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Lu Y, Chen D, Wang B, Chai W, Yan M, Chen Y, Zhan Y, Yang R, Zhou E, Dai S, Li Y, Dong R, Zheng B. Single-cell landscape of undifferentiated pleomorphic sarcoma. Oncogene 2024; 43:1353-1368. [PMID: 38459120 DOI: 10.1038/s41388-024-03001-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 02/29/2024] [Accepted: 03/01/2024] [Indexed: 03/10/2024]
Abstract
Undifferentiated pleomorphic sarcoma (UPS) is a highly aggressive malignant soft tissue tumor with a poor prognosis; however, the identity and heterogeneity of tumor populations remain elusive. Here, eight major cell clusters were identified through the RNA sequencing of 79,569 individual cells of UPS. UPS originates from mesenchymal stem cells (MSCs) and features undifferentiated subclusters. UPS subclusters were predicted to exist in two bulk RNA datasets, and had a prognostic value in The Cancer Genome Atlas (TCGA) dataset. The functional heterogeneity of malignant UPS cells and the immune microenvironment were characterized. Additionally, the fused cells were innovatively detected by expressing both monocyte/macrophage markers and other subcluster-associated genes. Based on the ligand-receptor interaction analysis, cellular interactions with epidermal growth factor receptor (EGFR) and vascular endothelial growth factor receptor (VEGFR) were abundant. Furthermore, 73% of patients with UPS (48/66) showed positive EGFR expression, which was associated with a poor prognosis. EGFR blockade with cetuximab inhibited tumor growth in a patient-derived xenograft model. Our transcriptomic studies delineate the landscape of UPS intratumor heterogeneity and serve as a foundational resource for further discovery and therapeutic exploration.
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Affiliation(s)
- Yifei Lu
- Department of Pediatric Surgery, Children's Hospital of Fudan University, and Shanghai Key Laboratory of Birth Defects, Shanghai, 201102, China
| | - Deqian Chen
- Department of Pediatric Surgery, Children's Hospital of Fudan University, and Shanghai Key Laboratory of Birth Defects, Shanghai, 201102, China
| | - Bingnan Wang
- Department of Musculoskeletal Oncology, Shanghai Cancer Center, and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Wenjun Chai
- Department of Animal Experimental Center, Fudan University Shanghai Cancer Center, Shanghai, 201102, China
| | - Mingxia Yan
- Department of Animal Experimental Center, Fudan University Shanghai Cancer Center, Shanghai, 201102, China
| | - Yong Chen
- Department of Musculoskeletal Oncology, Shanghai Cancer Center, and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Yong Zhan
- Department of Pediatric Surgery, Children's Hospital of Fudan University, and Shanghai Key Laboratory of Birth Defects, Shanghai, 201102, China
| | - Ran Yang
- Department of Pediatric Surgery, Children's Hospital of Fudan University, and Shanghai Key Laboratory of Birth Defects, Shanghai, 201102, China
| | - Enqing Zhou
- Department of Pediatric Surgery, Children's Hospital of Fudan University, and Shanghai Key Laboratory of Birth Defects, Shanghai, 201102, China
| | - Shuyang Dai
- Department of Pediatric Surgery, Children's Hospital of Fudan University, and Shanghai Key Laboratory of Birth Defects, Shanghai, 201102, China
| | - Yi Li
- Department of Pediatric Surgery, Children's Hospital of Fudan University, and Shanghai Key Laboratory of Birth Defects, Shanghai, 201102, China
| | - Rui Dong
- Department of Pediatric Surgery, Children's Hospital of Fudan University, and Shanghai Key Laboratory of Birth Defects, Shanghai, 201102, China.
| | - Biqiang Zheng
- Department of Musculoskeletal Oncology, Shanghai Cancer Center, and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
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Grimaudo MS, Renne SL, Colombo P, Giordano L, Gennaro N, Laffi A, Cariboni U, Cananzi FCM, Ruspi L, Santoro A, Bertuzzi AF. Prognostic value of mitotic count in leiomyosarcoma: A comprehensive monocentric retrospective study. Hum Pathol 2024; 143:17-23. [PMID: 38000682 DOI: 10.1016/j.humpath.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/03/2023] [Accepted: 11/17/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Leiomyosarcomas (LMSs) include heterogeneous entities with different clinical courses not entirely predicted by known prognostic factors. In particular, the value of mitotic count as independent prognostic factor in LMS has been poorly investigated. METHODS We retrospectively analyzed all patients with a diagnosis of LMS who accessed to our Institution from June 1999 to May 2022 for which mitotic count was numerically expressed within the pathology report. Univariate and multivariate analyses were conducted to explore the prognostic value of mitotic count along with other clinical and histological variables. RESULTS We identified 121 eligible patients, with a median follow-up of 91.03 months (range 0.62-275.2 months). Median progression-free survival (mPFS) was 16.7 months, and median overall survival (mOS) was 105.6 months. In univariate analysis, mitotic count showed a significant impact on PFS and OS, with an hazard ratio per mitotic unit of 1.03 (1.01-1.04, p < 0.001) and 1.03 (1.01-1.04, p = 0.007), respectively. Similar results were found for locally advanced and metastatic patients, separately. Other significant prognostic factors for PFS were stage at diagnosis, performance status, tumor size and Ki-67, while differentiation, necrosis, grade, stage at diagnosis, tumor size, performance status and age at diagnosis were identified for OS. In multivariate analysis, the only significant factors were mitotic count and the presence of metastases at diagnosis for PFS, whereas the same two factors plus age at diagnosis were identified for OS. CONCLUSION Mitotic count represented the most important histological prognostic factor for OS and PFS in localized and metastatic LMS.
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Affiliation(s)
- Maria Susanna Grimaudo
- IRCCS Humanitas Research Hospital, Department of Oncology & Hematology, Rozzano, Italy; Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy.
| | - Salvatore Lorenzo Renne
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy; IRCCS Humanitas Research Hospital, Department of Pathology, Rozzano, Italy.
| | - Piergiuseppe Colombo
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy; IRCCS Humanitas Research Hospital, Department of Pathology, Rozzano, Italy.
| | - Laura Giordano
- IRCCS Humanitas Research Hospital, Department of Oncology & Hematology, Rozzano, Italy.
| | - Nicolò Gennaro
- Northwestern University, Department of Radiology, Feinberg School of Medicine, Chicago, USA.
| | - Alice Laffi
- IRCCS Humanitas Research Hospital, Department of Oncology & Hematology, Rozzano, Italy.
| | - Umberto Cariboni
- IRCCS Humanitas Research Hospital, Department of Thoracic Surgery, Rozzano, Italy.
| | - Ferdinando Carlo Maria Cananzi
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy; IRCCS Humanitas Research Hospital, Department of Sarcoma Surgery, Rozzano, Italy.
| | - Laura Ruspi
- IRCCS Humanitas Research Hospital, Department of Sarcoma Surgery, Rozzano, Italy.
| | - Armando Santoro
- IRCCS Humanitas Research Hospital, Department of Oncology & Hematology, Rozzano, Italy; Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy.
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Ma JY, Fu HJ, Li ZS. Recurrence of undifferentiated pleomorphic sarcoma with pulmonary metastasis: A rare case originating in the thigh. Asian J Surg 2024; 47:647-648. [PMID: 37833224 DOI: 10.1016/j.asjsur.2023.09.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023] Open
Affiliation(s)
- Jin-Yang Ma
- Hulunbuir Clinical Medical College, Inner Mongolia University for Nationalities, Hulunbuir, 021000, China
| | - Hong-Jiang Fu
- Department of Imaging, Beijing Jishuitan Hospital Guizhou Hospital/Guizhou Provincial Orthopedic Hospital, Guiyang, 550014, China
| | - Zhen-Shan Li
- Hulunbuir Clinical Medical College, Inner Mongolia University for Nationalities, Hulunbuir, 021000, China; Department of Imaging, Hulunbeir People's Hospital, Hulunbuir, 021008, China.
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Taborska P, Lukac P, Stakheev D, Rajsiglova L, Kalkusova K, Strnadova K, Lacina L, Dvorankova B, Novotny J, Kolar M, Vrana M, Cechova H, Ransdorfova S, Valerianova M, Smetana K, Vannucci L, Smrz D. Novel PD-L1- and collagen-expressing patient-derived cell line of undifferentiated pleomorphic sarcoma (JBT19) as a model for cancer immunotherapy. Sci Rep 2023; 13:19079. [PMID: 37925511 PMCID: PMC10625569 DOI: 10.1038/s41598-023-46305-7] [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: 03/18/2023] [Accepted: 10/30/2023] [Indexed: 11/06/2023] Open
Abstract
Soft tissue sarcomas are aggressive mesenchymal-origin malignancies. Undifferentiated pleomorphic sarcoma (UPS) belongs to the aggressive, high-grade, and least characterized sarcoma subtype, affecting multiple tissues and metastasizing to many organs. The treatment of localized UPS includes surgery in combination with radiation therapy. Metastatic forms are treated with chemotherapy. Immunotherapy is a promising treatment modality for many cancers. However, the development of immunotherapy for UPS is limited due to its heterogeneity, antigenic landscape variation, lower infiltration with immune cells, and a limited number of established patient-derived UPS cell lines for preclinical research. In this study, we established and characterized a novel patient-derived UPS cell line, JBT19. The JBT19 cells express PD-L1 and collagen, a ligand of the immune checkpoint molecule LAIR-1. JBT19 cells can form spheroids in vitro and solid tumors in immunodeficient nude mice. We found JBT19 cells induce expansion of JBT19-reactive autologous and allogeneic NK, T, and NKT-like cells, and the reactivity of the expanded cells was associated with cytotoxic impact on JBT19 cells. The PD-1 and LAIR-1 ligand-expressing JBT19 cells show ex vivo immunogenicity and effective in vivo xenoengraftment properties that can offer a unique resource in the preclinical research developing novel immunotherapeutic interventions in the treatment of UPS.
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Affiliation(s)
- Pavla Taborska
- Department of Immunology, Second Faculty of Medicine, Charles University, and Motol University Hospital, V Uvalu 84, 150 06 Praha 5, Prague, Czech Republic
| | - Pavol Lukac
- Laboratory of Immunotherapy, Institute of Microbiology of the Czech Academy of Sciences, Prague, Czech Republic
- Department of Cell Biology, Faculty of Science, Charles University, Prague, Czech Republic
| | - Dmitry Stakheev
- Department of Immunology, Second Faculty of Medicine, Charles University, and Motol University Hospital, V Uvalu 84, 150 06 Praha 5, Prague, Czech Republic
- Laboratory of Immunotherapy, Institute of Microbiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Lenka Rajsiglova
- Laboratory of Immunotherapy, Institute of Microbiology of the Czech Academy of Sciences, Prague, Czech Republic
- Department of Cell Biology, Faculty of Science, Charles University, Prague, Czech Republic
| | - Katerina Kalkusova
- Department of Immunology, Second Faculty of Medicine, Charles University, and Motol University Hospital, V Uvalu 84, 150 06 Praha 5, Prague, Czech Republic
| | - Karolina Strnadova
- Institute of Anatomy, First Faculty of Medicine, Charles University, Prague, Czech Republic
- First Faculty of Medicine, BIOCEV, Charles University, Vestec, Czech Republic
| | - Lukas Lacina
- Institute of Anatomy, First Faculty of Medicine, Charles University, Prague, Czech Republic
- First Faculty of Medicine, BIOCEV, Charles University, Vestec, Czech Republic
- Department of Dermatovenerology, First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic
| | - Barbora Dvorankova
- Institute of Anatomy, First Faculty of Medicine, Charles University, Prague, Czech Republic
- First Faculty of Medicine, BIOCEV, Charles University, Vestec, Czech Republic
| | - Jiri Novotny
- Laboratory of Genomics and Bioinformatics, Institute of Molecular Genetics of the Czech Academy of Sciences, Prague, Czech Republic
| | - Michal Kolar
- Laboratory of Genomics and Bioinformatics, Institute of Molecular Genetics of the Czech Academy of Sciences, Prague, Czech Republic
| | - Milena Vrana
- HLA Department, Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Hana Cechova
- HLA Department, Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Sarka Ransdorfova
- Department of Cytogenetics, Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Marie Valerianova
- Department of Cytogenetics, Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Karel Smetana
- Institute of Anatomy, First Faculty of Medicine, Charles University, Prague, Czech Republic
- First Faculty of Medicine, BIOCEV, Charles University, Vestec, Czech Republic
| | - Luca Vannucci
- Laboratory of Immunotherapy, Institute of Microbiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Daniel Smrz
- Department of Immunology, Second Faculty of Medicine, Charles University, and Motol University Hospital, V Uvalu 84, 150 06 Praha 5, Prague, Czech Republic.
