1
|
Chen CC, Wu YY, Kao JT, Chang CH, Huang SC, Shih HN. Impact of resection margin on outcome in soft-tissue sarcomas of the extremities treated with limb-sparing surgery and postoperative radiotherapy. World J Surg Oncol 2024; 22:113. [PMID: 38664776 PMCID: PMC11046795 DOI: 10.1186/s12957-024-03380-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 04/06/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The standard curative treatments for extremity soft tissue sarcoma (ESTS) include surgical resection with negative margins and perioperative radiotherapy. However, the optimal resection margin remains controversial. This study aimed to evaluate the outcomes in ESTS between microscopically positive margin (R1) and microscopically negative margin (R0) according to the Union for International Cancer Control (UICC) (R + 1 mm) classification. METHODS Medical records of patients with localized ESTS who underwent primary limb-sparing surgery and postoperative radiotherapy between 2004 and 2015 were retrospectively reviewed. Patients were followed for at least 5 years or till local or distant recurrence was diagnosed during follow-up. Outcomes were local and distal recurrences and survival. RESULTS A total of 52 patients were included in this study, in which 17 underwent R0 resection and 35 underwent R1 resection. No significant differences were observed in rates of local recurrence (11.4% vs. 35.3%, p = 0.062) or distant recurrence (40.0% vs. 41.18%, p = 0.935) between R0 and R1 groups. Multivariate analysis showed that distant recurrences was associated with a Fédération Nationale des Centres de Lutte Contre le Cancer (FNCLCC) grade (Grade III vs. I, adjusted hazard ratio (aHR): 12.53, 95% confidence interval (CI): 2.67-58.88, p = 0.001) and tumor location (lower vs. upper extremity, aHR: 0.23, 95% CI: 0.07-0.7, p = 0.01). Kaplan-Meier plots showed no significant differences in local (p = 0.444) or distant recurrent-free survival (p = 0.161) between R0 and R1 groups. CONCLUSIONS R1 margins, when complemented by radiotherapy, did not significantly alter outcomes of ESTS as R0 margins. Further studies with more histopathological types and larger cohorts are necessary to highlight the path forward.
Collapse
Affiliation(s)
- Chun-Chieh Chen
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing Street, Guishan District, Taoyuan City, 333, Taiwan.
- College of Medicine, Chang Gung University, No. 259, Wenhua 1 Road, Guishan District, Taoyuan City, 333, Taiwan.
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing Street, Guishan District, Taoyuan City, 333, Taiwan.
| | - Yao-Yu Wu
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Keelung, No. 222, Maijin Rd., Anle Dist, Keelung City, 204, Taiwan
- College of Medicine, Chang Gung University, No. 259, Wenhua 1 Road, Guishan District, Taoyuan City, 333, Taiwan
| | - Jo-Ting Kao
- Hejiang Orthopedic Clinic, No. 200, Zhongzheng E. Rd., Zhubei City, Hsinchu County, 302, Taiwan
| | - Chih-Hsiang Chang
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing Street, Guishan District, Taoyuan City, 333, Taiwan
- College of Medicine, Chang Gung University, No. 259, Wenhua 1 Road, Guishan District, Taoyuan City, 333, Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing Street, Guishan District, Taoyuan City, 333, Taiwan
| | - Shih-Chiang Huang
- Department of Anatomic Pathology, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing Street, Guishan District, Taoyuan City, 333, Taiwan
- College of Medicine, Chang Gung University, No. 259, Wenhua 1 Road, Guishan District, Taoyuan City, 333, Taiwan
| | - Hsin-Nung Shih
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing Street, Guishan District, Taoyuan City, 333, Taiwan
- College of Medicine, Chang Gung University, No. 259, Wenhua 1 Road, Guishan District, Taoyuan City, 333, Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing Street, Guishan District, Taoyuan City, 333, Taiwan
| |
Collapse
|
2
|
Ji Q, Hu H, Li S, Tang J. A novel nomogram and recursive partitioning analysis for predicting cancer-specific survival of patients with subcutaneous leiomyosarcoma. Sci Rep 2024; 14:2861. [PMID: 38311615 PMCID: PMC10838934 DOI: 10.1038/s41598-024-53288-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 01/30/2024] [Indexed: 02/06/2024] Open
Abstract
