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Jiao Z, Liang C, Luo G, Liu M, Jiang K, Yang A, Liang Y. Prognostic Utility of Nutritional Risk Index in Patients with Head and Neck Soft Tissue Sarcoma. Nutrients 2023; 15:nu15030641. [PMID: 36771348 PMCID: PMC9920856 DOI: 10.3390/nu15030641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/19/2023] [Accepted: 01/21/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The nutritional risk index (NRI) is an excellent indicator of nutritional status and a significant prognostic factor in several malignancies, but the relationship between NRI and the prognosis of head and neck soft tissue sarcoma (HNSTS) patients remains unclear. The aim of this study was to investigate the role of NRI in patients with HNSTS. METHODS We retrospectively reviewed patients with HNSTS between 1990 and 2021. In order to determine the optimal cut-off value of NRI, the Maximally selected log-rank statistic was performed. We evaluated the effect of NRI on overall survival (OS) and progression-free survival (PFS) by using the Kaplan-Meier method and Cox regression analysis. Then, OS and PFS nomograms based on NRI were constructed. RESULTS In total, 436 HNSTS patients were included in this study. The optimal cut-off value of NRI was 99.34. Patients with low-NRI showed significantly worse OS and PFS than patients with high-NRI, respectively (5-year OS rate of 43.0 vs. 70.8%, 5-year PFS rate of 29.0 vs. 45.0%, all p < 0.05). In the multivariate analysis, distant metastasis, deep tumor depth, tumor grade, and NRI were prognostic factors for both PFS and OS, and treatment modality was associated with OS but not PFS. The concordance indexes (C-indexes) of OS and PFS nomograms were 0.794 (95% CI, 0.759-0.829) and 0.663 (95% CI, 0.626-0.700), respectively, which also performed well in the validation set. CONCLUSIONS NRI is an independent predictor of OS and PFS in HNSTS patients. The validated nomograms based on NRI provide useful predictions of OS and PFS for patients with HNSTS.
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Affiliation(s)
- Zan Jiao
- State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
- Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Chengcai Liang
- State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
- Department of Gastric Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Guangfeng Luo
- State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
- Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Mengmeng Liu
- State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
- Melanoma and Sarcoma Medical Oncology Unit, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Ke Jiang
- State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
- Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Ankui Yang
- State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
- Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
- Correspondence: (A.Y.); (Y.L.); Tel.: +86-13903052829 (A.Y.); +86-18664645900 (Y.L.)
| | - Yao Liang
- State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
- Department of Gastric Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
- Correspondence: (A.Y.); (Y.L.); Tel.: +86-13903052829 (A.Y.); +86-18664645900 (Y.L.)
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Wustrack RL, Shao E, Sheridan J, Zimel M, Cho SJ, Horvai AE, Luong D, Kwek SS, Fong L, Okimoto RA. Tumor morphology and location associate with immune cell composition in pleomorphic sarcoma. Cancer Immunol Immunother 2021; 70:3031-3040. [PMID: 33864502 PMCID: PMC8423706 DOI: 10.1007/s00262-021-02935-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/31/2021] [Indexed: 01/04/2023]
Abstract
Background Soft-tissue sarcomas (STS) are a rare group of mesenchymal malignancies that account for approximately 1% of adult human cancer. Undifferentiated pleomorphic sarcoma (UPS) is one of the most common subtypes of adult STS. Clinical stratification of UPS patients has not evolved for decades and continues to rely on tumor-centric metrics including tumor size and depth. Our understanding of how the tumor microenvironment correlates to these clinicopathologic parameters remains limited. Methods Here, we performed single-cell flow cytometric immune-based profiling of 15 freshly resected UPS tumors and integrated this analysis with clinical, histopathologic, and outcomes data using both a prospective and retrospective cohort of UPS patients. Results We uncovered a correlation between physiologic and anatomic properties of UPS tumors and the composition of immune cells in the tumor microenvironment. Specifically, we identified an inverse correlation between tumor-infiltrating CD8 + T cells and UPS tumor size; and a positive correlation between tumor-infiltrating CD8 + T cells and overall survival. Moreover, we demonstrate an association between anatomical location (deep or superficial) and frequency of CD4 + PD1hi infiltrating T cells in UPS tumors. Conclusions Our study provides an immune-based analysis of the tumor microenvironment in UPS patients and describes the different composition of tumor infiltrating lymphocytes based on size and tumor depth. Supplementary Information The online version contains supplementary material available at 10.1007/s00262-021-02935-2.