- Laboratory of Immunotherapy, Institute of Microbiology of the Czech Academy of Sciences, Prague, Czech Republic.
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5
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Kokubun H, Kijima T, Takada‐Owada A, Mamiya D, Kurashina R, Okubo N, Uematsu T, Takei K, Ishida K, Kamai T. A case of adrenal undifferentiated pleomorphic sarcoma with tertiary lymphoid structures responded to pembrolizumab. IJU Case Rep 2023; 6:440-444. [PMID: 37928308 PMCID: PMC10622227 DOI: 10.1002/iju5.12643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/06/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction Although undifferentiated pleomorphic sarcomas are aggressive, a subset of these tumors are immunogenic and may respond to immunotherapy. Case presentation A 69-year-old man developed bilateral adrenal tumors and underwent bilateral adrenalectomy. Pathological examination revealed undifferentiated pleomorphic sarcoma harboring tertiary lymphoid structures and infiltration of CD8+ T cells. Genome profiling revealed PD-L1 amplification, microsatellite instability, and a high tumor mutation burden. He developed local recurrence and multiple peritoneal dissemination 2 months after surgery; adriamycin chemotherapy was ineffective for these lesions. Sustained complete remission of all lesions was achieved by administering pembrolizumab. Conclusion Immunohistochemical analysis focusing on tertiary lymphoid structures and genome profiling to evaluate microsatellite instability and tumor mutation burden are essential for precision medicine and informed clinical decision-making when treating advanced undifferentiated pleomorphic sarcoma.
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Affiliation(s)
| | - Toshiki Kijima
- Department of UrologyDokkyo Medical UniversityTochigiJapan
| | | | - Daisuke Mamiya
- Department of UrologyDokkyo Medical UniversityTochigiJapan
| | - Ryo Kurashina
- Department of UrologyDokkyo Medical UniversityTochigiJapan
| | - Naoya Okubo
- Department of UrologyDokkyo Medical UniversityTochigiJapan
| | | | - Kohei Takei
- Department of UrologyDokkyo Medical UniversityTochigiJapan
| | - Kazuyuki Ishida
- Department of Diagnostic PathologyDokkyo Medical UniversityTochigiJapan
| | - Takao Kamai
- Department of UrologyDokkyo Medical UniversityTochigiJapan
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6
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Sacco R, Lalevé M, Pellegrino P, Ferro A, Yasmine B, André G, Matthieu G, Hamza A, Piana R, Dujardin F. Soft tissue sarcomas of the buttock: A systematic review and meta-analysis. Surg Oncol 2022; 45:101883. [DOI: 10.1016/j.suronc.2022.101883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/13/2022] [Accepted: 10/31/2022] [Indexed: 11/09/2022]
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7
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Judge SJ, Bloomstein JD, Sholevar CJ, Darrow MA, Stoffel KM, Vick LV, Dunai C, Cruz SM, Razmara AM, Monjazeb AM, Rebhun RB, Murphy WJ, Canter RJ. Transcriptome Analysis of Tumor-Infiltrating Lymphocytes Identifies NK Cell Gene Signatures Associated With Lymphocyte Infiltration and Survival in Soft Tissue Sarcomas. Front Immunol 2022; 13:893177. [PMID: 35874727 PMCID: PMC9300876 DOI: 10.3389/fimmu.2022.893177] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/16/2022] [Indexed: 01/26/2023] Open
Abstract
Purpose Clinical successes using current T-cell based immunotherapies have been limited in soft tissue sarcomas (STS), while pre-clinical studies have shown evidence of natural killer (NK) cell activity. Since tumor immune infiltration, especially tumor-infiltrating lymphocytes, is associated with improved survival in most solid tumors, we sought to evaluate the gene expression profile of tumor and blood NK and T cells, as well as tumor cells, with the goal of identifying potential novel immune targets in STS. Experimental Design Using fluorescence-activated cell sorting, we isolated blood and tumor-infiltrating CD3-CD56+ NK and CD3+ T cells and CD45- viable tumor cells from STS patients undergoing surgery. We then evaluated differential gene expression (DGE) of these purified populations with RNA sequencing analysis. To evaluate survival differences and validate primary DGE results, we also queried The Cancer Genome Atlas (TCGA) database to compare outcomes stratified by bulk gene expression. Results Sorted intra-tumoral CD3+ T cells showed significant upregulation of established activating (CD137) and inhibitory genes (TIM-3) compared to circulating T cells. In contrast, intra-tumoral NK cells did not exhibit upregulation of canonical cytotoxic genes (IFNG, GZMB), but rather significant DGE in mitogen signaling (DUSP4) and metabolic function (SMPD3, SLC7A5). Tumors with higher NK and T cell infiltration exhibited significantly increased expression of the pro-inflammatory receptor TLR4 in sorted CD45- tumor cells. TCGA analysis revealed that tumors with high TLR4 expression (P = 0.03) and low expression of STMN1 involved in microtubule polymerization (P < 0.001) were associated with significantly improved survival. Conclusions Unlike T cells, which demonstrate significant DGE consistent with upregulation of both activating and inhibiting receptors in tumor-infiltrating subsets, NK cells appear to have more stable gene expression between blood and tumor subsets, with alterations restricted primarily to metabolic pathways. Increased immune cell infiltration and improved survival were positively correlated with TLR4 expression and inversely correlated with STMN1 expression within tumors, suggesting possible novel therapeutic targets for immunotherapy in STS.
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Affiliation(s)
- Sean J. Judge
- Division of Surgical Oncology, Department of Surgery, University of California, Davis, Sacramento, CA, United States
| | - Joshua D. Bloomstein
- Division of Surgical Oncology, Department of Surgery, University of California, Davis, Sacramento, CA, United States
| | - Cyrus J. Sholevar
- Division of Surgical Oncology, Department of Surgery, University of California, Davis, Sacramento, CA, United States
| | - Morgan A. Darrow
- Department of Pathology and Laboratory Medicine, University of California, Davis, Sacramento, CA, United States
| | - Kevin M. Stoffel
- Department of Dermatology, University of California, Davis, Sacramento, CA, United States
| | - Logan V. Vick
- Department of Dermatology, University of California, Davis, Sacramento, CA, United States
| | - Cordelia Dunai
- Department of Dermatology, University of California, Davis, Sacramento, CA, United States
| | - Sylvia M. Cruz
- Division of Surgical Oncology, Department of Surgery, University of California, Davis, Sacramento, CA, United States
| | - Aryana M. Razmara
- Division of Surgical Oncology, Department of Surgery, University of California, Davis, Sacramento, CA, United States
| | - Arta M. Monjazeb
- Department of Radiation Oncology, University of California, Davis, Sacramento, CA, United States
| | - Robert B. Rebhun
- Center for Companion Animal Health, Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - William J. Murphy
- Department of Dermatology, University of California, Davis, Sacramento, CA, United States,Division of Hematology and Oncology, Department of Medicine, University of California, Davis, Sacramento, CA, United States
| | - Robert J. Canter
- Division of Surgical Oncology, Department of Surgery, University of California, Davis, Sacramento, CA, United States,*Correspondence: Robert J. Canter,
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Roulleaux Dugage M, Nassif EF, Italiano A, Bahleda R. Improving Immunotherapy Efficacy in Soft-Tissue Sarcomas: A Biomarker Driven and Histotype Tailored Review. Front Immunol 2021; 12:775761. [PMID: 34925348 PMCID: PMC8678134 DOI: 10.3389/fimmu.2021.775761] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/19/2021] [Indexed: 12/16/2022] Open
Abstract
Anti-PD-(L)1 therapies yield a disappointing response rate of 15% across soft-tissue sarcomas, even if some subtypes benefit more than others. The proportions of TAMs and TILs in their tumor microenvironment are variable, and this heterogeneity correlates to histotype. Tumors with a richer CD8+ T cell, M1 macrophage, and CD20+ cells infiltrate have a better prognosis than those infiltrated by M0/M2 macrophages and a high immune checkpoint protein expression. PD-L1 and CD8+ infiltrate seem correlated to response to immune checkpoint inhibitors (ICI), but tertiary lymphoid structures have the best predictive value and have been validated prospectively. Trials for combination therapies are ongoing and focus on the association of ICI with chemotherapy, achieving encouraging results especially with pembrolizumab and doxorubicin at an early stage, or ICI with antiangiogenics. A synergy with oncolytic viruses is seen and intratumoral talimogene laherpavec yields an impressive 35% ORR when associated to pembrolizumab. Adoptive cellular therapies are also of great interest in tumors with a high expression of cancer-testis antigens (CTA), such as synovial sarcomas or myxoid round cell liposarcomas with an ORR ranging from 20 to 50%. It seems crucial to adapt the design of clinical trials to histology. Leiomyosarcomas are characterized by complex genomics but are poorly infiltrated by immune cells and do not benefit from ICI. They should be tested with PIK3CA/AKT inhibition, IDO blockade, or treatments aiming at increasing antigenicity (radiotherapy, PARP inhibitors). DDLPS are more infiltrated and have higher PD-L1 expression, but responses to ICI remain variable across clinical studies. Combinations with MDM2 antagonists or CDK4/6 inhibitors may improve responses for DDLPS. UPS harbor the highest copy number alterations (CNA) and mutation rates, with a rich immune infiltrate containing TLS. They have a promising 15-40% ORR to ICI. Trials for ICB should focus on immune-high UPS. Association of ICI with FGFR inhibitors warrants further exploration in the immune-low group of UPS. Finally translocation-related sarcomas are heterogeneous, and although synovial sarcomas a poorly infiltrated and have a poor response rate to ICI, ASPS largely benefit from ICB monotherapy or its association with antiangiogenics agents. Targeting specific neoantigens through vaccine or adoptive cellular therapies is probably the most promising approach in synovial sarcomas.
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Affiliation(s)
- Matthieu Roulleaux Dugage
- Département d’Innovation Thérapeutique et des Essais Précoces (DITEP), Gustave Roussy, Université Paris Saclay, Villejuif, France
| | - Elise F. Nassif
- Département d’Innovation Thérapeutique et des Essais Précoces (DITEP), Gustave Roussy, Université Paris Saclay, Villejuif, France
| | - Antoine Italiano
- Département d’Innovation Thérapeutique et des Essais Précoces (DITEP), Gustave Roussy, Université Paris Saclay, Villejuif, France
- Département d’Oncologie Médicale, Institut Bergonié, Bordeaux, France
| | - Rastislav Bahleda
- Département d’Innovation Thérapeutique et des Essais Précoces (DITEP), Gustave Roussy, Université Paris Saclay, Villejuif, France
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9
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Socioeconomic factors associated with limb salvage versus amputation for adult extremity bone sarcomas in patients with insurance coverage. Surg Oncol 2021; 39:101664. [PMID: 34571448 DOI: 10.1016/j.suronc.2021.101664] [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: 05/28/2021] [Revised: 09/11/2021] [Accepted: 09/19/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Limb salvage (LS) has become the preferred treatment for adult patients with bone sarcoma of the extremities. The decision to perform LS versus an amputation is often dictated by tumor characteristics, however there may be socioeconomic factors associated with LS. Previously this has been linked to insurance status, however currently there is a paucity of data examining socioeconomic factors in patients with medical insurance at the time of sarcoma diagnosis. Therefore, the purpose of the current study was to examine socioeconomic factors which could be associated with the decision to perform LS versus amputation for adult bone sarcoma patients. METHODS Data from Optum Labs Data Warehouse, a national administrative claims database, was analyzed to identify patients with extremity bone sarcomas from 2006 to 2017. Bivariate regression was used to identify factors associated with LS versus amputation. RESULTS Of 1,390 (743 males, 647 female) patients, 252 (18%) under amputation while 1,138 (82%) underwent LS. Lower extremity tumors (OR 4.72, p < 0.001), income <$75,000 (OR 1.85, p = 0.03), being treated a public hospital (OR 1.41, p = 0.04) and a hospital with <200 beds (OR 1.90, p = 0.006) were associated with amputation. Income ≥$125,000 (OR 0.62, 0.04) were associated with LS. CONCLUSION In adult patients with medical insurance at the time of diagnosis, socioeconomic and hospital factors were associated with an amputation for bone sarcoma, with poorer patients, and those treated at smaller, and public hospitals more likely to undergo amputation.
