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Wang B, Xu L, Fang M, Zheng B, Yan W. Establishment of a staging system for visceral sarcoma. Cancer Med 2023; 13:e6791. [PMID: 38102873 PMCID: PMC10807571 DOI: 10.1002/cam4.6791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/22/2023] [Accepted: 11/23/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Visceral sarcoma is a rare malignancy with a poor prognosis. However, there is no recommended prognostic staging system for the malignant disease. METHOD We analyzed the data of patients diagnosed with primary soft tissue sarcoma (STS) of the abdomen and thoracic visceral organs between 2006 and 2017 at our hospital. Prognostic factors (size, tumor grade, and lymph node metastasis) were analyzed in our cohort (n = 203) and the SEER validation cohort (n = 5826). RESULTS Tumor size, grade, and lymph node metastasis were important prognostic factors for visceral sarcoma in both our and the SEER cohorts. Based on these prognostic factors, we established a new staging system for visceral sarcoma, by which patients could be stratified into clinically meaningful and non-overlapping stages in both our cohort and the SEER validation series. Moreover, the area under the curve (AUC) value of the staging system for 5-year survival was 0.84 (95% CI: 0.78-0.89) in our series and 0.80 (95% CI: 0.79-0.81) in SEER series, respectively. In addition, compared with the widely used FIGO staging system for female genital sarcoma, the visceral sarcoma staging system could more effectively and reliably stratify patients into four different prognostic groups. CONCLUSIONS The visceral sarcoma staging system is applicable for STS of the abdomen and thoracic visceral organs and is better than the current FIGO staging system for female genital sarcoma and should be incorporated into the AJCC Cancer Staging Manual.
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Affiliation(s)
- Bingnan Wang
- Department of Musculoskeletal OncologyFudan University Shanghai Cancer CenterShanghaiChina
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Lun Xu
- Department of Musculoskeletal OncologyFudan University Shanghai Cancer CenterShanghaiChina
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Meng Fang
- Department of Musculoskeletal OncologyFudan University Shanghai Cancer CenterShanghaiChina
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Biqiang Zheng
- Department of Musculoskeletal OncologyFudan University Shanghai Cancer CenterShanghaiChina
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Wangjun Yan
- Department of Musculoskeletal OncologyFudan University Shanghai Cancer CenterShanghaiChina
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
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Huang Q, Li W, He X, He Q, Lai Q, Yuan Q, Deng Z. Prognostic visualization model for primary pulmonary sarcoma: a SEER-based study. Sci Rep 2023; 13:17774. [PMID: 37853232 PMCID: PMC10584923 DOI: 10.1038/s41598-023-45058-7] [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: 03/17/2023] [Accepted: 10/15/2023] [Indexed: 10/20/2023] Open
Abstract
Primary pulmonary sarcoma (PPS) is a rare and poor prognostic malignancy that results from current clinical studies are lacking. Our study aimed to investigate the prognostic factors of PPS and to construct a predictive nomogram that predict the overall survival (OS) rate. We extracted data on patients diagnosed with PPS from 2010 to 2019 in the SEER database. A total of 169 patients were included after screening by inclusion and exclusion criteria. Univariate and multivariate COX regression analyses showed that age, pathological grade, liver metastasis, surgical intervention, and chemotherapy influenced the prognosis. We constructed the prediction model nomogram based on these factors. Moreover, the results of the internal and external ROC curves, calibration curves, and DCA plots confirmed that the model has good discrimination, accuracy, and clinical practice efficacy. The present study is the first population-based study to explore the factors affecting the prognosis of PPS. We established a novel prognostic nomogram to predict the OS rate, which can help to make proper clinical decisions.
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Affiliation(s)
- Qian Huang
- Sichuan North Medical College, Nanchong, 637000, Sichuan Province, China
| | - Wenqiang Li
- Zigong First People's Hospital, Zigong City, 643000, Sichuan Province, China
| | - Xiaoyu He
- Sichuan North Medical College, Nanchong, 637000, Sichuan Province, China
| | - Qian He
- West China Second Hospital of Sichuan University, Chengdu, 610044, Sichuan Province, China
| | - Qun Lai
- The First Hospital of Jilin University, Changchun, 130021, Jilin Province, China
| | - Quan Yuan
- Zigong First People's Hospital, Zigong City, 643000, Sichuan Province, China.
| | - Zhiping Deng
- Zigong First People's Hospital, Zigong City, 643000, Sichuan Province, China.