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Affiliation(s)
- Rosanna L Wustrack
- Department of Orthopedic Surgery, University of California, San Francisco, USA
| | - Evans Shao
- Division of Hematology and Oncology, Department of Medicine, University of California, 513 Parnassus Avenue, HSW1201, San Francisco, CA, 94143, USA
| | - Joey Sheridan
- Department of Orthopedic Surgery, University of California, San Francisco, USA
| | - Melissa Zimel
- Department of Orthopedic Surgery, University of California, San Francisco, USA
| | - Soo-Jin Cho
- Department of Pathology, University of California, San Francisco, USA
| | - Andrew E Horvai
- Department of Pathology, University of California, San Francisco, USA
| | - Diamond Luong
- Division of Hematology and Oncology, Department of Medicine, University of California, 513 Parnassus Avenue, HSW1201, San Francisco, CA, 94143, USA.,Helen Diller Comprehensive Cancer Center, University of California, San Francisco, USA.,Parker Institute of Cancer Immunotherapy, University of California, San Francisco, USA
| | - Serena S Kwek
- Division of Hematology and Oncology, Department of Medicine, University of California, 513 Parnassus Avenue, HSW1201, San Francisco, CA, 94143, USA.,Helen Diller Comprehensive Cancer Center, University of California, San Francisco, USA.,Parker Institute of Cancer Immunotherapy, University of California, San Francisco, USA
| | - Lawrence Fong
- Division of Hematology and Oncology, Department of Medicine, University of California, 513 Parnassus Avenue, HSW1201, San Francisco, CA, 94143, USA. .,Helen Diller Comprehensive Cancer Center, University of California, San Francisco, USA. .,Parker Institute of Cancer Immunotherapy, University of California, San Francisco, USA.
| | - Ross A Okimoto
- Division of Hematology and Oncology, Department of Medicine, University of California, 513 Parnassus Avenue, HSW1201, San Francisco, CA, 94143, USA. .,Helen Diller Comprehensive Cancer Center, University of California, San Francisco, USA.
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Lee DW, Kim HS, Han I. Actual long-term survival after resection of stage III soft tissue sarcoma. BMC Cancer 2021; 21:21. [PMID: 33402132 PMCID: PMC7786893 DOI: 10.1186/s12885-020-07730-3] [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: 09/03/2020] [Accepted: 12/13/2020] [Indexed: 12/13/2022] Open
Abstract
Background Actuarial survival based on the Kaplan–Meier method can overestimate actual long-term survival, especially among those with factors of poor prognosis. Patients with American Joint Committee on Cancer stage III soft tissue sarcoma (STS) represent a subset with a high risk of STS-specific mortality. Therefore, we aimed to characterize the clinicopathological characteristics associated with actual long-term survival in patients with stage III STS. Methods We retrospectively reviewed 116 patients who underwent surgical resection for stage III STS with curative intent between March 2000 and December 2013. Long-term survivors (n = 61), defined as those who survived beyond 5 years, were compared with short-term survivors (n = 36), who died of STS within 5 years. Results Multivariate logistic regression analyses showed that a tumor size < 10 cm [odds ratio (OR) 3.95, p = 0.047], histological grade of 2 (OR 8.12, p = 0.004), and American Society of Anesthesiologists (ASA) score of 1 (OR 11.25, p = 0.001) were independently associated with actual 5-year survival. However, 66% of the long-term survivors exhibited factors of poor prognosis: 36% had a tumor size > 10 cm and 48% had a histological grade of 3. Leiomyosarcoma (3 of 10) was negatively associated with actual long-term survival. Conclusions Actual 5-year survival after resection of stage III STS was associated with tumor size, histological grade, and ASA score. However, majority of the actual 5-year survivors exhibit factors of poor prognosis, suggesting that aggressive treatment should be offered for a chance of long-term survival in these patients.