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10
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Zhuang A, Wu Q, Tong H, Zhang Y, Lu W. Development and Validation of a Nomogram for Predicting Recurrence-Free Survival of Surgical Resected Retroperitoneal Liposarcoma. Cancer Manag Res 2021; 13:6633-6639. [PMID: 34466033 PMCID: PMC8402954 DOI: 10.2147/cmar.s321324] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/18/2021] [Indexed: 11/23/2022] Open
Abstract
Background and Objectives Surgical treatment is still the mainstay of curative therapy for retroperitoneal liposarcoma (RLPS), but often recurs after surgical resection. We aimed to establish a nomogram for postoperative recurrence of RLPS based on the Asian population. Methods Patients after surgical resection at the South Hospital of Zhongshan Hospital/Shanghai Public Health Clinical Center between August 2011 and December 2020 were included. The enrolled patients are randomly divided into training set and test set according to the ratio of 7:3. Prognostic factors were chosen based on Akaike Information Criterion, and the nomogram was built based on Cox regression and then internally validated through calibration plots and concordance index (C-index). Results A total of 447 patients were included. Gender, age, presentation status, organ invasion and FNCLCC grade were used to build nomogram. The calibration plots showed that RFS predicted probabilities are identical to the actual RFS rates. The C-index of the nomogram was 0.703 (95% CI 0.623–0.783) in the training set and 0.695 (95% CI 0.565–0.825) in test set. Conclusion The nomogram we established can accurately predict postoperative recurrence of RLPS patients for Asian population.
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Affiliation(s)
- Aobo Zhuang
- Department of General Surgery, South Hospital of Zhongshan Hospital/Shanghai Public Health Clinical Center, Fudan University, Shanghai, People's Republic of China
| | - Qian Wu
- Department of General Surgery, South Hospital of Zhongshan Hospital/Shanghai Public Health Clinical Center, Fudan University, Shanghai, People's Republic of China
| | - Hanxing Tong
- Department of General Surgery, South Hospital of Zhongshan Hospital/Shanghai Public Health Clinical Center, Fudan University, Shanghai, People's Republic of China.,Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Yong Zhang
- Department of General Surgery, South Hospital of Zhongshan Hospital/Shanghai Public Health Clinical Center, Fudan University, Shanghai, People's Republic of China.,Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Weiqi Lu
- Department of General Surgery, South Hospital of Zhongshan Hospital/Shanghai Public Health Clinical Center, Fudan University, Shanghai, People's Republic of China.,Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
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11
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Livingston MB, Jagosky MH, Robinson MM, Ahrens WA, Benbow JH, Farhangfar CJ, Foureau DM, Maxwell DM, Baldrige EA, Begic X, Symanowski JT, Steuerwald NM, Anderson CJ, Patt JC, Kneisl JS, Kim ES. Phase II Study of Pembrolizumab in Combination with Doxorubicin in Metastatic and Unresectable Soft-Tissue Sarcoma. Clin Cancer Res 2021; 27:6424-6431. [PMID: 34475102 DOI: 10.1158/1078-0432.ccr-21-2001] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/16/2021] [Accepted: 08/30/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE Doxorubicin is standard therapy for advanced soft-tissue sarcoma (STS) with minimal improvement in efficacy and increased toxicity with addition of other cytotoxic agents. Pembrolizumab monotherapy has demonstrated modest activity and tolerability in previous advanced STS studies. This study combined pembrolizumab with doxorubicin to assess safety and efficacy in frontline and relapsed settings of advanced STS. METHODS This single-center, single-arm, phase II trial enrolled patients with unresectable or metastatic STS with no prior anthracycline therapy. Patients received pembrolizumab 200 mg i.v. and doxorubicin (60 mg/m2 cycle 1 with subsequent escalation to 75 mg/m2 as tolerated). The primary endpoint was safety. Secondary endpoints included overall survival (OS), objective response rate (ORR), and progression-free survival (PFS) based on RECIST v1.1 guidelines. RESULTS Thirty patients were enrolled (53.3% female; median age 61.5 years; 87% previously untreated) with 4 (13.3%) patients continuing treatment. The study met its primary safety endpoint by prespecified Bayesian stopping rules. The majority of grade 3+ treatment-emergent adverse events were hematologic (36.7% 3+ neutropenia). ORR was 36.7% [95% confidence interval (CI), 19.9-56.1%], with documented disease control in 80.0% (95% CI, 61.4-92.3%) of patients. Ten (33.3%) patients achieved partial response, 1 (3.3%) patient achieved complete response, and 13 (43.3%) patients had stable disease. Median PFS and OS were 5.7 months (6-month PFS rate: 44%) and 17 months (12-month OS rate: 62%), respectively. Programmed cell death ligand-1 (PD-L1) expression was associated with improved ORR, but not OS or PFS. CONCLUSIONS Combination pembrolizumab and doxorubicin has manageable toxicity and preliminary promising activity in treatment of patients with anthracycline-naive advanced STS.
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Affiliation(s)
- Michael B Livingston
- Department of Solid Tumor Oncology, Levine Cancer Institute, Carolinas Medical Center, Atrium Health, Charlotte, North Carolina.
| | - Megan H Jagosky
- Department of Solid Tumor Oncology, Levine Cancer Institute, Carolinas Medical Center, Atrium Health, Charlotte, North Carolina
| | - Myra M Robinson
- Department of Biostatistics, Levine Cancer Institute, Carolinas Medical Center, Atrium Health, Charlotte, North Carolina
| | - William A Ahrens
- Carolinas Pathology Group, Atrium Health, Charlotte, North Carolina
| | - Jennifer H Benbow
- LCI Research Support, Clinical Trials Office, Levine Cancer Institute, Carolinas Medical Center, Atrium Health, Charlotte, North Carolina
| | - Carol J Farhangfar
- Clinical and Translational Research, Division of Therapeutic Research and Development, Levine Cancer Institute, Carolinas Medical Center, Atrium Health, Charlotte, North Carolina
| | - David M Foureau
- Immune Monitoring Core Laboratory, Levine Cancer Institute, Carolinas Medical Center, Atrium Health, Charlotte, North Carolina
| | - Deirdre M Maxwell
- Department of Solid Tumor Oncology, Levine Cancer Institute, Carolinas Medical Center, Atrium Health, Charlotte, North Carolina
| | - Emily A Baldrige
- LCI Research Support, Clinical Trials Office, Levine Cancer Institute, Carolinas Medical Center, Atrium Health, Charlotte, North Carolina
| | - Xhevahire Begic
- LCI Research Support, Clinical Trials Office, Levine Cancer Institute, Carolinas Medical Center, Atrium Health, Charlotte, North Carolina
| | - James T Symanowski
- Department of Biostatistics, Levine Cancer Institute, Carolinas Medical Center, Atrium Health, Charlotte, North Carolina
| | - Nury M Steuerwald
- The Molecular Biology and Genomics Laboratory, Levine Cancer Institute, Carolinas Medical Center, Atrium Health, Charlotte, North Carolina
| | - Colin J Anderson
- Department of Solid Tumor Oncology, Levine Cancer Institute, Carolinas Medical Center, Atrium Health, Charlotte, North Carolina.,Department of Orthopedic Surgery, Musculoskeletal Institute, Carolinas Medical Center, Atrium Health, Charlotte, North Carolina
| | - Joshua C Patt
- Department of Solid Tumor Oncology, Levine Cancer Institute, Carolinas Medical Center, Atrium Health, Charlotte, North Carolina.,Department of Orthopedic Surgery, Musculoskeletal Institute, Carolinas Medical Center, Atrium Health, Charlotte, North Carolina
| | - Jeffrey S Kneisl
- Department of Solid Tumor Oncology, Levine Cancer Institute, Carolinas Medical Center, Atrium Health, Charlotte, North Carolina.,Department of Orthopedic Surgery, Musculoskeletal Institute, Carolinas Medical Center, Atrium Health, Charlotte, North Carolina
| | - Edward S Kim
- Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, California
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12
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Wang Z, Tang Z, Zhao H, Zeng X, Han X, Zhang Q. Treatment of Recurrent Undifferentiated Pleomorphic Sarcoma of Infratemporal Fossa by Surgery Combined With Carbon Ion Radiotherapy: One Case Report. Front Surg 2021; 8:693774. [PMID: 34447783 PMCID: PMC8382945 DOI: 10.3389/fsurg.2021.693774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/09/2021] [Indexed: 11/13/2022] Open
Abstract
We retrospectively analyzed the diagnosis and treatment process of one patient with recurrent undifferentiated pleomorphic sarcoma (UPS) of infratemporal fossa and made a definite diagnosis by combining the imaging and pathological examination results. After treatment failure with 2 cycles of chemotherapy and several surgeries, UPS was eventually treated by surgery + carbon ion radiotherapy, and MRI reexamination showed no relapse. Head and neck UPS is located deeply, easily recurs after operation, and difficult to be resected completely by surgery, with a gradually shortened interval of relapse over the number of surgeries, which becomes a treatment challenge. After the last surgery, the patient received carbon ion radiotherapy, with a good therapeutic effect, and no sign of relapse just before sending this article. Based on the above advantages, we have concluded that surgery + carbon ion radiotherapy is a new effective pathway to treat head and neck UPS.
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Affiliation(s)
- Zaixing Wang
- Institute of ENT and Shenzhen Key Laboratory of ENT, Longgang ENT Hospital, Shenzhen, China
| | - Zhiyuan Tang
- Institute of ENT and Shenzhen Key Laboratory of ENT, Longgang ENT Hospital, Shenzhen, China
| | - Hailiang Zhao
- Institute of ENT and Shenzhen Key Laboratory of ENT, Longgang ENT Hospital, Shenzhen, China
| | - Xianhai Zeng
- Institute of ENT and Shenzhen Key Laboratory of ENT, Longgang ENT Hospital, Shenzhen, China
| | - Xiaodong Han
- Institute of ENT and Shenzhen Key Laboratory of ENT, Longgang ENT Hospital, Shenzhen, China
| | - Qiuhang Zhang
- Center of Skull Base Surgery, China INN and Department of Otolaryngology-Head and Neck Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
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13
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Patel SJ, Pappoppula L, Guddati AK. Analysis of Trends in Race and Gender Disparities in Incidence-Based Mortality in Patients Diagnosed with Soft Tissue Sarcomas from 2000 to 2016. Int J Gen Med 2021; 14:3787-3791. [PMID: 34335045 PMCID: PMC8318712 DOI: 10.2147/ijgm.s296309] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 06/30/2021] [Indexed: 11/23/2022] Open
Abstract
Background The clinical course of soft tissue sarcomas is often dependent on the grade of the tumor. The variability of incidence-based mortality in low-grade and high-grade soft tissue sarcomas (STS) with respect to gender and race over the past decade has not been well studied. This study analyzes the rates of incidence-based mortality from the years 2000 to 2016 amongst the grades, genders and racial groups of patients with STS. Methods The Surveillance, Epidemiology, and End Results (SEER) database was queried to conduct a nation-wide analysis for the years 2000 to 2016. Incidence-based mortality for all stages of low-grade and high-grade soft tissue sarcomas was queried and the results were grouped by race (Caucasian/White vs African American/Black) and gender. All stages and ages were included in the analysis and trend from 2000 to 2016 was analyzed. Results The incidence-based mortality rates for Caucasians are similar to African Americans in both grades and genders. Rates were not analyzed for American Indian and Asian/Pacific Islanders due to small sample size. Mortality rates of high-grade soft tissue sarcomas were significantly higher compared to low-grade tumors. A higher rate of mortality is noted in Caucasian males compared to African Americans males despite past observations of higher incidence in African Americans. There was no significant change in the rate when trended over the past decade (2007 to 2016). Conclusion This study highlights the higher rate of incidence-based mortality in Caucasian males compared to African American males in the past 15 years despite a lower incidence reported in the 1995 to 2008 period. With no significant change in mortality rates/year noted during this time period, this study implies that soft tissue sarcomas in Caucasian males have worse outcomes. Further research is needed to understand the mechanism underlying this disparity.