Accurately predicting prognosis subcutaneous leiomyosarcoma (LMS) is crucial for guiding treatment decisions in patients. The objective of this study was to develop prediction models for cancer-specific survival (CSS) in patients with subcutaneous LMS. The collected cases of diagnosed subcutaneous LMS were randomly divided into a training cohort and a validation cohort at a 6:4 ratio based on tumor location and histological code. The X-tile program was utilized to determine the optimal cutoff points for age index. Univariate and Cox multivariate regression analyses were conducted to identify independent risk factors for subcutaneous LMS patients. Nomograms were constructed to predict CSS, and their performance was assessed using C-index and calibration plots. Additionally, a decision tree model was established using recursive partitioning analysis to determine the total score for CSS prediction in subcutaneous LMS patients based on the nomogram model. A total of 1793 patients with subcutaneous LMS were found. X-tile software divides all patients into ≤ 61 years old, 61-82 years old, and ≥ 82 years old. The most important anatomical sites were the limbs (including the upper and lower limbs, 48.0%). Only 6.2% of patients received chemotherapy, while 44% had a history of radiotherapy and 92.9% underwent surgery. The independent risk factors for patients with subcutaneous LMS were age, summary stage, grade, and surgery. CSS was significantly decreased in patients with distant metastases, which showed the highest independent risk predictor (HR 4.325, 95% CI 3.010-6.214, p < 0.001). The nomogram prediction model of LMS was constructed based on four risk factors. The C-index for this model was 0.802 [95% CI 0.781-0.823] and 0.798 [95% CI 0.768-0.829]. The training cohort's 3-, 5-, and 10-year AUCs for CSS in patients with subcutaneous LMS were 0.833, 0.830, and 0.859, and the validation cohort's AUC for predicting CSS rate were 0.849, 0.830, and 0.803, respectively. Recursive segmentation analysis divided patients into 4 risk subgroups according to the total score in the nomogram, including low-risk group < 145, intermediate-low-risk group ≥ 145 < 176, intermediate-high-risk group ≥ 176 < 196, and high-risk group ≥ 196; The probability of the four risk subgroups is 9.1%, 34%, 49%, and 79% respectively. In this retrospective study, a novel nomogram or corresponding risk classification system for patients with subcutaneous LMS were developed, which may assist clinicians in identifying high-risk patients and in guiding the clinical decision.
Collapse
Affiliation(s)
- Qiang Ji
- Department of Aesthetic Plastic Surgery, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, China
| | - Hua Hu
- Department of Burn and Plastic Surgery, West China Hospital, Sichuan University, Guoxue Alley, Wuhou District, Chengdu, 610041, China
| | - Shulian Li
- Department of Thyroid Surgery, West China Hospital, Sichuan University, Guoxue Alley, Wuhou District, Chengdu, 610041, China
| | - Jun Tang
- Department of Thyroid Surgery, West China Hospital, Sichuan University, Guoxue Alley, Wuhou District, Chengdu, 610041, China.
| |
Collapse
|
3
|
Wei J, Liu L, Li Z, Ren Z, Zhang C, Cao H, Fen Z. A web-based nomogram to predict overall survival for postresection leiomyosarcoma patients with lung metastasis. Medicine (Baltimore) 2023; 102:e35478. [PMID: 37800795 PMCID: PMC10553185 DOI: 10.1097/md.0000000000035478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/13/2023] [Indexed: 10/07/2023] Open
Abstract
To investigate the overall survival of post-resection leiomyosarcoma (LMS) patients with lung metastasis, data of post-resection LMS patients with lung metastasis between 2010 and 2016 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. The clinical characteristics and survival data for post-resection LMS patients with lung metastasis at Tianjin Medical University Cancer Hospital & Institute (TJMUCH) between October 2010 and July 2018 were collected. Patients derived from the SEER database and TJMUCH were divided into training and validation cohorts, respectively. Univariate and multivariate Cox regression analyses were performed and a nomogram was established. The area under the curve (AUC) and the calibration curve were used to evaluate the nomogram. A web-based nomogram was developed based on the established nomogram. Eventually, 226 patients from the SEER database who were diagnosed with LMS and underwent primary lesion resection combined with lung metastasis were enrolled in the training cohort, and 17 patients from TJMUCH were enrolled in the validation cohort. Sex, race, grade, tumor size, chemotherapy, and bone metastasis were correlated with overall survival in patients with LMS. The C-index were 0.65 and 0.75 in the SEER and Chinese set, respectively. Furthermore, the applicable AUC values of the ROC curve in the SEER cohort to predict the 1-, 3-, 5- years survival rate were 0.646, 0.682, and 0.689, respectively. The corresponding AUC values in the Chinese cohort were 0.970, 0.913, and 0.881, respectively. The calibration curve showed that the nomogram performed well in predicting the overall survival in post-resection LMS patients with lung metastasis. A web-based nomogram (https://weijunqiang.shinyapps.io/survival_lms_lungmet/) was established. The web-based nomogram (https://weijunqiang.shinyapps.io/survival_lms_lungmet/) is an accurate and personalized tool for predicting the overall survival of post-resection LMS with lung metastasis.