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Affiliation(s)
- Do Weon Lee
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Han-Soo Kim
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, South Korea.,Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Ilkyu Han
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, South Korea. .,Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea.
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Xu F, Zhao F, Feng X, Li C, Han D, Zheng S, Liu Y, Lyu J. Nomogram for predicting cancer-specific survival in undifferentiated pleomorphic sarcoma: A Surveillance, Epidemiology, and End Results -based study. Cancer Control 2021; 28:10732748211036775. [PMID: 34405711 PMCID: PMC8377322 DOI: 10.1177/10732748211036775] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 06/09/2021] [Accepted: 07/16/2021] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION The purpose of this study was to construct and validate a nomogram for predicting cancer-specific survival (CSS) in undifferentiated pleomorphic sarcoma (UPS) patients at 3, 5, and 8 years after the diagnosis. METHODS Data for UPS patients were extracted from the SEER (Surveillance, Epidemiology, and End Results) database. The patients were randomly divided into a training cohort (70%) and a validation cohort (30%). The backward stepwise Cox regression model was used to select independent prognostic factors. All of the factors were integrated into the nomogram to predict the CSS rates in UPS patients at 3, 5, and 8 years after the diagnosis. The nomogram' s performance was then validated using multiple indicators, including the area under the time-dependent receiver operating characteristic curve (AUC), consistency index (C-index), calibration curve, decision-curve analysis (DCA), integrated discrimination improvement (IDI), and net reclassification improvement (NRI). RESULTS This study included 2,009 UPS patients. Ten prognostic factors were identified after analysis of the Cox regression model in the training cohort, which were year of diagnosis, age, race, primary site, histological grade, T, N, M stage, surgery status, and insurance status. The nomogram was then constructed and validated internally and externally. The relatively high C-indexes and AUC values indicated that the nomogram has good discrimination ability. The calibration curves revealed that the nomogram was well calibrated. NRI and IDI values were both improved, indicating that our nomogram was superior to the AJCC (American Joint Committee on Cancer) system. DCA curves demonstrated that the nomogram was clinically useful. CONCLUSIONS The first nomogram for predicting the prognosis of UPS patients has been constructed and validated. Its usability and performance showed that the nomogram can be applied to clinical practice. However, further external validation is still needed.
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Affiliation(s)
- Fengshuo Xu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Fanfan Zhao
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Xiaojie Feng
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Chengzhuo Li
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Didi Han
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Shuai Zheng
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
- School of Public Health, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Yue Liu
- Xiyuan Hospital of China Academy of Chinese Medicinal Science, Beijing, China
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
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5
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Ku JY, Roh JL, Cho KJ, Song JS, Choi SH, Nam SY, Kim SY. Risk factors for survival of head and neck soft tissue sarcomas: A comparison between 7th and 8th edition AJCC staging systems. Oral Oncol 2020; 106:104705. [PMID: 32298997 DOI: 10.1016/j.oraloncology.2020.104705] [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: 11/30/2019] [Revised: 02/05/2020] [Accepted: 04/08/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Soft tissue sarcomas of the head and neck (HNSTS) show various histological types and clinical behaviour. Recently, the 8th edition of the American Joint Committee on Cancer (AJCC) proposed a staging system for HNSTS independent of other body soft tissue sarcomas, which requires validation. Therefore, we evaluated the prognostic factors for the survival of HNSTS patients through a comparison between previous and current AJCC staging systems. MATERIALS AND METHODS This study involved 135 consecutive HNSTS patients who underwent primary surgery, chemoradiotherapy or chemotherapy. Patients were grouped into staged (S) and not staged (NS) cancer according to the AJCC 8th edition staging. Cox proportional-hazard regression analyses were used to identify factors associated with overall survival (OS), and progression-free survival (PFS) in all, S or NS patients. RESULTS Median follow-up period was 75 months and the 5-year OS and PFS rates of all patients were 67.8% and 53.4%, respectively, which was similar between S and NS groups. Age, tumour size and grade, overall stage (7th edition) and resection margin were the significant prognostic factors for OS and PFS in all patients and NS group (all P < 0.05), whereas positive resection margin was the only significant factor for OS and PFS in the S group (P < 0.001). While OS was poorly discriminated among different 8th edition T-categories, different 7th edition showed good discrimination among overall stages in all patients and the NS group. CONCLUSION The revised staging system may not provide an improved risk stratification for survival of HNSTS patients.