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Affiliation(s)
- Sunny J Patel
- Medical College of Georgia, Augusta University, Augusta, GA, 30912, USA
| | - Lakshmi Pappoppula
- Division of Hematology/Oncology, Georgia Cancer Center, Augusta University, Augusta, GA, 30912, USA
| | - Achuta K Guddati
- Division of Hematology/Oncology, Georgia Cancer Center, Augusta University, Augusta, GA, 30912, USA
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14
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Chen L, Zeng H, Du Z, Zhao Y, Ma X. Nomogram based on pre-treatment inflammatory biomarkers predicting survival in patients with head and neck soft tissue sarcoma. Cancer Biomark 2021; 29:151-161. [PMID: 32623392 DOI: 10.3233/cbm-201739] [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] [Indexed: 02/05/2023]
Abstract
BACKGROUND Systemic inflammatory biomarkers reflect level of inflammatory response, which have been suggested as prognostic factors in cancer patients. OBJECTIVE To estimate the prognostic value of inflammatory biomarkers in 149 patients with head and neck soft tissue sarcoma (HNSTS). METHODS Pre-treatment neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), neutrophil-platelet score (NPS) and Aarhus Composite Biomarker Score (ACBS) were analyzed for association with overall survival (OS) and progression-free survival (PFS). Nomograms were consisted of independent predictors for OS and PFS, and evaluated by calibration curve and concordance index (C-index). RESULTS In multivariate analysis, LMR (HR = 0.42, 95% CI: 0.19-0.94, P= 0.035), ACBS (HR = 2.05, 95% CI: 1.02-4.12, P= 0.045) and AJCC stage were independent prognostic markers of OS. Moreover, high NLR (HR = 1.78, 95% CI: 1.07-2.94, P= 0.024) and advanced AJCC stage were independently related with worse PFS. Calibration curves reflected good discriminative ability of prognosis. The nomograms showed better accuracy of predicting OS (C-index: 0.748 vs. 0.690, P= 0.009) and PFS (C-index: 0.644 vs. 0.612, P= 0.028) than stage. CONCLUSIONS Pre-treatment LMR, ACBS and AJCC stage were effective predictor of OS. The NLR and AJCC stage could independently predict PFS. The nomogram might act as a promising prognostic model for OS and PFS in HNSTS.
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Affiliation(s)
- Linyan Chen
- Department of Biotherapy, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Department of Biotherapy, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hao Zeng
- Department of Biotherapy, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Department of Biotherapy, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ze Du
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yunuo Zhao
- Department of Biotherapy, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xuelei Ma
- Department of Biotherapy, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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15
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Aytekin MN, Öztürk R, Amer K, Yapar A. Epidemiology, incidence, and survival of synovial sarcoma subtypes: SEER database analysis. J Orthop Surg (Hong Kong) 2021; 28:2309499020936009. [PMID: 32618221 DOI: 10.1177/2309499020936009] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Synovial sarcoma (SyS) is a rare malignancy that is typically located on the limbs and occurs predominantly in adolescents. A study in a large population for SyS comparing subtypes has not yet been reported. METHODS National Cancer Institute's Surveillance, Epidemiology, and End Results database was queried for patients diagnosed with SyS between January 1975 and December 2016. Patients were classified demographically according to gender, age, race/ethnicity, and marital status, and they were also classified by tumors, subtypes, localization, grade, year of diagnosis, laterality, type of treatment, and follow-up results. RESULTS A total of 3228 patients were included, with a mean age of 39.3 ± 18.8 (range: 1-94), of which 1521 (47.1%) were females and 1707 (52.9%) were males. According to its subtypes, 47.2% were SyS not otherwise specified, 32.3% were spindle cell, 19.9% were biphasic, and 0.6% were epithelioid type. The overall survival period is 138.0 (95% confidence interval: 113.2-162.8) months. Survival duration was found to be significantly different between groups according to gender (log-rank test; p < 0.001), age groups (log-rank test; p < 0.001), race (log-rank test; p = 0.001), marital status (log-rank test; p < 0.001), tumor subtypes (log-rank test; p < 0.001), tumor location (log-rank test; p < 0.001), tumor laterality (log-rank test; p < 0.001), date of diagnosis (log-rank test; p = 0.025), tumor grade (log-rank test; p < 0.001), historic stage (log-rank test; p < 0.001), state of chemotherapy (log-rank test; p < 0.001), state of radiotherapy (log-rank test; p < 0.001), presence of metastasis (log-rank test; p < 0.001), and total number of malignant tumors (log-rank test; p < 0.001). CONCLUSION Male gender, being colored individual, being over 35 years at the time of diagnosis, epithelioid type, non-head and neck region localization is associated with poor prognosis. While radiotherapy improves survival, benefit of chemotherapy is unclear. LEVEL OF EVIDENCE III retrospective analysis.
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Affiliation(s)
- Mahmut Nedim Aytekin
- Department of Orthopedics and Traumatology, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Recep Öztürk
- Department of Orthopedics and Traumatology, Dr Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Kamil Amer
- Department of Orthopaedics, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Aliekber Yapar
- Department of Orthopedics and Traumatology, Dr Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
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16
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Khan AJJ, Khan NAJ. High-Grade Malignant Spindle Cell Sarcoma of the Pelvis Presenting With Bloody Diarrhea and Urinary Retention: A Rare Case With a Rare Presentation. Cureus 2020; 12:e10622. [PMID: 33123435 PMCID: PMC7584330 DOI: 10.7759/cureus.10622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Soft tissue sarcomas (STSs) are rare malignant tumors originating from mesenchymal cells. Extremities are the most commonly affected anatomical sites, and majority of them present as a painless mass. We present a very interesting case of high-grade spindle cell sarcoma of the pelvis manifested as urinary retention and bloody diarrhea. A 68-year-old male presented to the emergency department with abdominal pain, inability to void urine, and bloody diarrhea. Straight urinary catheterization retrieved 900 mL of urine, and a Foley catheter was placed. All laboratory workup including complete blood count, complete metabolic panel, and urinalysis were within normal limits, but computed tomography (CT) of the abdomen and pelvis with contrast was remarkable for bilateral moderate hydronephrosis and a large 14 x 9.1 cm pelvic mass fistulizing into the rectum. To better identify the extent of disease, magnetic resonance imaging (MRI) with contrast was performed, which also revealed a similar large pelvic mass fistulizing into the rectum. Core needle biopsy of the mass was performed, which showed malignant spindle and epithelioid neoplasm with necrosis consistent with high-grade sarcoma. This is a very rare presentation of STS, and, to the best of our knowledge, only few similar cases have been reported thus far.
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Affiliation(s)
| | - Noman Ahmed Jang Khan
- Hematology and Oncology, Joan C. Edwards School of Medicine, Marshall University, Huntington, USA
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17
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Gingrich AA, Marrufo AS, Liu Y, Li CS, Darrow MA, Monjazeb AM, Thorpe SW, Canter RJ. Radiotherapy is Associated With Improved Survival in Patients With Synovial Sarcoma Undergoing Surgery: A National Cancer Database Analysis. J Surg Res 2020; 255:378-387. [PMID: 32599458 DOI: 10.1016/j.jss.2020.05.075] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 05/20/2020] [Accepted: 05/27/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Previous studies have demonstrated an association of perioperative radiotherapy (RT) with improved survival in patients with synovial sarcoma (SS) undergoing surgery, but the mechanism for this is unknown. In this study, we sought to further analyze this association using a hospital-based data set where data on chemotherapy administration and surgical margin status are available. METHODS Using the National Cancer Database, we identified 1216 patients with SS (aged ≥18 y) from 2004-2012 undergoing surgery. Cox proportional hazards analysis was used to study the effect of clinicopathologic variables on overall survival (OS). RESULTS Mean age at diagnosis was 41.5 y (range 18-90), and 71.3% of tumors were high grade; 22.9% underwent surgery alone, 59.6% received RT with surgery, 44.2% received chemotherapy with surgery, and 26.3% received trimodality therapy. Age, sex, grade, Charlson-Deyo score, and RT (hazard ratio, 0.676; 95% confidence interval, 0.519-0.880; P = 0.004) were associated with improved OS, whereas chemotherapy (hazard ratio, 1.20; 95% confidence interval, 0.899-1.60; P = 0.217) and surgical margin status were not. Trimodality therapy with surgery, RT, and chemotherapy was associated with improved OS when compared with therapy with surgery and chemotherapy alone. CONCLUSIONS In patients with SS undergoing surgery, we observed a significant improved association of OS with the addition of RT when adjusting for comorbidity score, margin status, and receipt of chemotherapy. These data further support routine implementation of RT in the treatment of patients with SS, including those receiving aggressive multimodality and trimodality care.
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Affiliation(s)
- Alicia A Gingrich
- Department of Surgery, University of California Davis, Sacramento, California
| | - Angelica S Marrufo
- Department of Surgery, University of California Davis, Sacramento, California
| | - Yu Liu
- Department of Public Health Sciences, University of California Davis, Davis, California
| | - Chin-Shang Li
- Department of Public Health Sciences, University of California Davis, Davis, California
| | - Morgan A Darrow
- Department of Pathology, University of California Davis, Sacramento, California
| | - Arta M Monjazeb
- Department of Radiation Oncology, University of California Davis, Sacramento, California
| | - Steven W Thorpe
- Department of Orthopedic Surgery, University of California Davis, Sacramento, California
| | - Robert J Canter
- Department of Surgery, University of California Davis, Sacramento, California.
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18
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Boro SS, Borthakur BB, Mamidala V. Reconstruction of Brachial Artery with Great Saphenous Vein Graft in A Case of Residual Soft Tissue Sarcoma Arm. World J Plast Surg 2020; 9:88-91. [PMID: 32190598 PMCID: PMC7068183 DOI: 10.29252/wjps.9.1.88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Soft tissue sarcomas of the upper extremities are very rare tumors. Due to the complex anatomy of the arm, the management of the soft tissue sarcoma becomes very challenging for the operating surgeons. Nonetheless, a large portion of the patients can be treated in a limb-sparing manner ,if surgical expertises are present .We report a case of 30 years old lady with soft tissue sarcoma of right arm operated in an another hospital, came to our institute with pain in the operated site and positive histological margins. The patient had feeble radial and ulnar artery pulses. We had done a MR angiography of that limb and it showed no flow from mid arm level in the brachial artery, but presence of collaterals around elbow joint. We had removed the residual tumor and also excised 14 cm of right brachial artery. On opening the brachial artery, tumor thrombus was seen along the whole length of the excised segment. The defect was reconstructed with reverse great saphenous vein graft taken from left leg. Post-operative period was uneventful. Doppler ultrasonography done at 6 and 12 months later showed good flow in the grafted segment with minimal narrowing of the anastomosis sites.
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Affiliation(s)
- Sumanjit S Boro
- Department of Plastic Surgery, Dr B. Barooah Cancer Institute, Guwahati, Assam, Branch of Tata Memorial Hospital, Mumbai, India
| | - Bibhuti Bhusan Borthakur
- Department of Surgical Oncology, Dr B. Barooah Cancer Institute, Guwahati, Assam, Branch of Tata Memorial Hospital, Mumbai, India
| | - Vinay Mamidala
- Department of Surgical Oncology, Dr B. Barooah Cancer Institute, Guwahati, Assam, Branch of Tata Memorial Hospital, Mumbai, India
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19
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Zheng B, Zhang S, Cai W, Wang J, Wang T, Tang N, Shi Y, Luo X, Yan W. Identification of Novel Fusion Transcripts in Undifferentiated Pleomorphic Sarcomas by Transcriptome Sequencing. Cancer Genomics Proteomics 2020; 16:399-408. [PMID: 31467233 DOI: 10.21873/cgp.20144] [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] [Received: 06/30/2019] [Revised: 07/03/2019] [Accepted: 07/04/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND/AIM Undifferentiated pleomorphic sarcoma (UPS) is an aggressive mesenchymal neoplasm characterized by chromosomal instability. The aim of this study was to identify fusion events involved in UPS. MATERIALS AND METHODS Transcriptome sequencing was performed to search for new fusion genes in 19 UPS samples, including two paired recurrent (R) and re-recurrent (RR) samples. RESULTS A total of 66 fusion genes were detected. Among them, 10 novel fusion genes were further confirmed by reverse transcription polymerase chain reaction (RT-PCR) and Sanger sequencing. Retinoblastoma (RB1) fusions (2 cases) were the most recurrent fusion genes. The gene fusions RB1-RNASEH2B, RB1-FGF14-AS1, and E2F6-FKBP4 were correlated with the Rb/E2F pathway. Pseudogenes were involved in the formation of the gene fusions CIC-DUX4L8 and EIF2AK4-ANXA2P2. Importantly, targetable gene fusions (PDGFRA-MACROD2 and NCOR1-MAP2K1) were detected in UPS. CONCLUSION Screening for the presence of fusion transcripts will provide vital clues to the understanding of genetic alterations and the finding of new targeted therapies for UPS.
