houston, TX
| | - Angshumoy Roy
- Departments of Pathology and Immunology, Texas Children’s Hospital, Houston, TX
| | - Rajkumar Venkatramani
- Department of Pediatrics, Texas Children’s Hospital, Houston, TX
- Texas Children’s Cancer and Hematology Centers, Texas Children’s Hospital, Houston, TX
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6
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Zhao M, Zhang Q, He X, Zhang D. Primary Renal BCOR-CCNB3 Fusion Sarcoma: A Case Report and Review of the Literature. Urol Int 2021; 106:644-648. [PMID: 34515251 DOI: 10.1159/000518563] [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: 05/25/2021] [Accepted: 07/08/2021] [Indexed: 11/19/2022]
Abstract
BCOR-CCNB3 fusion sarcoma is a recently described undifferentiated sarcoma with a novel recurrent inversion of 2 nearby genes BCOR and CCNB3. It typically affects bone and soft tissues of the pelvis, extremity, and paraspinal region and pursues variable clinical course. Primary renal BCOR-CCNB3 fusion sarcoma is very rare, and only a small number of cases have been documented. Accurate diagnosis is often challenging, and there is not any agreement for the treatment of this entity due to its rarity. We report findings of primary renal BCOR-CCNB3 fusion sarcoma in a 16-year-old boy with a brief review of the literature.
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Affiliation(s)
- Ming Zhao
- Department of Pathology, Laboratory Medicine Center, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Qi Zhang
- Department of Urology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Xianglei He
- Department of Pathology, Laboratory Medicine Center, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Dahong Zhang
- Department of Urology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
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7
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Kyriazoglou A, Bagos P. Meta-analysis of BCOR rearranged sarcomas: challenging the therapeutic approach. Acta Oncol 2021; 60:721-726. [PMID: 33630701 DOI: 10.1080/0284186x.2021.1890818] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION BCOR rearranged sarcomas comprise a group of malignant mesenchymal tumors that until recently were classified as Ewing sarcomas or as undifferentiated round cell sarcomas. The identification of alterations involving BCOR gene such as BCOR-CCNB3, BCOR-MAML3, ZC3H7B-BCOR fusion genes and BCOR internal tandem duplication (ITD) is characteristic for the differential diagnosis of BCOR rearranged sarcomas. Due to the rarity of these tumors there is no consensus or guidelines regarding the optimal therapeutic algorithm, that clinicians should follow. PATIENTS AND METHODS Herein we have conducted a meta-analysis of the current reports dealing with the therapeutic approach of BCOR rearranged sarcomas. RESULTS Meta-analysis of the 57 eligible cases from 10 studies resulted to similar Incidence Rate Ratio (IRR) and overall survival (OS) for patients who received Ewing protocols and non-Ewing oriented treatment. Further similar death rate was reported for both strategies (non-Ewing 20% Vs Ewing 21.8%). CONCLUSION Our data support that non-Ewing treatment strategy can be considered a safe option, being at least equal to Ewing protocols. The current study provides a hint toward the optimal therapeutic approach of BCOR rearranged sarcomas. Further, the present study challenges the use of the term Ewing-like sarcomas, since the current literature supports that BCOR rearranged sarcomas deserve their own distinct classification in terms of genetics, pathology and therapy.
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Affiliation(s)
- Anastasios Kyriazoglou
- Second Propaedeutic Department of Medicine, Attikon University Hospital, Chaidari, Athens, Greece
| | - Pantelis Bagos
- Department of Computer Science and Biomedical Informatics, University of Thessaly, Lamia, Greece
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Setoodeh S, Palsgrove DN, Park JY, Pedrosa I, Kapur P, Jia L. Primary Renal Sarcoma With BCOR-CCNB3 Gene Fusion in an 18-Year-Old Male: A Rare Lesion With a Diagnostic Quandary. Int J Surg Pathol 2020; 29:194-197. [PMID: 32648496 DOI: 10.1177/1066896920941087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Primary renal sarcoma with BCOR-CCNB3 gene fusion is a rare tumor with only 7 cases reported in the English literature. The morphologic features of this tumor strikingly overlap with clear cell sarcoma of the kidney and synovial sarcoma. Accurate diagnosis can be challenging. In this article, we report a case of an 18-year-old male who presented with hematuria. Subsequent imaging study showed a left renal mass with level II (infra-hepatic) inferior vena cava thrombus, which was resected. Detailed pathologic findings and immunohistochemical and molecular studies revealed an ovoid to spindle cell renal mass with a BCOR-CCNB3 gene fusion.
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Affiliation(s)
- Sasan Setoodeh
- Department of Pathology, 89063UT Southwestern Medical Center, Dallas TX, USA
| | - Doreen N Palsgrove
- Department of Pathology, 89063UT Southwestern Medical Center, Dallas TX, USA
| | - Jason Y Park
- Department of Pathology, 89063UT Southwestern Medical Center, Dallas TX, USA
| | - Ivan Pedrosa
- Department of Radiology, UT Southwestern Medical Center, Dallas TX, USA
| | - Payal Kapur
- Department of Pathology, 89063UT Southwestern Medical Center, Dallas TX, USA
| | - Liwei Jia
- Department of Pathology, 89063UT Southwestern Medical Center, Dallas TX, USA
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