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Affiliation(s)
- Ja Yoon Ku
- Departments of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong-Lyel Roh
- Department of Otorhinolaryngology-Head and Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea.
| | - Kyung-Ja Cho
- Departments of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Joon Seon Song
- Departments of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Ho Choi
- Departments of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Soon Yuhl Nam
- Departments of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Yoon Kim
- Departments of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Akiyama T, Ogura K, Gokita T, Tsukushi S, Iwata S, Nakamura T, Matsumine A, Yonemoto T, Nishida Y, Saita K, Kawai A, Matsumoto S, Yamaguchi T. Analysis of the Infiltrative Features of Chordoma: The Relationship Between Micro-Skip Metastasis and Postoperative Outcomes. Ann Surg Oncol 2017; 25:912-919. [DOI: 10.1245/s10434-017-6268-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Indexed: 01/31/2023]
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Abstract
The management of recurrent soft tissue sarcoma is a challenging problem for clinicians and has a significant physical, mental, emotional, and oncologic impact for the patient. Despite excellent limb-preservation therapies, approximately one-quarter of patients may eventually develop recurrence of disease. How to most appropriately manage these patients is a matter of debate. Several treatment options exist, including surgical resection, irradiation, systemic chemotherapy, amputation, and regional therapies. This article highlights the management of recurrent extremity soft tissue sarcoma.
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Affiliation(s)
- Whitney M Guerrero
- Department of Surgery, University of Tennessee Health Science Center, 910 Madison Ave, Suite 300, Memphis, TN 38163, USA
| | - Jeremiah L Deneve
- Department of Surgery, University of Tennessee Health Science Center, 910 Madison Ave, Suite 300, Memphis, TN 38163, USA; Division of Surgical Oncology, University of Tennessee Health Science Center, 910 Madison Avenue, Suite 300, Memphis, TN 38163, USA.
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8
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Cable MG, Randall RL. Extremity Soft Tissue Sarcoma: Tailoring Resection to Histologic Subtype. Surg Oncol Clin N Am 2016; 25:677-95. [PMID: 27591492 DOI: 10.1016/j.soc.2016.05.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Soft tissue sarcomas comprise tumors originating from mesenchymal or connective tissue. Histologic grade is integral to prognosis. Because sarcoma management is multimodal, histologic subtype should inform optimum treatment. Appropriate biopsy and communication between surgeon and pathologist can help ensure a correct diagnosis. Treatment often involves surgical excision with wide margins and adjuvant radiotherapy. There is no consensus on what constitutes an adequate margin for histologic subtypes. An appreciation of how histology corresponds with tumor biology and surgical anatomic constraints is needed for management of this disease. Even with the surgical goal of wide resection being obtained, many patients do not outlive their disease.
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Affiliation(s)
- Matthew G Cable
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - R Lor Randall
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.