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Affiliation(s)
- Biqiang Zheng
- Department of Musculoskeletal Cancer Surgery, Fudan University Shanghai Cancer Center, Shanghai, P.R. China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China
| | | | - Weiluo Cai
- Department of Musculoskeletal Cancer Surgery, Fudan University Shanghai Cancer Center, Shanghai, P.R. China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China
| | - Jian Wang
- Department of Musculoskeletal Cancer Surgery, Fudan University Shanghai Cancer Center, Shanghai, P.R. China.,Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, P.R. China
| | - Ting Wang
- State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P.R. China
| | - Ning Tang
- State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P.R. China
| | - Yingqiang Shi
- Department of Musculoskeletal Cancer Surgery, Fudan University Shanghai Cancer Center, Shanghai, P.R. China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China
| | - Xiaoying Luo
- State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P.R. China
| | - Wangjun Yan
- Department of Musculoskeletal Cancer Surgery, Fudan University Shanghai Cancer Center, Shanghai, P.R. China .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China
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20
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Zeller J, Kiefer J, Braig D, Winninger O, Dovi-Akue D, Herget GW, Stark GB, Eisenhardt SU. Efficacy and Safety of Microsurgery in Interdisciplinary Treatment of Sarcoma Affecting the Bone. Front Oncol 2019; 9:1300. [PMID: 31850204 PMCID: PMC6901986 DOI: 10.3389/fonc.2019.01300] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 11/11/2019] [Indexed: 01/08/2023] Open
Abstract
Background: Sarcomas are tumors of mesenchymal origin with high variation in anatomical localization. Sarcomas affecting the bone often require an interdisciplinary resection and reconstruction approach. However, it is critical that microsurgical reconstruction strategies do not negatively impact tumor safety and overall survival, as limb salvage is only the secondary goal of tumor surgery. Here, we analyzed the efficacy and safety of microsurgery in interdisciplinary treatment of sarcoma affecting the bone. Patients and Methods: We performed a retrospective chart review of all patients treated for soft-tissue and bone sarcoma at the senior author's institution with a focus on bone affection and microsurgical reconstruction between 2000 and 2019. This particular subgroup was further investigated for tumor resection status, 5-year survival rate, length of hospital stay, as well as overall complication and amputation rates. Results: Between 2000 and 2019, 803 patients were operated for sarcoma resection and reconstruction by the Department of Plastic and Hand Surgery. Of these, 212 patients presented with sarcoma of the extremity affecting the bone. Within this subgroup, 40 patients required microsurgical reconstruction for limb salvage, which was possible in 38 cases. R0 resection was achieved in 93.8%. The 5-year survival was 96.7%, and the overall complication rate was 25%, of which 40% were microsurgery associated complications. Conclusion: Safe and function-preserving treatment of soft-tissue and bone sarcoma is challenging. Primary reconstruction with microsurgical techniques of sarcoma-related defects enables limb-sparing and adequate oncosurgical cancer treatment without increasing the risk for local recurrence or prolonged hospital stay. The treatment of sarcoma patients should be reserved to high-volume centers with experienced plastic surgeon embedded in a comprehensive treatment concept.
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Affiliation(s)
- Johannes Zeller
- Department of Plastic and Hand Surgery, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Jurij Kiefer
- Department of Plastic and Hand Surgery, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - David Braig
- Department of Plastic and Hand Surgery, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany.,Plastic and Reconstructive Surgery, Sir Charles Gairdner Hospital, Perth, WA, Australia.,Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Oscar Winninger
- Department of Plastic and Hand Surgery, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - David Dovi-Akue
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Georg W Herget
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - G B Stark
- Department of Plastic and Hand Surgery, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Steffen U Eisenhardt
- Department of Plastic and Hand Surgery, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
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Zheng B, Qu Y, Wang J, Shi Y, Yan W. Pathogenic and Targetable Genetic Alterations in Resected Recurrent Undifferentiated Pleomorphic Sarcomas Identified by Targeted Next-generation Sequencing. Cancer Genomics Proteomics 2019; 16:221-228. [PMID: 31018952 DOI: 10.21873/cgp.20127] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 03/17/2019] [Accepted: 03/18/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND/AIM Undifferentiated pleomorphic sarcomas (UPSs) are difficult to treat, with a high recurrence rate. However, the genetic and molecular characterization of recurrent UPS has not been identified. PATIENTS AND METHODS In this study, we investigated the pathogenic and targetable genetic alterations in 16 paired locally pre-recurrent and post-recurrent UPS cases by targeted next-generation sequencing (466 genes). RESULTS Sequence variations were most frequently found in TP53 (66%), ATRX (34%), and RB1 (28%). In addition, for the first time, recurrent IL7R gene amplification (19%) and KMT2C gene mutation (16%) were detected in UPS. Interestingly, genetic alterations varied with tumor relapse. Importantly, targetable driver variants were found in recurrent UPS. Mutated genes were correlated with the cell cycle, PI3K/mTOR and RAS/MAPK signaling pathways. TMB was also found to be increased after tumor recurrence (4.6 vs. 7.5 mutations/MB, p=0.0343). CONCLUSION Routine use of targeted next-generation sequencing for recurrent UPS can facilitate timely therapeutic decision-making.
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Affiliation(s)
- Biqiang Zheng
- Department of Musculoskeletal Cancer Surgery, Fudan University Shanghai Cancer Center, Shanghai, P.R. China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China
| | | | | | - Yingqiang Shi
- Department of Musculoskeletal Cancer Surgery, Fudan University Shanghai Cancer Center, Shanghai, P.R. China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China
| | - Wangjun Yan
- Department of Musculoskeletal Cancer Surgery, Fudan University Shanghai Cancer Center, Shanghai, P.R. China .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China
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A Meta-Analysis of the Association Between Radiation Therapy and Survival for Surgically Resected Soft-Tissue Sarcoma. Am J Clin Oncol 2019; 41:348-356. [PMID: 26886948 DOI: 10.1097/coc.0000000000000274] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Radiotherapy for soft-tissue sarcoma (STS) has been shown to reduce local recurrence, but without clear improvement in survival. We conducted a meta-analysis to study the association between radiotherapy and survival in patients undergoing surgery for STS. METHODS A systematic review was conducted from PubMed, EMBASE, Web of Science, and Cochrane databases. Our population of interest consisted of adults with primary extremity, chest wall, trunk, or back STS. Our metameters were either an odds or hazard ratio for mortality. A bias score was generated for each study based on margin status and grade. RESULTS Of 1044 studies, 30 met inclusion criteria for final analysis. The pooled odds ratio in patients receiving radiation was 0.94 (95% confidence interval [CI], 0.78-1.14). The pooled estimate of the hazards ratio in patients receiving radiation was 0.87 (95% CI, 0.73-1.03) overall and 0.65 (95% CI, 0.52-0.82) for studies judged to be at low risk of bias. Significant publication bias was not seen. CONCLUSIONS High-quality studies reporting adjusted hazard ratios are associated with improved survival in patients receiving radiotherapy for STS. Studies in which odds ratios are calculated from event data and those that do not report adjusted outcomes do not show the same association, likely due to confounding by indication.
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23
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Sari SY, Yazici G, Gultekin M, Hurmuz P, Gurkaynak M, Ozyigit G. Sarcoma. Radiat Oncol 2019. [DOI: 10.1007/978-3-319-97145-2_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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24
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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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Verschoor A, Litière S, Marréaud S, Judson I, Toulmonde M, Wardelmann E, van der Graaf W, Le Cesne A, Gronchi A, Gelderblom H. Prognostic relevance of distant metastases versus locally advanced disease in soft tissue sarcomas: An EORTC-STBSG database study. Eur J Cancer 2018; 94:187-198. [DOI: 10.1016/j.ejca.2018.02.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 02/03/2018] [Accepted: 02/08/2018] [Indexed: 10/17/2022]
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26
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Séguin B. Canine Soft Tissue Sarcomas: Can Being a Dog's Best Friend Help a Child? Front Oncol 2017; 7:285. [PMID: 29218302 PMCID: PMC5704538 DOI: 10.3389/fonc.2017.00285] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 11/10/2017] [Indexed: 12/14/2022] Open
Abstract
Soft tissue sarcomas (STSs) remain a therapeutic challenge for pediatric and adolescent and young adult (AYA) patients. Still today, surgery, radiation therapy, and chemotherapy remain the mainstay of treatment. Obstacles in developing new treatment approaches to improve the outcome are: few patients to enroll in clinical trials, and the diversity of tumor biology between histologic subtypes. Pet dogs may offer an additional strategy to discover and test new therapeutic avenues. The number of dogs diagnosed with a STS each year in the United States is estimated to be around 27,000 to 95,000. In comparison, approximately 900 children less than 20 years old and 1,500 AYAs between 15 and 29 years old are diagnosed with a STS each year in the United States. The mainstay for treatment of STSs in dogs is also surgery, with radiation therapy and chemotherapy when necessary. Similar to what is seen in humans, grade and stage are prognostic in dogs. In one comparative study of the histology and immunohistochemistry of canine STSs, most tumors were diagnosed as the human equivalent of undifferentiated sarcoma, spindle cell sarcoma, or unclassified spindle cell sarcoma. But much work remains to be done to fully assess the validity of canine STSs as a model. Gene expression analysis has been done in a limited number of canine STSs. Tissue banking, development of cell lines, and the ability to mobilize large-scale clinical trials will become essential in veterinary medicine to benefit both dogs and humans.
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Affiliation(s)
- Bernard Séguin
- Flint Animal Cancer Center, Department of Clinical Sciences, Colorado State University, Fort Collins, CO, United States
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27
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Lewin J, Garg S, Lau BY, Dickson BC, Traub F, Gokgoz N, Griffin AM, Ferguson PC, Andrulis IL, Sim HW, Kamel-Reid S, Stockley TL, Siu LL, Wunder JS, Razak ARA. Identifying actionable variants using next generation sequencing in patients with a historical diagnosis of undifferentiated pleomorphic sarcoma. Int J Cancer 2017; 142:57-65. [PMID: 28891048 DOI: 10.1002/ijc.31039] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 07/19/2017] [Accepted: 08/24/2017] [Indexed: 12/22/2022]
Abstract
There are limited data regarding the molecular characterization of undifferentiated pleomorphic sarcomas (UPS; formerly malignant fibrous histiocytoma). This study aimed to investigate the utility of next generation sequencing (NGS) in UPS to identify subsets of patients who harbour actionable mutations. Patients diagnosed with UPS underwent pathological re-evaluation by a pathologist specializing in sarcoma. Tumor DNA was isolated from archived fresh frozen tissue samples and genotyped using NGS with the Illumina MiSeq TruSeq Amplicon Cancer Panel (48 genes, 212 amplicons). In total, 95 patients initially classified with UPS were identified. Following pathology re-review the histological subtypes were reclassified to include: Myxofibrosarcoma (MFS, N = 44); UPS(N = 18); and Others (N = 27; including undifferentiated spindle cell sarcoma (N = 15) and dedifferentiated liposarcoma (N = 6)). Seven cases were excluded from further analysis for other reasons. Baseline demographics of the finalized cohort (N = 88) showed a median age of 66 years (32-95), primarily with stage I-III disease (92%) and high-grade (86%) lesions. Somatic mutations were identified in 31 cases (35%)(Total mutations = 36: solitary mutation(n = 27); two mutations( =n = 3); three mutations(n = 1)). The most commonly identified mutations were in TP53 (n = 24), ATM (n = 3) and PIK3CA (n = 2). Three of 43 patients with MFS and one of 18 patients with UPS had clinically relevant mutations, mainly related to biomarkers of prediction of response; however few had targetable driver mutations. Somatic mutation status did not influence disease free or overall survival. Based on the small number of clinically relevant mutations, these data do not support the routine use of targeted NGS panels outside of research protocols in UPS.