Collapse
Affiliation(s)
- Junqiang Wei
- Department of Orthopedics, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Lirui Liu
- Department of Neonatology, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Zhehong Li
- Department of Orthopedics, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Zhiwu Ren
- Department of bone and soft tissue tumor, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin’s Medical University Cancer Institute and Hospital, Tianjin, China
| | - Chao Zhang
- Department of bone and soft tissue tumor, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin’s Medical University Cancer Institute and Hospital, Tianjin, China
| | - Haiying Cao
- Department of Orthopedics, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Zhen Fen
- Department of Orthopedics, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| |
Collapse
|
4
|
Wei J, Liu L, Li Z, Ren Z, Zhang C, Cao H, Fen Z, Jin Y. Web-based nomogram to predict postresection risk of distant metastasis in patients with leiomyosarcoma: retrospective analysis of the SEER database and a Chinese cohort. J Int Med Res 2023; 51:3000605231188647. [PMID: 37523501 PMCID: PMC10392527 DOI: 10.1177/03000605231188647] [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: 08/02/2023] Open
Abstract
OBJECTIVES This study investigated risk factors and constructed an online tool to predict distant metastasis (DM) risk in patients with leiomyosarcoma (LMS) after surgical resection. METHODS Data regarding patients with LMS who underwent surgical resection between 2010 and 2018 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Data were collected regarding patients with LMS who underwent surgical resection at Tianjin Medical University Cancer Hospital and Institute (TJMUCH) between October 2010 and July 2018. Patients were randomly divided into training and validation sets. Logistic regression analyses were performed; a nomogram was established. The area under the curve (AUC) and calibration curve were used to evaluate the nomogram, which served as the basis for a web-based nomogram. RESULTS This study included 4461 and 76 patients from the SEER database and TJMUCH, respectively. Age, ethnicity, grade, T stage, N stage, radiotherapy, and chemotherapy were associated with DM incidence. C-index values were 0.815 and 0.782 in the SEER and Chinese datasets, respectively; corresponding AUC values were 0.814 and 0.773, respectively. A web-based nomogram (https://weijunqiang-leimyosarcoma-seer.shinyapps.io/dynnomapp/) was established. CONCLUSIONS Our web-based nomogram is an accurate and user-friendly tool to predict DM risk in patients with LMS; it can aid clinical decision-making.