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3
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Gu H, Song R, Beeraka NM, Li T, Zhao D, Liu J, Fan R. SEER-Based Survival Nomogram (1998-2015) Based on 'Stage, Lymph Node Dissection, Tumor Size and Degree of Differentiation, and Therapies' for Prognosis of Primary Pulmonary Sarcoma. Technol Cancer Res Treat 2023; 22:15330338221150732. [PMID: 36740992 PMCID: PMC9903015 DOI: 10.1177/15330338221150732] [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: 02/07/2023] Open
Abstract
Objective: Primary pulmonary sarcoma (PPS) is very rare in terms of incidence, henceforth, the clinical evidence pertinent to the prognosis of PPS is limited. The aim of this study was to construct a nomogram for evaluating the overall survival (OS) of patients diagnosed with PPS based on the stage, lymph node dissection, tumor size and degree of differentiation, and therapies. Methods: A total of 515 patients diagnosed with PPS during the period of 1998 to 2015 were obtained from the surveillance, epidemiology, and end results database and randomly segregated into 'training group' and 'validation group' with a ratio of 7:3. Regression analysis was executed for the training group to obtain the independent factors influencing prognosis of PPS patients. A nomogram was constructed as per the results obtained through multivariate Cox regression analysis subsequently validated using C index, receiver operating characteristic (ROC) curve, and calibration curves. Results: Age, tumor size, histology type, lymph node surgery, summary stage and differentiation grade were independent factors affecting the prognosis. C index was 0.775 and 0.737 for both training group, and validation group, respectively. Areas under the ROC curve of 1-year, 3-year, and 5-year OS were 87.6 (95% CI: 83.8-91.3), 90.1 (95% CI: 86.2-94.0) and 90.6 (95% CI: 85.8-95.4), respectively, in training group. Area under the curve values of 1-year, 3-year, and 5-year OS in the validation group were 83.1 (95% CI: 75.8-90.5), 82.9 (95% CI: 73.2-92.7) and 87.0 (95% CI: 75.9-98.1), respectively. Based on the nomogram, patients were segregated into low-risk group and high-risk group (degree of risk: cutoff score 193). OS of low-risk group was significantly higher when compared to high-risk group (P < .001) in the training group and validation group. Radiotherapy was a risk factor for the low-risk group and adjuvant chemotherapy has not exhibited influence on OS pertinent to low-risk group. However, adjuvant radiotherapy or chemotherapy both significantly improved the prognosis of PPS patients (P < .001) in the high-risk group. Conclusion: Constructed nomogram could have a strong predictive ability with higher accuracy for the prognosis of patients with PPS. Patients at low risk could not benefit from adjuvant radiotherapy or chemotherapy, while the prognosis clearly improved in the high-risk populations treated with either radiotherapy or chemotherapy.
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Affiliation(s)
- Hao Gu
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ruixia Song
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Narasimha M. Beeraka
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China,I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia,JSS College of Pharmacy, JSS Academy of Higher Education and Research (JSS AHER), Mysuru, Karnataka, India
| | - Tingxuan Li
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Di Zhao
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Junqi Liu
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China,Junqi Liu, Department of Radiation Oncology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Erqi District, Zhengzhou 450000, Henan Province, China.
| | - Ruitai Fan
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China,Ruitai Fan, Department of Radiation Oncology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Erqi District, Zhengzhou 450000, Henan Province, China.
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Rajpoot A, Gangakhedkar M, Singh M, Mishra M. Primary pulmonary undifferentiated pleomorphic sarcoma: A rare malignant lung tumor. J Cancer Res Ther 2023; 19:S983-S985. [PMID: 38384097 DOI: 10.4103/jcrt.jcrt_1612_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 08/16/2022] [Indexed: 11/19/2022]
Abstract
ABSTRACT Undifferentiated Pleomorphic Sarcoma (UPS) is a common soft tissue sarcoma that can develop in various organs, but lung involvement is usually due to metastasis. UPS originating primarily in the lungs is called primary pulmonary undifferentiated pleomorphic Sarcoma (PPUPS) and is exceptionally rare. It is a high-grade pleomorphic neoplasm with no identifiable lines of differentiation. Thus, it is essentially a diagnosis of exclusion that requires extensive clinical, radiographic and histopathological evaluation. Herein we report the case of a 49-year-old gentleman who presented with anemia and weight loss and was found to have a large right lung mass. The lesion was diagnosed as PPUPS after detailed histopathological, immunohistochemical and molecular analysis and exclusion of a possible extrapulmonary origin.