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Affiliation(s)
- Jeremy Lewin
- Sarcoma Program, Mount Sinai Hospital, Toronto, Canada.,Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada
| | - Swati Garg
- Advanced Molecular Diagnostics Laboratory, Princess Margaret Cancer Centre, Toronto, Canada
| | - Beatrice Y Lau
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Canada
| | - Brendan C Dickson
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Canada
| | - Frank Traub
- Department of Orthopedic surgery, University Hospital Tuebingen, Erberhad Karls University Tuebingen, Germany
| | - Nalan Gokgoz
- Lunenfeld-Tanenbaum Research Institute, Toronto, Canada
| | | | - Peter C Ferguson
- Department of Surgery, Mount Sinai Hospital, University of Toronto, University Musculoskeletal Oncology Unit and Division of Orthopaedic Surgery, Toronto, Canada
| | - Irene L Andrulis
- Lunenfeld-Tanenbaum Research Institute, Toronto, Canada.,Department of Molecular Genetics, University of Toronto, Toronto, Canada
| | - Hao-Wen Sim
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada
| | - Suzanne Kamel-Reid
- Advanced Molecular Diagnostics Laboratory, Princess Margaret Cancer Centre, Toronto, Canada.,Department of Clinical Laboratory Genetics, Laboratory Medicine Program, University Health Network, Toronto, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Candada.,Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | - Tracy L Stockley
- Advanced Molecular Diagnostics Laboratory, Princess Margaret Cancer Centre, Toronto, Canada.,Department of Clinical Laboratory Genetics, Laboratory Medicine Program, University Health Network, Toronto, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Candada
| | - Lillian L Siu
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada
| | - Jay S Wunder
- Department of Surgery, Mount Sinai Hospital, University of Toronto, University Musculoskeletal Oncology Unit and Division of Orthopaedic Surgery, Toronto, Canada
| | - Albiruni R A Razak
- Sarcoma Program, Mount Sinai Hospital, Toronto, Canada.,Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada
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28
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Prognostic microRNAs modulate the RHO adhesion pathway: A potential therapeutic target in undifferentiated pleomorphic sarcomas. Oncotarget 2016; 6:39127-39. [PMID: 25970788 PMCID: PMC4770761 DOI: 10.18632/oncotarget.3926] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 04/08/2015] [Indexed: 12/31/2022] Open
Abstract
A common and aggressive subtype of soft-tissue sarcoma, undifferentiated pleomorphic sarcoma (UPS) was examined to determine the role of micro-RNAs (miRNAs) in modulating distant metastasis. Following histopathologic review, 110 fresh frozen clinically annotated UPS samples were divided into two independent cohorts for Training (42 patients), and Validation (68 patients) analyses. Global miRNA profiling on the Training Set and functional analysis in vitro suggested that miRNA-138 and its downstream RHO-ROCK cell adhesion pathway was a convergent target of miRNAs associated with the development of metastasis. A six-miRNA signature set prognostic of distant metastasis-free survival (DMFS) was developed from Training Set miRNA expression values. Using the six-miRNA signature, patients were successfully categorized into high- and low-risk groups for DMFS in an independent Validation Set, with a hazard ratio (HR) of 2.25 (p = 0.048). After adjusting for other known prognostic variables such as age, gender, tumor grade, size, depth, and treatment with radiotherapy, the six-miRNA signature retained prognostic value with a HR of 3.46 (p < 0.001). A prognostic miRNA biomarker for clinical validation was thus identified along with a functional pathway that modulates UPS metastatic phenotype.
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29
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Significant blockade of multiple receptor tyrosine kinases by MGCD516 (Sitravatinib), a novel small molecule inhibitor, shows potent anti-tumor activity in preclinical models of sarcoma. Oncotarget 2016; 7:4093-109. [PMID: 26675259 PMCID: PMC4826192 DOI: 10.18632/oncotarget.6547] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 11/25/2015] [Indexed: 01/12/2023] Open
Abstract
Sarcomas are rare but highly aggressive mesenchymal tumors with a median survival of 10–18 months for metastatic disease. Mutation and/or overexpression of many receptor tyrosine kinases (RTKs) including c-Met, PDGFR, c-Kit and IGF1-R drive defective signaling pathways in sarcomas. MGCD516 (Sitravatinib) is a novel small molecule inhibitor targeting multiple RTKs involved in driving sarcoma cell growth. In the present study, we evaluated the efficacy of MGCD516 both in vitro and in mouse xenograft models in vivo. MGCD516 treatment resulted in significant blockade of phosphorylation of potential driver RTKs and induced potent anti-proliferative effects in vitro. Furthermore, MGCD516 treatment of tumor xenografts in vivo resulted in significant suppression of tumor growth. Efficacy of MGCD516 was superior to imatinib and crizotinib, two other well-studied multi-kinase inhibitors with overlapping target specificities, both in vitro and in vivo. This is the first report describing MGCD516 as a potent multi-kinase inhibitor in different models of sarcoma, superior to imatinib and crizotinib. Results from this study showing blockade of multiple driver signaling pathways provides a rationale for further clinical development of MGCD516 for the treatment of patients with soft-tissue sarcoma.
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30
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Boerkamp KM, Hellmén E, Willén H, Grinwis GCM, Teske E, Rutteman GR. Unclassified sarcomas: a study to improve classification in a cohort of Golden Retriever dogs. J Vet Diagn Invest 2016; 28:623-631. [PMID: 27698172 DOI: 10.1177/1040638716660130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Morphologically, canine soft-tissue sarcomas (STSs) resemble human STSs. In humans, proper classification of STSs is considered essential to improve insight in the biology of these tumors, and to optimize diagnosis and therapy. To date, there is a paucity of data published on the significance of detailed classification of STSs in the dog. We revised a cohort (n = 110) of proliferative lesions obtained from a study in Golden Retrievers that were considered "soft tissue sarcoma, not otherwise specified or of uncertain subtype" in order to optimize the diagnoses of these lesions. The criteria according to the veterinary WHO classification, recent veterinary literature, and the WHO classification for humans were applied. Revision was initially based on morphologic characteristics of hematoxylin and eosin-stained histologic sections of the neoplasms. If considered necessary (n = 76), additional immunohistochemistry was applied to aid characterization. The diagnosis of STS was confirmed in 75 neoplasms (68%). Of this group, diagnosis of a specific subtype of the STSs was possible in 58 neoplasms. Seven neoplasms had morphologic characteristics that were suggestive for sarcoma subtypes only described in the WHO classification for humans. Seventeen neoplasms remained "unclassified STSs." Thirty-one lesions (28%) were diagnosed "neoplasm, not being STS." Four lesions (4%) were considered nonneoplastic. Because incorrect classification of a tumor could lead to inappropriate therapeutic intervention and prognostication, the results of our study clearly illustrate the importance of revision and further diagnosis of "unclassified STSs" in dogs.
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Affiliation(s)
- Kim M Boerkamp
- Departments of Clinical Sciences of Companion Animals (Boerkamp, Teske), Faculty of Veterinary Medicine, Utrecht University, Utrecht, The NetherlandsPathobiology (Grinwis), Faculty of Veterinary Medicine, Utrecht University, Utrecht, The NetherlandsDepartment of Anatomy, Physiology and Biochemistry, Swedish University of Agricultural Sciences, Uppsala, Sweden (Hellmén)University Hospital, Clinical Pathology and Cytology, Uppsala, Sweden (Willén)Oncology Section, Veterinary Specialist Center De Wagenrenk, Wageningen, The Netherlands (Rutteman)
| | - Eva Hellmén
- Departments of Clinical Sciences of Companion Animals (Boerkamp, Teske), Faculty of Veterinary Medicine, Utrecht University, Utrecht, The NetherlandsPathobiology (Grinwis), Faculty of Veterinary Medicine, Utrecht University, Utrecht, The NetherlandsDepartment of Anatomy, Physiology and Biochemistry, Swedish University of Agricultural Sciences, Uppsala, Sweden (Hellmén)University Hospital, Clinical Pathology and Cytology, Uppsala, Sweden (Willén)Oncology Section, Veterinary Specialist Center De Wagenrenk, Wageningen, The Netherlands (Rutteman)
| | - Helena Willén
- Departments of Clinical Sciences of Companion Animals (Boerkamp, Teske), Faculty of Veterinary Medicine, Utrecht University, Utrecht, The NetherlandsPathobiology (Grinwis), Faculty of Veterinary Medicine, Utrecht University, Utrecht, The NetherlandsDepartment of Anatomy, Physiology and Biochemistry, Swedish University of Agricultural Sciences, Uppsala, Sweden (Hellmén)University Hospital, Clinical Pathology and Cytology, Uppsala, Sweden (Willén)Oncology Section, Veterinary Specialist Center De Wagenrenk, Wageningen, The Netherlands (Rutteman)
| | - Guy C M Grinwis
- Departments of Clinical Sciences of Companion Animals (Boerkamp, Teske), Faculty of Veterinary Medicine, Utrecht University, Utrecht, The NetherlandsPathobiology (Grinwis), Faculty of Veterinary Medicine, Utrecht University, Utrecht, The NetherlandsDepartment of Anatomy, Physiology and Biochemistry, Swedish University of Agricultural Sciences, Uppsala, Sweden (Hellmén)University Hospital, Clinical Pathology and Cytology, Uppsala, Sweden (Willén)Oncology Section, Veterinary Specialist Center De Wagenrenk, Wageningen, The Netherlands (Rutteman)
| | - Erik Teske
- Departments of Clinical Sciences of Companion Animals (Boerkamp, Teske), Faculty of Veterinary Medicine, Utrecht University, Utrecht, The NetherlandsPathobiology (Grinwis), Faculty of Veterinary Medicine, Utrecht University, Utrecht, The NetherlandsDepartment of Anatomy, Physiology and Biochemistry, Swedish University of Agricultural Sciences, Uppsala, Sweden (Hellmén)University Hospital, Clinical Pathology and Cytology, Uppsala, Sweden (Willén)Oncology Section, Veterinary Specialist Center De Wagenrenk, Wageningen, The Netherlands (Rutteman)
| | - Gerard R Rutteman
- Departments of Clinical Sciences of Companion Animals (Boerkamp, Teske), Faculty of Veterinary Medicine, Utrecht University, Utrecht, The NetherlandsPathobiology (Grinwis), Faculty of Veterinary Medicine, Utrecht University, Utrecht, The NetherlandsDepartment of Anatomy, Physiology and Biochemistry, Swedish University of Agricultural Sciences, Uppsala, Sweden (Hellmén)University Hospital, Clinical Pathology and Cytology, Uppsala, Sweden (Willén)Oncology Section, Veterinary Specialist Center De Wagenrenk, Wageningen, The Netherlands (Rutteman)
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The demographic features, clinicopathologic characteristics, treatment outcome and disease-specific prognostic factors of solitary fibrous tumor: a population-based analysis. Oncotarget 2016; 6:41875-83. [PMID: 26496033 PMCID: PMC4747195 DOI: 10.18632/oncotarget.6174] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 10/06/2015] [Indexed: 11/25/2022] Open
Abstract
Background Solitary fibrous tumor's (SFT) demographic features, clinicopathologic characteristics, treatment outcome and disease-specific prognostic factors were unexplored comprehensively. Methods SEER program was used to identify patients diagnosed with SFT from 1973 to 2012. Overall collected data were analyzed by using the SPSS 18.0. Results In total, 804 cases were found including 613 cases with SFT-specific mortality and 801 patients were analyzed for overall survival (OS). The 3-year disease specific survival (DSS), 5-year DSS and 10-year DSS were 73.3%, 65.7% and 53.3%. The 3-year OS, 5-year OS and 10-year OS were 71.9%, 63.3% and 47.3%. In the multivariate survival analysis, the age > 51 years (hazard ratio [HR] = 1.851 for DSS, P = 0.024 and HR = 1.652 for OS, P = 0.033; Reference [Ref] ≤ 51 years for DSS and ≤ 53 years for OS), SEER stage metastasized tumor (HR = 4.269 for DSS, P = 0.000 and HR = 2.905 for OS, P = 0.028, Ref - localized + regional tumor), pathologic grade III + IV (HR = 2.734 for DSS, P = 0.001 and HR = 2.585 for OS, P = 0.000, Ref - grade I + II) were adversely associated with DSS and OS. In addition, surgery was favorably associated with DSS (HR = 0.217, P = 0.045, Ref - surgery + radiotherapy). Conclusions The surgery was an independent prognostic factor for DSS. The patient's age, SEER stage and pathologic grade were SFT-specific independent prognostic indicators for DSS and OS.
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33
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Bray JP. Soft tissue sarcoma in the dog - part 1: a current review. J Small Anim Pract 2016; 57:510-519. [PMID: 27624929 DOI: 10.1111/jsap.12556] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 07/07/2016] [Accepted: 08/08/2016] [Indexed: 12/24/2022]
Abstract
Soft tissue sarcomas are derived from tissues of mesenchymal origin. Although local recurrence following surgical resection is the characteristic challenge in their management, 40% dogs with high-grade tumours may also develop metastatic disease, despite successful local control. Soft tissue sarcoma is a complex disease and there are many uncertainties regarding the biology and optimal clinical management. There are currently no diagnostic tests that can reliably predict the amount of surgical margin required for a particular tumour, so there can be a mismatch between treatment and disease. Historically, the tendency has been to always recommend wide excision margins but this is not fully supported by recent evidence. A selection bias for less aggressive soft tissue sarcomas in primary care practice can account for good outcomes that are achieved despite narrow surgical excision margins. On the other hand, inappropriately conservative treatment will adversely affect outcomes for patients with more aggressive disease. This review provides an update on the current understanding of management of canine soft tissue sarcomas.
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Affiliation(s)
- J P Bray
- Veterinary Teaching Hospital, Institute for Veterinary, Animal and Biomedical Sciences, Massey University, Palmerston North 4442, New Zealand.