Collapse
Affiliation(s)
- Junqiang Wei
- Department of Orthopedics, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Lirui Liu
- Department of Neonatology, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Zhehong Li
- Department of Orthopedics, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Zhiwu Ren
- Department of Bone and Soft Tissue Tumor, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin's Medical University Cancer Institute and Hospital, Tianjin, China
| | - Chao Zhang
- Department of Bone and Soft Tissue Tumor, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin's Medical University Cancer Institute and Hospital, Tianjin, China
| | - Haiying Cao
- Department of Orthopedics, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Zhen Fen
- Department of Orthopedics, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Yu Jin
- Department of Orthopedics, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| |
Collapse
|
5
|
Souza F, Cardoso FN, Cortes C, Rosenberg A, Subhawong TK. Soft Tissue Tumors. Radiol Clin North Am 2022; 60:283-299. [DOI: 10.1016/j.rcl.2021.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
6
|
Magnetic resonance imaging of soft tissue sarcoma: features related to prognosis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:1567-1575. [PMID: 34052920 DOI: 10.1007/s00590-021-03003-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/11/2021] [Indexed: 01/03/2023]
Abstract
Magnetic Resonance Imaging is a fundamental tool in the evaluation of soft tissue sarcoma. Imaging features are relevant for the assessment of treatment strategies, surgical planning and also for patients' prognosis prediction. Among soft tissue sarcoma and also other malignancies, the size of the mass is usually considered the prognostic key element in diagnostic imaging. Moreover, several other features should be obtained from MRI studies with prognostic implications in all type of soft tissue sarcoma: peritumoral enhancement, signs of necrosis, deep location, ill-defined borders/signs of infiltrations. Focusing on soft tissue sarcoma subtypes, some other magnetic resonance imaging features are more specific and related to prognosis. In myxofibrosarcoma the magnetic resonance imaging "tail sign" and a "water-like" appearance on fluid-sensitive sequences, due to rich myxoid matrix content, are both associated with higher risk of local recurrence after surgical excision; nevertheless, the "tail sign" is also related to a higher risk of distant metastases at diagnosis. The "tail sign" is associated with higher risk of local recurrence after surgical excision in undifferentiated pleomorphic sarcoma as well. In patients affected by synovial sarcoma, the "triple sign" identifiable in magnetic resonance imaging (T2w sequences) is associated with decreased disease-free survival and indicates the simultaneous presence of solid cellular elements (intermediate signal intensity), hemorrhage or necrosis (high signal intensity) and fibrotic regions (low signal intensity). In addition, absence of calcifications are associated with reduced disease-free survival in patients affected by synovial sarcoma. Signal heterogeneity is associated with worst prognosis in all type of soft tissue sarcoma, particularly in myxoid liposarcoma. In recent years, several new quantitative tools applied on magnetic resonance imaging have been proved to predict patients' prognosis. Above all the new tools, radiomics seems to be one of the most promising, and, has been proved to have the capability in discriminating low-grade from high-grade soft tissue sarcomas. Therefore, magnetic resonance imaging studies in patients with soft tissue sarcoma should be accurately evaluated and their results should be taken into account for prognostic assessment.
Collapse
|
7
|
Coiner BL, Cates J, Kamanda S, Giannico GA, Gordetsky JB. Leiomyosarcoma of the urinary bladder: A SEER database study and comparison to leiomyosarcomas of the uterus and extremities/trunk. Ann Diagn Pathol 2021; 53:151743. [PMID: 33964611 DOI: 10.1016/j.anndiagpath.2021.151743] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 12/12/2022]
Abstract
No well-established staging system exists for bladder leiomyosarcoma (LMS), and the current staging system does not include tumor size, a thoroughly validated prognostic parameter for sarcomas. Uterine and extremity/trunk LMS are more common than those in the bladder and have well-established staging systems incorporating tumor size. We aim to improve the understanding of LMS of the urinary bladder by assessing cancer-specific survival (CSS) and comparing LMS at this unusual anatomic site to those arising at other sites using the Surveillance, Epidemiology, and End Results (SEER) database. The SEER database (1973-2013) was queried for bladder, uterus, and trunk/extremity LMS. Multivariable Cox proportional hazard regression was performed to identify predictors of CSS for each anatomic location and used to compare outcomes at different sites. We identified 165 bladder, 4987 uterus, and 2536 extremity/trunk LMS cases. Five-year CSS was 52% for uterus, 73% for bladder, and 82% for extremity/trunk LMS. For LMS at all sites, uterine location (HR = 2.14, P < 0.001) and increasing tumor size (HR = 1.05, P < 0.001) were significant predictors of worse CSS on multivariate analysis. For bladder LMS, increasing tumor size (HR = 1.18, P = 0.003) was an independent prognostic factor and the conventional staging cut-off threshold of 5 cm for sarcomas outside the head/neck showed statistical significance in stratifying patient risk of cancer-related death. Bladder LMS appears to have clinical behavior intermediate between those of the extremities/trunk and uterus. We suggest that the conventional sarcoma staging protocols based on tumor size be applied to LMS of the urinary bladder.