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Affiliation(s)
- Akhlesh Rajpoot
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Mihir Gangakhedkar
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Monika Singh
- Department of Pathology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Mayank Mishra
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Zhang MY, Tang LS, Qin ZJ, Hao YT, Cheng K, Zheng A. Clinical features and prognostic factors of pulmonary carcinosarcoma: A nomogram development and validation based on surveillance epidemiology and end results database. Front Med (Lausanne) 2022; 9:988830. [PMID: 36330063 PMCID: PMC9622765 DOI: 10.3389/fmed.2022.988830] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 10/03/2022] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Pulmonary carcinosarcoma (PCS) is a rare but aggressive malignant disease in the lung. It is characterized by coexisting histologic elements of carcinomatous and sarcomatous components. This study aimed to comprehensively understand the clinical features of PCS and develop a nomogram for prognostic prediction of PCS patients. METHODS Data were collected from the Surveillance Epidemiology and End Results (SEER) database between 1975 and 2018. Propensity-score matching (PSM) was used to match the demographic characteristic of the PCS vs. pulmonary sarcoma (PS). Cancer-specific survival (CSS) and overall survival (OS) were the main endpoints of the survival of patients and were evaluated using the Kaplan Meier curves and Cox proportional hazards regression. We further randomly split enrolled PCS patients from SEER into the training and validation sets. All independent predictors for OS of the training set were integrated to create a predictive nomogram. The performance of the nomogram was determined by discrimination, calibration ability, clinical usefulness, and risk stratification ability both in the training and validation cohorts. In addition, the clinical data of PCS patients from the West China Hospital were also retrospectively analyzed by this model. RESULTS A total of 428 PCS patients and 249 PS patients were enrolled from SEER. Compared to pure PS, PCS was associated with significantly better survival in the unmatched cohorts, whereas non-significantly better survival after PSM. In subgroup analysis, PCS showed significantly worse survival than pure PS in subgroups among the race, marital status, and radiation treatment. A nomogram was constructed for PCS patients' survival prediction by combining the independent risk factors, including gender, stage, surgery, radiation, and chemotherapy. The nomogram showed good discrimination, calibration, and predictive power in the training and validation sets. Risk stratification analysis indicated that the nomogram scores efficiently divided PCS patients into low and high-risk groups. CONCLUSION PCS is a rare malignant disease of the lung with distinct clinical features. It had a comparable survival compared with pure PS in the matched cohorts. In addition, a nomogram was developed and validated for predicting the OS in PCS patients.
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Affiliation(s)
- Ming-Yi Zhang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lian-Sha Tang
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhao-Juan Qin
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ya-Ting Hao
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, Ningxia, China
| | - Ke Cheng
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ai Zheng
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
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Badheeb A, Al Gharem N, Al Hammadi S, Elsagheer S, Badheeb M, Ahmed F. Primary pulmonary leiomyosarcoma with coexistent pulmonary aspergillosis: a case report. Pan Afr Med J 2022; 42:135. [PMID: 36060845 PMCID: PMC9429989 DOI: 10.11604/pamj.2022.42.135.34116] [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: 03/04/2022] [Accepted: 06/10/2022] [Indexed: 11/26/2022] Open
Abstract
Coexisting primary pulmonary leiomyosarcoma (PPL) with pulmonary Aspergillosis in immunocompetent patients is a rare occurrence. Here, we presented a 54-year-old woman presented with a dry cough for two months. Bronchoscopy revealed pulmonary aspergillosis. The patient was treated with antifungal therapy for one month without improvement. To evaluate further, a chest computed tomography (CT) scan showed a large heterogeneous enhancing mass in the lower lobe of the left lung with left atrium thrombosis. Computed tomography-guided biopsy was performed, and histopathology demonstrated the diagnosis of PPL. The metastasis workup staging showed multiple metastases in vertebrae, scapula, rib, and liver. The patient was treated with chemotherapy followed by tumor bed radiotherapy. Unfortunately, her general condition worsened, and she passed away with overall survival of fourteen months. In conclusion, clinicians should be alert to underlying malignant disease if airway Aspergillus infection is suspicious in patients without strong risk factors for invasive fungal infection.