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Koulaxouzidis G, Simunovic F, Bannasch H. Soft Tissue Sarcomas of the Arm - Oncosurgical and Reconstructive Principles within a Multimodal, Interdisciplinary Setting. Front Surg 2016; 3:12. [PMID: 26942183 PMCID: PMC4762988 DOI: 10.3389/fsurg.2016.00012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 02/11/2016] [Indexed: 11/13/2022] Open
Abstract
Soft tissue sarcomas of the upper extremity represent a severe threat for the patient and a difficult task for the treatment team. Due to the complex anatomy of the arm, most sarcomas involve valuable functional structures. Nonetheless, a large portion of the patients can be treated in a limb-sparing manner, and surgery is the mainstay of local tumor control. This review gives an overview of the disease entities and their epidemiology, on necessary patient work-up, staging, and imaging modalities, as well as the importance of interdisciplinary decision-making. The surgical therapies and principles of tumor excision are outlined, as well as reconstructive options. Furthermore, adjuvant treatments are discussed with a special focus on the various application techniques for radiation therapy. In spite of established treatment algorithms, each case is an individual challenge and individually tailored therapy is required. This aspect is illustrated by presenting three comprehensive cases demonstrating useful strategies. A summary of the relevant literature is given.
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Affiliation(s)
- Georgios Koulaxouzidis
- Department of Plastic and Hand Surgery, University of Freiburg Medical Center , Freiburg , Germany
| | - Filip Simunovic
- Department of Plastic and Hand Surgery, University of Freiburg Medical Center , Freiburg , Germany
| | - Holger Bannasch
- Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Freiburg, Germany; Section for -Plastic-Reconstructive Tumor Surgery, University of Freiburg Medical Center, Freiburg, Germany
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35
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Yuen NK, Li CS, Monjazeb AM, Borys D, Bold RJ, Canter RJ. Older age impacts radiotherapy-related outcomes in soft tissue sarcoma. J Surg Res 2015; 199:494-504. [PMID: 26163324 DOI: 10.1016/j.jss.2015.06.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 05/27/2015] [Accepted: 06/10/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Radiation therapy (RT) is a standard component in the multimodality management of localized soft tissue sarcoma (STS). Increasing studies are focusing on biological modifiers that may influence the host's response to RT, including immunologic mechanisms known to change with the aging process. We hypothesized that the effects of RT would be influenced by age, contributing to differences in treatment outcome. METHODS Using Surveillance, Epidemiology, and End Results (1990-2011), we identified 30,898 adult patients (>18 y) with nonmetastatic STS undergoing initial surgery. We compared patient demographics, tumor characteristics, and treatments by age. Multivariable analyses were used to analyze overall survival (OS) and disease-specific survival (DSS). Hazard ratios (HRs) were calculated based on multivariable Cox proportional hazards models. RESULTS Mean age at diagnosis was 56.6 ± 16.8 y, and 33.6% of patients were ≥65 y. Of the total, 52.1% of patients were male and 67% were white; 59.9% of patients underwent surgery alone, 33.3% received adjuvant RT, and 6.8% neoadjuvant RT. On multivariable analysis, age, sex, year of diagnosis, histology, grade, size, marital status, and RT predicted OS, whereas age, year of diagnosis, ethnicity, histology, site, grade, RT, size, and marital status predicted DSS. In all patients, RT was associated with improved OS and DSS compared to surgery alone (median OS 136 ± 13 mo with RT versus 118 ± 9 mo without RT and 5-y OS 63.2 ± 1.4% with RT versus 60.5 ± 1.2% without, P < 0.01). Patients ≥65 y derived greater improvements in OS and DSS compared with patients <65 y. These benefits were most notable after neoadjuvant RT with patients ≥65 y having significantly better OS (HR = 0.63; 95% confidence interval = 0.53-0.75), whereas patients <65 y did not (HR = 0.96; 95% confidence interval = 0.83-1.10). In addition, interaction testing demonstrated a significant modifier effect between RT and age (P < 0.05). CONCLUSIONS RT is associated with improved survival in patients with STS undergoing surgical treatment, but improvements in oncologic outcome with RT were greatest among older patients. Further studies into the mechanism of these age-related effects are needed.
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Affiliation(s)
- Noah K Yuen
- Division of Surgical Oncology, Department of Surgery, UC Davis School of Medicine, Sacramento, California
| | - Chin-Shang Li
- Division of Biostatistics, Department of Public Health Sciences, UC Davis, Sacramento, California
| | - Arta M Monjazeb
- Department of Radiation Oncology, UC Davis School of Medicine, Sacramento, California
| | - Dariusz Borys
- Department of Pathology, Stritch School of Medicine, Loyola University, Chicago, Illinois
| | - Richard J Bold
- Division of Surgical Oncology, Department of Surgery, UC Davis School of Medicine, Sacramento, California
| | - Robert J Canter
- Division of Surgical Oncology, Department of Surgery, UC Davis School of Medicine, Sacramento, California.
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Lazarides AL, Eward WC, Speicher PJ, Hou CH, Nussbaum DP, Green C, Blazer DG, Kirsch DG, Brigman BE. The Use of Radiation Therapy in Well-Differentiated Soft Tissue Sarcoma of the Extremities: An NCDB Review. Sarcoma 2015; 2015:186581. [PMID: 26064077 PMCID: PMC4439510 DOI: 10.1155/2015/186581] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Revised: 04/10/2015] [Accepted: 04/21/2015] [Indexed: 11/17/2022] Open
Abstract
Objective. This study investigated patterns of utilization of radiation therapy (RT) and correlated this with overall survival by assessing patients with well-differentiated soft tissue sarcoma of the extremity (STS-E) in the National Cancer Database (NCDB). Methods. All patients diagnosed with well-differentiated STS-E between 1998 and 2006 were identified in the NCDB. Patients were stratified by use of surgery alone versus use of adjuvant RT after surgery and analyzed using multivariate analysis, Kaplan-Meier analysis, and propensity matching. Results. 2113 patients with well-differentiated STS-E were identified in the NCDB for inclusion with a mean follow-up time of 74 months. 69% of patients were treated with surgery alone, while 26% were treated with surgery followed by adjuvant RT. Patients undergoing amputation were less likely to receive adjuvant RT. There was no difference in overall survival between patients with well-differentiated STS treated with surgery alone and those patients who received adjuvant RT. Conclusions. In the United States, adjuvant RT is being utilized in a quarter of patients being treated for well-differentiated STS-E. While the use of adjuvant RT may be viewed as a means to facilitate limb salvage, this large national database review confirms no survival benefit, regardless of tumor size or margin status.
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Affiliation(s)
| | - William C. Eward
- Department of Surgery, Division of Orthopedic Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Paul J. Speicher
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Chun-Han Hou
- Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei 10617, Taiwan
| | - Daniel P. Nussbaum
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Cindy Green
- Department of Surgery, Division of Orthopedic Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Dan G. Blazer
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | - David G. Kirsch
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710, USA
| | - Brian E. Brigman
- Department of Surgery, Division of Orthopedic Surgery, Duke University Medical Center, Durham, NC 27710, USA
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Naing KW, Monjazeb AM, Li CS, Lee LY, Yang A, Borys D, Canter RJ. Perioperative radiotherapy is associated with improved survival among patients with synovial sarcoma: A SEER analysis. J Surg Oncol 2014; 111:158-64. [PMID: 25176165 DOI: 10.1002/jso.23780] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 08/05/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND METHODS We examined the outcomes of synovial sarcoma (SS) patients in a national database. We identified 1,189 patients from the Surveillance, Epidemiology, and End Results (SEER) database with data on site and extent of surgery. We excluded patients diagnosed before 1990, <18 years, or lacking pathologic confirmation. Using Kaplan-Meier and Cox proportional hazards analyses, we determined predictors of overall (OS) and disease-specific survival (DSS). RESULTS The mean age was 41, 49.3% were female, and 82.2% were white. Radiotherapy (RT) was administered to 57.5%. On multivariable analysis, age at diagnosis, sex, race, anatomic site, SEER summary stage, tumor size, surgery type, and RT predicted OS. Similar predictors of DSS were identified. The hazard ratio (HR) for OS was 0.65 (95% CI 0.48-0.88) in favor of RT and 0.62 (95% CI 0.45-0.86) for DSS. Five-year OS improved 8.4 ± 1.0% with RT (P=0.003), and five-year DSS improved 7.7 ± 1.0% with RT (P=0.015). CONCLUSIONS In the largest study to date examining the role of RT in synovial sarcoma, we observed that RT was associated with a statistically significant improvement in oncologic outcome among SS patients. These data support the use of RT in the multi-modality treatment of patients with SS.
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Affiliation(s)
- Khatija W Naing
- Division of Surgical Oncology, Department of Surgery, Davis Medical Center, University of California, Sacramento, California
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Costs Associated with Intravenous Cancer Therapy Administration in Patients with Metastatic Soft Tissue Sarcoma in a US Population. Sarcoma 2014; 2013:947413. [PMID: 24453570 PMCID: PMC3884837 DOI: 10.1155/2013/947413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 11/25/2013] [Indexed: 11/17/2022] Open
Abstract
Background. The most common chemotherapies in metastatic soft tissue sarcoma (mSTS) require intravenous (IV) administration. This often requires patients to make multiple outpatient visits per chemotherapy cycle, possibly impeding patients' daily activities and increasing caregiver burden and medical costs. This study investigated costs associated with IV cancer therapy administration in mSTS from the payer perspective of the health care system. Patients and Methods. From the Experian Healthcare database, 1,228 mSTS patients were selected. Data were analyzed on outpatient visits during 2005–2012 involving IV cancer therapy administration. Costs were estimated on a per patient per visit (PPPV) and per patient per month (PPPM) basis. Results. The mean (median) cost of IV therapy was $2,427 ($1,532) PPPV and $5,468 ($4,310) PPPM, of which approximately 60% was IV drug costs. IV administration costs averaged $399 PPPV and $900 PPPM, representing 16.5% of total visit costs. Anthracycline and alkylating-agents-based therapies had the highest PPPV and PPPM IV administration costs, respectively (mean $479 and $1,336, resp.). Patients with managed care insurance had the highest IV administration costs (mean $504 PPPV; $1,120 PPPM). Conclusions. IV administration costs constitute a considerable proportion of the total costs of receiving an IV cancer therapy to treat mSTS.
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Potter BK, Hwang PF, Forsberg JA, Hampton CB, Graybill JC, Peoples GE, Stojadinovic A. Impact of margin status and local recurrence on soft-tissue sarcoma outcomes. J Bone Joint Surg Am 2013; 95:e151. [PMID: 24132366 DOI: 10.2106/jbjs.l.01149] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The impact of local recurrence and surgical resection margin status on survival in extremity soft-tissue sarcomas remains to be clearly defined. Our aim was to conduct a retrospective analysis of prospectively collected data to determine the prognostic relevance of positive resection margins and local recurrence for extremity soft-tissue sarcomas for survival. METHODS Three hundred and sixty-three patients who underwent resection of localized primary extremity soft-tissue sarcomas with curative intent were selected from the United States Department of Defense Automated Central Tumor Registry. Outcomes for local recurrence, distant recurrence, disease-specific survival, and overall survival were analyzed according to clinical, pathological, and treatment variables with use of the Kaplan-Meier method (log-rank test) and the multivariate Cox regression model. RESULTS Positive margins (hazard ratio, 1.99 [95% confidence interval, 1.15 to 3.45]), local recurrence (hazard ratio, 2.93 [95% confidence interval, 1.38 to 6.23]), and distant recurrence (hazard ratio, 12.13 [95% confidence interval, 5.97 to 24.65]) were significantly associated with overall survival on multivariate Cox regression analysis. However, for disease-specific survival, local recurrence was not significant and tumor size of >10 cm (hazard ratio, 2.83 [95% confidence interval, 1.15 to 6.95]), positive margins (hazard ratio, 1.95 [95% confidence interval, 1.05 to 3.63]), and distant recurrence (hazard ratio, 9.46 [95% confidence interval, 4.37 to 20.47]) were independent adverse prognostic factors. The disease-specific survival rate for patients with localized soft-tissue sarcomas was 89% (95% confidence interval, 85% to 92%) for five years and 75% (95% confidence interval, 70% to 81%) for ten years. CONCLUSIONS Positive surgical margins are consistently associated with adverse survival-related outcomes in localized soft-tissue sarcomas of the extremity. Local recurrence had a significant impact on overall survival, but not on disease-specific survival.