Collapse
Affiliation(s)
| | - Justin Cates
- Department of Pathology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sonia Kamanda
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Giovanna A Giannico
- Department of Pathology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jennifer B Gordetsky
- Department of Pathology, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA.
| |
Collapse
|
8
|
Gusho CA, Blank AT, Gitelis S. Comparison of clinicopathological features and outcomes in patients with primary leiomyosarcoma of bone and soft tissue. J Surg Oncol 2021; 123:1274-1283. [PMID: 33524203 DOI: 10.1002/jso.26404] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/06/2021] [Accepted: 01/18/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUNDS AND OBJECTIVES This investigation sought to describe the outcomes of primary leiomyosarcoma of bone (PLB) compared to soft tissue leiomyosarcoma (SLMS). METHODS This was a review of the Surveillance, Epidemiology, and End Results database from 1975 to 2016. Kaplan-Meier methods were used to estimate disease-specific survival (DSS), and a Cox regression model was used to identify prognostic factors. RESULTS Of the 7502 identifiable cases, 1% (n = 74) were PLB and 99% (n = 7428) were SLMS. Survival was the same between PLB and SLMS (p = .209). On multivariable analysis for high-grade SLMS, radiation (neoadjuvant: hazard ratio [HR], 0.56; 95% confidence interval [CI], 0.4-0.8; p = .003; adjuvant: HR, 0.75; 95% CI, 0.6-0.9; p = .008) and surgery (procedure specific) improved DSS. For PLB, wide resection/limb salvage (HR, 0.40; 95% CI, 0.3-0.5; p = .018) and amputation (HR, 0.69; 95% CI, 0.5-0.9; p < .001) were positive prognostic factors. Neither radiation nor chemotherapy were prognostic factors for survival in PLB. CONCLUSIONS For SLMS, radiation portends a survival advantage. For PLB, however, neither chemotherapy nor radiation were significant prognostic factors, which suggests the optimal treatment for PLB, similar to other primary soft tissue sarcomas originating in bone, remains an unmet medical need.
Collapse
Affiliation(s)
- Charles A Gusho
- Department of Orthopedic Surgery, Section of Orthopedic Oncology, Rush University Medical Center, Chicago, Illinois, USA
| | - Alan T Blank
- Department of Orthopedic Surgery, Section of Orthopedic Oncology, Rush University Medical Center, Chicago, Illinois, USA
| | - Steven Gitelis
- Department of Orthopedic Surgery, Section of Orthopedic Oncology, Rush University Medical Center, Chicago, Illinois, USA
| |
Collapse
|
9
|
Rath B, Hardes J, Tingart M, Braunschweig T, Eschweiler J, Migliorini F. [Resection margins in soft tissue sarcomas]. DER ORTHOPADE 2019; 48:768-775. [PMID: 31463543 DOI: 10.1007/s00132-019-03795-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Soft tissue sarcomas (STS) are a rare and heterogeneous group of malignant tumors that arise from the mesenchymal tissue. STS can form anywhere in the human body, with the extremities being preferred sites of predilection. TREATMENT A fundamental pillar of treatment is the surgical resection of soft tissue sarcomas. The goal is always an R0 resection with a safety margin. There is no consensus in the literature about the desired tumor-free resection margin. The decisive factors for these resection margins are histopathology, presence of anatomical barriers (capsule, tendon, fascia, cartilage, periosteum) and possibilities of (neo-) adjuvant therapy. DISCUSSION References in the literature support the role of resection margins as a predictor of local recurrence. Regarding the role of resection margins in overall survival, available data is divergent. There are known prognostic factors that influence overall survival, such as histological subtype, tumor size, tumor grading, and presence of metastases. So far, several studies have attempted to quantify the margins of resection, but no consensus has been reached, and debates are ongoing. When analyzing all the results of the data in the literature, it seems appropriate to aim for a negative resection margin >1 mm including an anatomical border structure, if possible.
