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Tumor-skin invasion is a reliable risk factor for poor prognosis in superficial soft tissue sarcomas. PLoS One 2022; 17:e0274077. [PMID: 36054224 PMCID: PMC9439222 DOI: 10.1371/journal.pone.0274077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/23/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction Superficial soft tissue sarcomas are often left untreated unless they invade the skin and skin ulcers manifest. Progressive sarcomas frequently result in dismal oncological outcomes despite multidisciplinary treatment. This study aimed to identify prognostic factors for superficial soft tissue sarcomas. Materials and methods This study retrospectively analyzed the clinicopathological data of 82 patients with superficial soft tissue sarcomas treated between August 2003 and December 2020 at our institution. A superficial soft tissue sarcoma was defined if the percentage of the area occupied by the tumor in the assessed region (skin, subcutaneous) was more than 50%. Age, sex, location, tumor size, tumor-skin invasion, tumor grade, and distant metastasis at initial diagnosis were evaluated as potential prognostic factors. Cox proportional hazards regression models were used to identify the prognostic factors. Five-year survival rates were assessed by the Kaplan-Meier method. Results The mean follow-up time was 60.1 months. The 5-year overall survival, 5-year local recurrence-free survival, and 5-year metastasis survival rates were 76.4%, 60.6%, and 71.0%, respectively. Univariate analysis showed significant relationships between poor prognosis and tumor size ≥5 cm, distant metastasis at initial diagnosis, and tumor-skin invasion. In the multivariate analysis, only the tumor-skin invasion was associated with worse overall survival. Conclusions Superficial soft tissue sarcomas have biologically been considered a separate category due to their better prognosis. In this study, the tumor-skin invasion was the only significant factor associated with a poor prognosis. Therefore, all superficial soft tissue sarcomas without tumor-skin invasion should be treated as early as possible.
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Get It Off Your Chest: A Narrative Review of Breast Ulcers. Adv Skin Wound Care 2022; 35:306-313. [PMID: 35703852 DOI: 10.1097/01.asw.0000826864.20824.b5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
GENERAL PURPOSE To provide comprehensive information about breast ulcers to facilitate accurate diagnosis and treatment of these lesions. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will:1. Differentiate common wound complications after mastectomy.2. Identify the clinical manifestations of various types of breast ulcers.3. Explain appropriate pharmacologic and nonpharmacologic treatment options for various types of breast ulcers.
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Okajima K, Kobayashi H, Okuma T, Arai S, Zhang L, Hirai T, Ishibashi Y, Ikegami M, Shinoda Y, Akiyama T, Goto T, Tanaka S. Prognosis and surgical outcome of soft tissue sarcoma with malignant fungating wounds. Jpn J Clin Oncol 2021; 51:78-84. [PMID: 33037437 DOI: 10.1093/jjco/hyaa176] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/29/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Malignant fungating wounds are ulcerating tumors that infiltrate the overlying skin. Little evidence exists regarding the prognosis or treatment of malignant fungating wound in soft tissue sarcoma. This study aimed to reveal the prognosis and outcome of surgical treatment of malignant fungating wound in soft tissue sarcoma. METHODS We retrospectively reviewed 26 patients with malignant fungating wound in high-grade soft tissue sarcoma between 2005 and 2018. The patients' characteristics, treatments, surgical wound complications, local recurrences and prognoses were analyzed. Overall survival was analyzed using the Kaplan-Meier method and compared with that of the control cohort, consisting of 236 consecutive patients with non-malignant fungating wound high-grade soft tissue sarcoma treated during the same period. RESULTS Among the 26 patients, undifferentiated pleomorphic sarcoma was the most common subtype. Twenty-three patients, including 20 (87%) and 3 (13%), underwent limb-salvage surgery and amputation, respectively. Among the 20 patients who underwent limb-salvage surgery, 4 (20%) had surgical wound complications, which required additional surgical procedures. Excluding the patients who underwent palliative surgery, local recurrence occurred in 2 patients (11%). The 5-year overall survival rate for all high-grade malignant fungating wound and non-malignant fungating wound patients was 26.0 and 67.3% (P < 0.0001), respectively. CONCLUSIONS Malignant fungating wounds in soft tissue sarcoma were significantly associated with a poor prognosis; however, the incidence of surgical complications and local recurrence after limb-salvage surgery was comparable to that of general soft tissue sarcoma cases. Limb-salvage surgery should be considered, if possible, to preserve the patient's quality of life because of the dismal prognosis of patients with malignant fungating wound in soft tissue sarcoma.
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Affiliation(s)
- Koichi Okajima
- Department of Musculoskeletal Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.,Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo Hospital, Tokyo
| | - Hiroshi Kobayashi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo Hospital, Tokyo
| | - Tomotake Okuma
- Department of Musculoskeletal Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Sho Arai
- Department of Musculoskeletal Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Liuzhe Zhang
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo Hospital, Tokyo
| | - Toshihide Hirai
- Department of Musculoskeletal Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.,Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo Hospital, Tokyo
| | - Yuki Ishibashi
- Department of Orthopaedic Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Masachika Ikegami
- Department of Musculoskeletal Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.,Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo Hospital, Tokyo
| | - Yusuke Shinoda
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo Hospital, Tokyo
| | - Toru Akiyama
- Department of Orthopaedic Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Takahiro Goto
- Department of Musculoskeletal Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo Hospital, Tokyo
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