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Affiliation(s)
- Ahmed Badheeb
- Department Oncology, King Khalid Hospital, Najran, Saudi Arabia.,Department of Internal Medicine, Faculty of Medicine, Hadhramout University, Hadhramout, Yemen
| | - Nasser Al Gharem
- Department of Radiology, King Khalid Hospital, Najran, Saudi Arabia
| | | | - Said Elsagheer
- Department of Thoracic Surgery, King Khalid Hospital, Najran, Saudi Arabia
| | - Mohamed Badheeb
- Department of General Medicine, King Khalid Hospital, Najran, Saudi Arabia
| | - Faisal Ahmed
- Urology Research Center, Al-Thora General Hospital, Department of Urology, School of Medicine, Ibb University of Medical Science, Ibb, Yemen
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Sayan M, Kankoc A, Ozkan D, Celik A, Kurul IC, Tastepe AI. Prognostic Analysis of Primary Pulmonary Malignant Mesenchymal Tumors Treated Surgically. J Chest Surg 2021; 54:356-360. [PMID: 34376628 PMCID: PMC8548186 DOI: 10.5090/jcs.21.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/31/2021] [Accepted: 06/15/2021] [Indexed: 11/16/2022] Open
Abstract
Background Primary pulmonary malignant mesenchymal tumors are rare, constituting only 0.4% of all lung cancers. Since sarcomas are chemo/radio-resistant, surgical resection is the optimal treatment choice for patients with suitable medical conditions and tumor stage. In the present study, we analyzed the surgical outcomes and survival of primary pulmonary malignant mesenchymal tumors treated surgically. Methods We retrospectively examined the records of patients with primary pulmonary malignant mesenchymal tumors who underwent surgical resection at our department between January 2010 and December 2020. Patient data were analyzed according to age, sex, tumor grade and stage, resection completeness, surgical type, and tumor histopathology. Results Twenty patients were included in the study. There were 13 men (65%) and 7 women (35%). The median survival rate was 36 months (range, 19–53 months), and the 5-year overall survival rate was 37%. Unfavorable prognostic factors for overall survival included parietal pleural invasion (p=0.02), high tumor grade (p=0.02), advanced tumor stage (p=0.02), and extensive parenchymal resection (pneumonectomy and bilobectomy, p=0.01). The median length of disease-free survival was 31 months (interquartile range, 21–41 months), and the 5-year disease-free survival rate was 32%. The most unfavorable prognostic factors for recurrence were parietal pleural invasion (p=0.02), high tumor grade (p=0.01), and tumors requiring lung resection with chest wall resection (p=0.02). Conclusion Primary malignant mesenchymal lung tumors are aggressive and have a high mortality rate. However, acceptable overall and disease-free survival rates can be obtained with surgical therapy.
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Affiliation(s)
- Muhammet Sayan
- Department of Thoracic Surgery, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Aykut Kankoc
- Department of Thoracic Surgery, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Dilvin Ozkan
- Department of Thoracic Surgery, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ali Celik
- Department of Thoracic Surgery, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ismail Cuneyt Kurul
- Department of Thoracic Surgery, Faculty of Medicine, Gazi University, Ankara, Turkey
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Sihag S. Commentary: Sarcomas and sarcomatoid tumors of the lung…not your average lung cancers. J Thorac Cardiovasc Surg 2020; 162:285-286. [PMID: 32482398 DOI: 10.1016/j.jtcvs.2020.04.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Smita Sihag
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
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Commentary: Primary pulmonary sarcomas and pulmonary carcinosarcomas, challenging and enigmatic, but treatable! J Thorac Cardiovasc Surg 2020; 162:286-287. [PMID: 32386767 DOI: 10.1016/j.jtcvs.2020.03.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 03/27/2020] [Accepted: 03/30/2020] [Indexed: 11/21/2022]
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