Collapse
Affiliation(s)
- B Rath
- Klinik für Orthopädie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland.
| | - J Hardes
- Abteilung für Tumororthopädie und Sarkomchirurgie, Westdeutsches Tumorzentrum, Universitätsklinikum Essen, Essen, Deutschland
| | - M Tingart
- Klinik für Orthopädie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
| | - T Braunschweig
- Institut für Pathologie, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - J Eschweiler
- Klinik für Orthopädie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
| | - F Migliorini
- Klinik für Orthopädie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
| |
Collapse
|
10
|
Wang W, Hong J, Meng J, Wu H, Shi M, Yan S, Huang Y. Nomograms Predict Cancer-Specific and Overall Survival of Patients With Primary Limb Leiomyosarcoma. J Orthop Res 2019; 37:1649-1657. [PMID: 30977539 DOI: 10.1002/jor.24298] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 03/27/2019] [Indexed: 02/04/2023]
Abstract
To date, there have been no data to predict the survival of patients with leiomyosarcoma from soft limb tissue because of the rarity of this disease. Nomograms have been widely applied in clinical oncology to precisely predict the survival of individual patients. This was a retrospective study to construct and validate nomograms to predict the cancer-specific survival (CSS) and overall survival (OS) of patients with primary limb leiomyosarcoma (PL-LMS). A total of 1,208 patients with LMS from limb soft tissue were collected from the Surveillance, Epidemiology, and End Results database from 1975 to 2015. We identified independent prognostic factors using univariate and multivariate Cox analyses. These prognostic factors were then included in the nomograms to predict 3- and 5-year CSS and OS rates. Finally, we validated the nomograms internally and externally. A total of 1208 patients were collected and divided into validation (N = 604) and training (N = 604) groups. Age, race, grade, tumor size, stage, and surgical types were demonstrated as independent prognostic factors for CSS and OS (all p < 0.05) and further used to construct the nomograms. The concordance index (C-index) for CSS was 0.857 for internal validation and 0.727 for external validation. The C-index for OS and CSS both demonstrated that the nomogram prediction agreed perfectly with actual survival. We developed nomograms to predict CSS and OS in PL-LMS patients and can benefit from using them to identify patients' mortality risk and make more precise assessments regarding survival. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1649-1657, 2019.
Collapse
Affiliation(s)
- Wei Wang
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, P. R. China
| | - Jianqiao Hong
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, P. R. China
| | - Jiahong Meng
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, P. R. China
| | - Haobo Wu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, P. R. China
| | - Mingmin Shi
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, P. R. China
| | - Shigui Yan
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, P. R. China
| | - Yiting Huang
- Division of Reproductive Medicine & Infertility, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, P. R. China
| |
Collapse
|
11
|
Muratori F, Greto D, Cenatiempo M, Mazzei G, Frenos F, Roselli G, Livi L, Capanna R, Baldi G, Campanacci DA. Leiomyosarcoma: Clinicopathological study and retrospective analysis of prognostic factors in a series of 100 patients. J Orthop 2019; 16:303-307. [PMID: 30976144 DOI: 10.1016/j.jor.2019.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 03/01/2019] [Indexed: 12/01/2022] Open
Abstract
The Authors reported a retrospective study of 100 Leiomyosarcoma (LMS), evaluating factors that may influence Overall Survival (OS), Local Recurrence Free Survival (LRFS), Metastasis Free Survival (MFS). Tumor Size (P = 0,0009), Local Recurrence (P = 0,0487), Distant relapse (P < 0,0001), Type of Presentation (P = 0,0213) were significant risk factors affecting overall survival (OS). Tumor Size (P = 0.024), age at diagnosis (P = 0,0086), type of presentation (P < 0,0001) and Local Recurrence (P = 0.0152) affected metastasis free survival (MFS). Type of presentation (P = 0,001) was an independent prognostic factor of local recurrence-free survival (LRFS).
