Analysis of prognostic factors in soft tissue sarcoma: Cancer registry from a single tertiary hospital in Indonesia. A retrospective cohort study

Establishing biomarkers for soft tissue sarcomas

INTRODUCTION

Soft tissue sarcomas (STS) are a rare and diverse group of tumors. Curative options are limited to localized disease, with surgery being the mainstay. Advanced stages are associated with a poor prognosis. Currently, the prognosis of the patient is based on histological classification and clinical characteristics, with only a few biomarkers having entered clinical practice.

AREAS COVERED

This article covers extensive recent research that has established novel potential biomarkers based on genomics, proteomics, and clinical characteristics. Validating and incorporating these biomarkers into clinical practice can improve prognosis, prediction of recurrence, and treatment response. Relevant literature was collected from PubMed, Scopus, and clinicaltrials.gov databases (November 2023).

EXPERT OPINION

Currently, defining prognostic markers in soft tissue sarcomas remains challenging. More studies are required, especially to personalize treatment through advanced genetic profiling and analysis using individual tumor and patient characteristics.

C‑reactive protein and related predictors in soft tissue sarcoma (Review)

C-reactive protein (CRP) is a useful predictor of poor survival in patients with several types of cancer because inflammation is strongly associated with cancer progression. The production of CRP in hepatocytes appears to be primarily induced at the transcriptional level following the elevation of circulating interleukin-6 (IL-6), which is produced by various cell types, including cancer cells and cancer-associated fibroblasts. Serum CRP levels are associated with serum IL-6 levels in patients with soft tissue sarcoma (STS). Additionally, patients with elevated CRP levels had worse oncological outcomes than those with normal CRP levels. It has been attempted to combine CRP levels with other inflammatory or immune markers, and the utility of this has been demonstrated. Therefore, a novel treatment strategy should be developed for patients with STS with elevated CRP levels. The present review aimed to clarify the role of CRP levels and related tools in predicting clinical outcomes in patients with STS.

An atypical lipomatous tumor of the hypopharynx, a unique entity? A rare case report

INTRODUCTION

Liposarcomas are thought to be the most prevalent kind of soft tissue sarcoma in adults. A well-differentiated liposarcoma that has a higher incidence of a local recurrence following surgical excision is referred to as an atypical lipomatous tumor. The incidence are extremely rare in which <1 % of head and neck sarcoma cases. This is unusual liposarcoma localization warrants great interest in reporting such a case.

PRESENTATION OF CASE

In this report we present a case of a 50-year-old male complained with difficulty swallowing solid food and continuous presence of lump in the throat. Fiber Optic Laryngoscopy (FOL) showed a tumor filled the hypopharynx and CT scan suggested a benign mass that was most likely a fibrolipoma.

DISCUSSION

Tumor was found infiltrating the lateral pharyngeal wall and protruding into the hypopharyngeal lumen. Because the tumor had spread to the right thyroid lobe, surgical excision via a transcervical approach was combined with a right thyroidectomy. There was a positive margin at the end of resection, thus a chemoradiation was added. Two years post-operative evaluation shows no sign of recurrence.

CONCLUSION

The main treatment for hypopharyngeal liposarcoma is based on surgery, either through an endoscopic or transcervical approach which determined by the size of the tumor and surgical field. Adjuvant chemoradiation is given to help prevent the recurrence.

Case report: Recurrent parosteal lipoma at Dr. Moewardi hospital

Background

Parosteal lipoma is a rare and benign neoplasm originating from mature adipose tissue near the periosteum. Clinically, it is difficult to diagnose due to its similarity to the clinical manifestation of sarcoma, so imaging, histopathology, and immunohistochemistry examinations are necessary.

Case presentation

A 54-year-old woman presented with lump on the right thigh that had gone through surgery eight years prior, with a diameter of 20 cm, with a partly hard and partly soft consistency, the patient was diagnosed with suspected recurrent liposarcoma. We performed wide excision and histopathological results showed a proliferation of bone cells and cartilage cells that were lobulated, surrounded by a proliferation of fat cells with no pleomorphism or immature cells.

Discussion

Parosteal lipomas are neoplasms derived from adult adipose tissue, usually connected to the periosteum, and rare and benign. Two theories of pathogenesis of parosteal lipomas. (1) tumors arise from the differentiation of stem cells derived from adipose tissue, (2) the tumor is derived from secondary metaplasia of fibroblasts due to recurrent trauma, metabolic changes, or ischemia. Based on the theory, it is likely that in this case is due to the presence of differentiation of adiposa tissue due to the non-acquisition of a history of trauma.

Conclusion

Parosteal lipoma is a rare case of benign neoplasm, which is difficult to diagnose clinically due to its similar sarcoma, thus requiring imaging and histopathological examination. The treatment of choice is wide excision by taking the entire tumor to prevent a recurrence.

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45 year old woman with recurrent parosteal lipoma.

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The case of parosteal lipoma is a benign tumor.

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A neoplasm originating from mature adipose tissue, mostly located in the bone cortex below the periosteum.

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The incidence is 0.3% of all types of lipomas and 0.1% of primary bone neoplasms.

Prognostic value of pretreatment anemia in patients with soft tissue sarcoma: A meta-analysis

BACKGROUND

Anemia is one of the most common manifestations in patients with cancer. Recently, multiple studies have shown a positive correlation between pretreatment anemia and tumor prognosis. Yet, the relationship between pretreatment anemia and the prognosis of soft tissue sarcomas (STS) is unclear.

METHODS

We searched the PubMed and EMBASE databases to identify relevant studies. Eligible studies were included according to the inclusion criteria to assess the relationship between pretreatment anemia and the prognosis of patients with STS. Prognostic significance was determined by studying hazard ratios (HR) and 95% confidence intervals (CIs).

RESULTS

A total of 12 studies are included. If there is significant heterogeneity, a random-effects model is used. Pooled data indicated that pretreatment anemia is related to poor overall survival (HR = 2.13; 95%CI = 1.52-2.98), disease-specific survival (HR = 1.53; 95%CI = 1.20-1.96), and disease-free survival (HR = 1.55; 95%CI = 1.10-2.17). The results of the subgroup analysis also support this conclusion.

CONCLUSION

Our results suggest that pretreatment anemia may be a prognostic biomarker for STS.