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Affiliation(s)
- Benjamin K Potter
- Departments of Orthopaedics (B.K.P., C.B.H., and J.A.F) and Surgery (P.F.H. and J.C.G.), Walter Reed National Military Medical Center, 8901 Rockville Pike, America Building (Building 19), 2nd Floor, Orthopaedics, Bethesda, MD 20889. E-mail address for B.K. Potter:
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Binitie O, Tejiram S, Conway S, Cheong D, Temple HT, Letson GD. Adult soft tissue sarcoma local recurrence after adjuvant treatment without resection of core needle biopsy tract. Clin Orthop Relat Res 2013; 471:891-8. [PMID: 22968531 PMCID: PMC3563812 DOI: 10.1007/s11999-012-2569-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Core needle biopsies of sarcomas allow a diagnosis in a high percentage of patients with few complications. However, it is unclear whether the tract needs to be excised to prevent recurrences. QUESTIONS/PURPOSES We therefore determined the rates of recurrence and metastases in patients with Stage III extremity sarcomas, who underwent wide local resection without excision of the needle tract and also received adjuvant treatment. METHODS We retrospectively reviewed 59 adult patients with deep, larger than 5 cm, high-grade soft tissue sarcomas of the upper or lower extremity treated between January 1999 and April 2009. All the patients underwent a core needle biopsy. Resection was performed with wide margins. The biopsy tract was not resected during the definitive surgery. Fifty-seven patients (97%) received preoperative and/or postoperative radiation, whereas 49 patients (83%) received chemotherapy. Local recurrence and distant recurrence rates were determined. The minimum followup was 24 months (median, 56 months; range, 24-122 months). RESULTS The local recurrence rate was 9%. Fifteen patients (25%) developed metastasis after diagnosis. Seven of the 59 patients (12%) had microscopic positive margins at resection. CONCLUSIONS Our data demonstrate no increase in local recurrence rates or rates of metastatic disease compared with previously published studies when resection of the core biopsy tract was not performed. LEVEL OF EVIDENCE Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Odion Binitie
- />H. Lee Moffitt Cancer Center & Research Institute, Sarcoma Program, 12902 Magnolia Drive, Tampa, FL 33612 USA
| | - Shawn Tejiram
- />H. Lee Moffitt Cancer Center & Research Institute, Sarcoma Program, 12902 Magnolia Drive, Tampa, FL 33612 USA
| | - Sheila Conway
- />Department of Orthopaedics and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL USA
| | - David Cheong
- />H. Lee Moffitt Cancer Center & Research Institute, Sarcoma Program, 12902 Magnolia Drive, Tampa, FL 33612 USA
| | - H. Thomas Temple
- />Department of Orthopaedics and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL USA
| | - G. Douglas Letson
- />H. Lee Moffitt Cancer Center & Research Institute, Sarcoma Program, 12902 Magnolia Drive, Tampa, FL 33612 USA
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Ipach I, Ingmar I, Wingert T, Tobias W, Kunze B, Beate K, Kluba T, Torsten K. Oncological outcome and prognostic factors in the therapy of soft tissue sarcoma of the extremities. Orthop Rev (Pavia) 2012; 4:e34. [PMID: 23589762 PMCID: PMC3626305 DOI: 10.4081/or.2012.e34] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 09/18/2012] [Accepted: 10/02/2012] [Indexed: 11/22/2022] Open
Abstract
Uniform conclusions about therapeutic concepts and survival time of bone and soft tissue sarcoma patients are difficult due to the heterogeneity of histological subtypes as well as the different responses to neoadjuvant therapy. The subject of this retrospective study was the analysis of tumour free survival, risk and prognostic factors of sarcoma patients treated by limb sparing techniques or amputation. We included 118 patients with soft tissue sarcoma of the extremities treated primarily or secondarily at our institution between 1990 and 2008 with a minimum follow-up of 12 months. Data about the tumour free survival time, operative techniques and potential prognostic factors were analysed. The tumour-specific and overall survival were significantly influenced by two factors: the grading and distant metastases present at time of diagnosis. Optimal multimodal therapeutic concepts at a specialized Cancer Center decreased the risk of local recurrence. The importance of optimal preoperative and surgical course concerning the oncological long term outcome was investigated. The decrease in local recurrence as a result of multimodal therapeutic concepts at a specialized Cancer Center was confirmed. To evaluate the individual prognosis of a patient, multiple factors have to be considered. Factors for a poor prognosis are primary metastasis, high-grade tumours and several histological entities (e.g. synovial sarcoma, not other specified).
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Affiliation(s)
- Ingmar Ipach
- Department of Orthopaedic Surgery, University of Tuebingen
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Smith CA, Martinez SR, Tseng WH, Tamurian RM, Bold RJ, Borys D, Canter RJ. Predicting Survival for Well-Differentiated Liposarcoma: The Importance of Tumor Location. J Surg Res 2012; 175:12-7. [DOI: 10.1016/j.jss.2011.07.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 07/07/2011] [Accepted: 07/11/2011] [Indexed: 10/17/2022]
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Forsberg JA, Healey JH, Brennan MF. A probabilistic analysis of completely excised high-grade soft tissue sarcomas of the extremity: an application of a Bayesian belief network. Ann Surg Oncol 2012; 19:2992-3001. [PMID: 22526900 DOI: 10.1245/s10434-012-2345-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Indexed: 12/28/2022]
Abstract
BACKGROUND It is important to understand the relative importance of prognostic variables in patients with soft tissue sarcomas. The purpose of this study was to describe the hierarchical relationships between features inherent to completely excised, localized high-grade soft tissue sarcomas of the extremity and compare the associations to those previously reported. METHODS Data were collected from the Memorial Sloan-Kettering Cancer Center Sarcoma Database. All adult patients with high-grade extremity soft tissue sarcomas who underwent complete excision (R0 margins) at our institution between 1982 and 2010 were included in the analysis. Bayesian belief network (BBN) modeling software was used to develop a hierarchical network of features trained to estimate the likelihood of disease-specific survival. Important relationships depicted by the BBN model were compared to those previously reported. RESULTS The records of 1318 consecutive patients met the inclusion criteria, and all were included in the analysis. First-degree associates of disease-specific survival were the primary tumor size; presence of and time to distant recurrence; and presence of and time to local recurrence. On cross-validation, the BBN model was sufficiently robust, with an area under the curve of 0.94 (95 % confidence interval 0.93-0.96). CONCLUSIONS We successfully described the hierarchical relationships between features inherent to patients with completely excised high-grade soft tissue sarcomas of the extremity. The relationships defined by the BBN model were similar to those previously reported. Cross-validation results were encouraging, demonstrating that BBN modeling can be used to graphically illustrate the complex hierarchical relationships between prognostic features in this setting.
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Abbott AM, Habermann EB, Parsons HM, Tuttle T, Al-Refaie W. Prognosis for primary retroperitoneal sarcoma survivors. Cancer 2012; 118:3321-9. [DOI: 10.1002/cncr.26665] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Revised: 08/30/2011] [Accepted: 09/01/2011] [Indexed: 01/01/2023]
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Reconstructive treatment of soft tissue sarcoma of the upper extremity. J Hand Surg Am 2011; 36:1241-7. [PMID: 21664071 DOI: 10.1016/j.jhsa.2011.04.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Accepted: 04/27/2011] [Indexed: 02/02/2023]
Abstract
Limb-sparing surgery is currently the cornerstone of treatment for most patients with soft-tissue sarcoma of the upper extremity. To achieve the best outcome, the reconstructive surgeon must be part of a multidisciplinary team and is required to have a thorough understanding of the whole treatment concept. This article provides an update for the current surgical management of patients with soft tissue sarcoma of the upper extremity. Relevant nonsurgical aspects are also highlighted.
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Bibliography. Supportive care. Current world literature. Curr Opin Oncol 2011; 23:415-6. [PMID: 21654394 DOI: 10.1097/cco.0b013e328348d4f4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sacramento area breast cancer epidemiology study: use of postmastectomy breast reconstruction along the rural-to-urban continuum. Plast Reconstr Surg 2011; 126:1815-1824. [PMID: 21124121 DOI: 10.1097/prs.0b013e3181f444bc] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Health care disparities have been documented in rural populations. The authors hypothesized that breast cancer patients in urban counties would have higher rates of postmastectomy breast reconstruction relative to patients in surrounding near-metro and rural counties. METHODS The authors used the Surveillance, Epidemiology, and End Results database to identify patients diagnosed with breast cancer and treated with mastectomy in the greater Sacramento area between 2000 and 2006. Counties were categorized as urban, near-metro, or rural. Univariate models evaluated the relationship of rural, near-metro, or urban location with use of breast reconstruction by means of the chi-square test. Multivariate logistic regression models controlling for patient, tumor, and treatment-related factors predicted use of breast reconstruction. The likelihood of undergoing breast reconstruction was reported as odds ratios with 95 percent confidence intervals; significance was set at p≤0.05. RESULTS Complete information was available for 3552 breast cancer patients treated with mastectomy. Of these, 718 (20.2 percent) underwent breast reconstruction. On univariate analysis, differences in the rates of breast reconstruction were noted among urban, near-metro, and rural areas (p<0.001). On multivariate analysis, patients from rural (odds ratio, 0.51; 95 percent confidence interval, 0.28 to 0.93; p<0.03) and near-metro (odds ratio, 0.73; 95 percent confidence interval, 0.59 to 0.89; p=0.002) areas had a decreased likelihood of undergoing breast reconstruction relative to patients from urban areas. CONCLUSIONS Patients from near-metro and rural areas are less likely to undergo breast reconstruction following mastectomy for breast cancer than their urban counterparts. Differences in use of breast reconstruction detected at a population level should guide future interventions to increase rates of breast reconstruction at the local level.
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Dennis MM, McSporran KD, Bacon NJ, Schulman FY, Foster RA, Powers BE. Prognostic Factors for Cutaneous and Subcutaneous Soft Tissue Sarcomas in Dogs. Vet Pathol 2010; 48:73-84. [DOI: 10.1177/0300985810388820] [Citation(s) in RCA: 165] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- M. M. Dennis
- Faculty of Veterinary Science, University of Sydney, Sydney, New South Wales, Australia
| | | | - N. J. Bacon
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - F. Y. Schulman
- Department of Veterinary Pathology, Armed Forces Institute of Pathology, Washington, DC, and Marshfield Labs, Veterinary Services, Marshfield, Wisconsin
| | - R. A. Foster
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - B. E. Powers
- Veterinary Diagnostic Laboratory, Colorado State University, Fort Collins, Colorado
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Tseng WH, Martinez SR. Tumor location predicts survival in cutaneous head and neck melanoma. J Surg Res 2010; 167:192-8. [PMID: 21176922 DOI: 10.1016/j.jss.2010.10.008] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Revised: 10/06/2010] [Accepted: 10/13/2010] [Indexed: 11/29/2022]
Abstract
BACKGROUND Prior studies documented poorer outcomes in patients with cutaneous head and neck melanoma (CHNM) relative to those with melanoma at other sites. We evaluated survival differences attributable to tumor location in patients with CHNM. METHODS We queried the Surveillance, Epidemiology, and End Results (SEER) database for patients undergoing surgery for CHNM from 1988 to 2006, excluding patients without biopsy-proven diagnoses, those diagnosed at autopsy, and patients with distant metastases. Using the Kaplan-Meier method, we assessed patient, tumor, and treatment-specific factors on overall survival (OS) and melanoma specific survival (MSS). Cox proportional hazards models assessed the role of tumor location (ear, eyelid, face, lip, scalp/neck) on OS and MSS, while controlling for patient age, gender, race, tumor thickness, tumor ulceration, lymph node status, histologic subtype, type of surgery, and use of radiation. Risks of overall and melanoma-specific mortality were reported as hazard ratios (HR) with 95% confidence intervals (CI). RESULTS Among 27,097 patients, 10-y rates of OS and MSS were 56.1% and 84.7%, respectively. On multivariate analysis, scalp/neck primary site was associated with an increased risk of overall (HR 1.20, CI 1.14-1.26; P < 0.001) and melanoma-specific mortality (HR 1.64, CI 1.49-1.80, P < 0.001) relative to melanomas of the face. Tumors of the lip had poorer MSS (HR 1.55; CI 1.05-2.28, P = 0.03) but not OS (HR 1.03, CI 0.80-1.34; P = 0.80). CONCLUSIONS Patients with melanomas of the scalp/neck have poorer OS and MSS and those with lip melanomas have poorer MSS. These anatomic areas should not be overlooked when performing skin examinations.
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Affiliation(s)
- Warren H Tseng
- Department of Surgery, Division of Surgical Oncology, University of California Davis, Sacramento, California, USA
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