Collapse
Affiliation(s)
- Francesco Muratori
- Divisione di Ortopedia Oncologica e Ricostruttiva Azienda Ospedaliero Universitaria Careggi Firenze, Italy
| | - Daniela Greto
- Unità di Radioterapia Azienda Ospedaliero Universitaria Careggi Firenze, Italy
| | - Mauro Cenatiempo
- Divisione di Ortopedia Oncologica e Ricostruttiva Azienda Ospedaliero Universitaria Careggi Firenze, Italy
| | - Giacomo Mazzei
- Divisione di Ortopedia Oncologica e Ricostruttiva Azienda Ospedaliero Universitaria Careggi Firenze, Italy
| | - Filippo Frenos
- Divisione di Ortopedia Oncologica e Ricostruttiva Azienda Ospedaliero Universitaria Careggi Firenze, Italy
| | - Giuliana Roselli
- Divisione di Radiologia Azienda Ospedaliero Universitaria Careggi Firenze, Italy
| | - Lorenzo Livi
- Unità di Radioterapia Azienda Ospedaliero Universitaria Careggi Firenze, Italy
| | | | | | - Domenico Andrea Campanacci
- Divisione di Ortopedia Oncologica e Ricostruttiva Azienda Ospedaliero Universitaria Careggi Firenze, Italy
| |
Collapse
|
12
|
Qian SJ, Wu JQ, Wang Z, Zhang B. Surgery plus chemotherapy improves survival of patients with extremity soft tissue leiomyosarcoma and metastasis at presentation. J Cancer 2019; 10:2169-2175. [PMID: 31258720 PMCID: PMC6584406 DOI: 10.7150/jca.29874] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 04/07/2019] [Indexed: 11/05/2022] Open
Abstract
Purpose: Extremity soft tissue leiomyosarcoma (LMS) with metastasis is a rare disease with a poor prognosis. The purpose of our study was to define clinical features of extremity soft tissue LMS with metastasis as well as to identify multivariable predictors of survival. Methods: During 1973-2015, 239 patients with metastatic extremity soft tissue LMS were identified from the Surveillance, Epidemiology, and End Results (SEER) program database. The prognostic analysis was performed using the Kaplan-Meier method and a Cox proportional hazards regression model. Results: This group comprised 126 females (52.7%) and 113 males (47.3%), whose ages ranged from 8 to 95 years (median 67 years). The overall survival (OS) and cancer-specific survival (CSS) rates of the entire group at 3 years were 22.6% and 23.4%, respectively. The median OS and CSS were 14.0±1.5 and 15.0±2.3 months, respectively. Multivariate analysis revealed that tumor size >10 cm, no surgery and no chemotherapy were independent risk factors of decreased OS and CSS. Radiotherapy was not significantly associated with OS or CSS. Conclusion: Extremity soft tissue LMS patients who present with metastasis at diagnosis had a poor prognosis. Patients who performed surgery for primary tumors and chemotherapy had a better chance for prolonged survival.
Collapse
Affiliation(s)
- Sheng-Jun Qian
- Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, Department of Orthopaedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, Zhejiang 310000, P.R. China
| | - Jia-Qi Wu
- Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, Department of Orthopaedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, Zhejiang 310000, P.R. China
| | - Zhan Wang
- Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, Department of Orthopaedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, Zhejiang 310000, P.R. China
| | - Bo Zhang
- Department of Orthopedics, Ningbo No.2 Hospital, 41 North West Street, Ningbo, Zhejiang 315010, P.R. China
| |
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
Mestiri S, Elghali MA, Bourigua R, Abdessayed N, Nasri S, Amine BA, Missaoui N, Ben Maitig M, Hmissa S, Sriha B, Mokni M. Soft tissue leiomyosarcoma-diagnostics, management, and prognosis: Data of the registry cancer of the center of Tunisia. Rare Tumors 2019; 11:2036361318820171. [PMID: 30719261 PMCID: PMC6348570 DOI: 10.1177/2036361318820171] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 11/27/2018] [Indexed: 11/29/2022] Open
Abstract
Background: Soft tissue leiomyosarcomas are rare, accounting for almost 5%–10% of all soft tissue sarcomas; they account for almost 1% of all sarcomas. They are aggressive tumors where location, size, and management require a multidisciplinary approach. Since there are few series published, we here analyze epidemiological pattern, clinical and pathologic features of soft tissue leiomyosarcomas. Methods: We conducted a retrospective study of 29 consecutive cases of histologically proven soft tissue leiomyosarcoma extracted from the database of the Cancer Registry of the Center of Tunisia and the Department of Pathology of Farhat Hached University Hospital of Sousse of Tunisia, during a 10-year period (from January 1996 to December 2005). Epidemiologic details, clinico-pathological features, and treatment modalities were assessed with focus on patients’ 5-year overall survival, tumor relapse, and metastases. Results: Soft tissue leiomyosarcoma accounted for 17.5% of all soft tissue sarcomas diagnosed at our pathology department. Most of patients were of advanced age (median: 52 years), with extremes ranging from 12 and 87 years. There was a slight male predominance (sex-ratio = 1.07). Tumors were located mostly in the lower limbs (45%). Deep sites as retroperitoneum was found only in two cases. Tumor size was more than 5 cm in 83% of cases (average size = 9.4 cm). Five cases had metastasis on initial staging. For 24 patients, the disease was locally limited at the moment of diagnosis. Palliative chemotherapy was indicated for four patients and surgery was performed for 20 patients. Local recurrence occurred in 11 patients (55% of operated patients) and metastasis in 6 patients. Overall, 5-year survival was about 24%. Conclusion: Our study results highlight the scarcity of soft tissue leiomyosarcoma. Unfortunately, unusual tumor sites, disease’s advanced stages, and intralesional resection made the prognosis poorer than in other series. Clinical course of soft tissue leiomyosarcoma was highly marked by local recurrence and metastasis.
Collapse
Affiliation(s)
- Sarra Mestiri
- Department of Pathology, Farhat Hached University Hospital, Sousse, Tunisia.,Cancer Registry of the Center of Tunisia, Sousse, Tunisia
| | | | - Rym Bourigua
- Department of Oncology, Farhat Hached University Hospital, Sousse, Tunisia
| | - Nihed Abdessayed
- Department of Pathology, Farhat Hached University Hospital, Sousse, Tunisia.,Department of Oncology, Farhat Hached University Hospital, Sousse, Tunisia
| | - Salsabil Nasri
- Department of General Surgery, Farhat Hached University Hospital, Sousse, Tunisia
| | - Ben Abdallah Amine
- Department of Pathology, Farhat Hached University Hospital, Sousse, Tunisia
| | - Nabiha Missaoui
- Department of Pathology, Farhat Hached University Hospital, Sousse, Tunisia.,Cancer Registry of the Center of Tunisia, Sousse, Tunisia
| | | | - Sihem Hmissa
- Department of Pathology, Farhat Hached University Hospital, Sousse, Tunisia.,Cancer Registry of the Center of Tunisia, Sousse, Tunisia.,Research Unit UR14ES17, Cancer Epidemiology and Cytopathology in Tunisian Center, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Badreddine Sriha
- Department of Pathology, Farhat Hached University Hospital, Sousse, Tunisia.,Cancer Registry of the Center of Tunisia, Sousse, Tunisia
| | - Moncef Mokni
- Department of Pathology, Farhat Hached University Hospital, Sousse, Tunisia.,Cancer Registry of the Center of Tunisia, Sousse, Tunisia
| |
Collapse
|
15
|
Harati K, Lehnhardt M. The changing paradigm of resection margins in sarcoma resection. Innov Surg Sci 2017; 2:165-170. [PMID: 31579750 PMCID: PMC6754025 DOI: 10.1515/iss-2017-0043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 11/20/2017] [Indexed: 11/15/2022] Open
Abstract
Soft tissue sarcomas (STS) are a heterogeneous group of rare mesenchymal tumors that account for approximately 1% of all adult malignancies. They can arise throughout the body due to their mesenchymal origin, although 60% of all STS occur in the extremities. Locally advanced STS can lead to significant functional morbidity and tend to local recurrences despite surgical resection. About 30% of all STS patients develop distant metastases with a median overall survival of less than 15 months. The treatment of choice in patients with localized disease is still surgical resection with negative margins. However, there has been a paradigm shift in the last few decades. Large retrospective analyses could not establish a strong association between radical resections and improved local control or survival. Previous radical concepts in STS surgery have been gradually replaced by more moderate approaches with function- and limb-sparing resections combined with radiotherapy. Here, the margin status appears to be of prognostic significance. However, several large retrospective analyses have presented inconsistent results, questioning the independent prognostic impact of surgical margins. This article reviews the literature critically, focusing on the changing role of surgical margins in STS surgery.
Collapse
Affiliation(s)
- Kamran Harati
- Department of Plastic Surgery, BG-University Hospital Bergmannsheil, Bochum, Germany
| | - Marcus Lehnhardt
- Department of Plastic Surgery, BG-University Hospital Bergmannsheil, Bochum, Germany
| |
Collapse
|