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9
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Harati K, Kirchhoff P, Behr B, Daigeler A, Goertz O, Hirsch T, Lehnhardt M, Ring A. Soft tissue sarcomas of the distal lower extremities: A single-institutional analysis of the prognostic significance of surgical margins in 120 patients. Oncol Rep 2016; 36:863-70. [DOI: 10.3892/or.2016.4862] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 05/23/2016] [Indexed: 11/06/2022] Open
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10
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Harati K, Daigeler A, Hirsch T, Jacobsen F, Behr B, Wallner C, Lehnhardt M, Becerikli M. Tumor-associated fibroblasts promote the proliferation and decrease the doxorubicin sensitivity of liposarcoma cells. Int J Mol Med 2016; 37:1535-41. [PMID: 27082154 PMCID: PMC4867885 DOI: 10.3892/ijmm.2016.2556] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 04/05/2016] [Indexed: 02/07/2023] Open
Abstract
The reasons for the distinct chemoresistance of liposarcomas and their high risk of local recurrence still remain unclear. Depending on the histological subtype of liposarcoma, first-line therapy with the cytostatic agent, doxorubicin, only achieves response rates of approximately 36%. Approximatley 70% of all local recurrences develop in spite of complete surgical resection of the primary tumor with microscopically negative margins. In this study, we aimed to assess the influence of tumor-associated fibroblasts (TAFs) obtained from surgically removed liposarcomas on the well-established human liposarcoma SW872 cell line. Intratumoral TAFs were isolated from intermediate- and high-grade liposarcoma samples. The human liposarcoma cell line, SW872, was co-cultured with the corresponding TAFs or with dermal fibroblasts as a control. The proliferation (by BrdU assay), cell viability (by MTT assay) and sensitivity to doxorubicin (using the iCELLigence system) of the co-cultured SW872 cells were examined. The SW872 cells exhibited a significant increase in proliferation and viability when co-cultured with the TAFs. As detected by real-time cell analysis, the SW872 cells co-cultured with the TAFs exhibited a diminished response towards doxorubicin. Notably, co-culture with TAFs obtained from high-grade liposarcoma samples resulted in higher proliferation and increased chemoresistance than co-culture with TAFs obtained from intermediate-grade liposarcoma samples. The findings of the present study thus indicate that TAFs from liposarcomas enhance the proliferation and decrease the chemosensitivity of SW872 liposarcoma cells significantly compared with normal fibroblasts from the dermis. TAFs from more malignant liposarcomas promoted tumor cell proliferation and chemoresistance more strikingly than TAFs from less malignant liposarcomas. These data provide evidence for the influence of the tumor microenvironment on liposarcoma and support for further investigations in patients with different liposarcoma subentities, assessing the influence of TAFs on tumor progression.
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Affiliation(s)
- Kamran Harati
- Department of Plastic Surgery, Burn Center, Hand Center, Sarcoma Reference Center, BG-University Hospital Bergmannsheil, D-44789 Bochum, Germany
| | - Adrien Daigeler
- Department of Plastic Surgery, Burn Center, Hand Center, Sarcoma Reference Center, BG-University Hospital Bergmannsheil, D-44789 Bochum, Germany
| | - Tobias Hirsch
- Department of Plastic Surgery, Burn Center, Hand Center, Sarcoma Reference Center, BG-University Hospital Bergmannsheil, D-44789 Bochum, Germany
| | - Frank Jacobsen
- Department of Plastic Surgery, Burn Center, Hand Center, Sarcoma Reference Center, BG-University Hospital Bergmannsheil, D-44789 Bochum, Germany
| | - Björn Behr
- Department of Plastic Surgery, Burn Center, Hand Center, Sarcoma Reference Center, BG-University Hospital Bergmannsheil, D-44789 Bochum, Germany
| | - Christoph Wallner
- Department of Plastic Surgery, Burn Center, Hand Center, Sarcoma Reference Center, BG-University Hospital Bergmannsheil, D-44789 Bochum, Germany
| | - Marcus Lehnhardt
- Department of Plastic Surgery, Burn Center, Hand Center, Sarcoma Reference Center, BG-University Hospital Bergmannsheil, D-44789 Bochum, Germany
| | - Mustafa Becerikli
- Department of Plastic Surgery, Burn Center, Hand Center, Sarcoma Reference Center, BG-University Hospital Bergmannsheil, D-44789 Bochum, Germany
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Glenn CA, Fung KM, Tullos HJ, McNall-Knapp RY, Gunda D, Mapstone TB. Primary Intracranial Sarcoma Presenting as Chronic Subdural Fluid Collections in a Child. World Neurosurg 2016; 86:514.e13-8. [DOI: 10.1016/j.wneu.2015.08.077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 08/20/2015] [Indexed: 10/23/2022]
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12
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Long-term outcome after local recurrence of soft tissue sarcoma: a retrospective analysis of factors predictive of survival in 135 patients with locally recurrent soft tissue sarcoma. Br J Cancer 2014; 110:1456-64. [PMID: 24481401 PMCID: PMC3960604 DOI: 10.1038/bjc.2014.21] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 12/08/2013] [Accepted: 01/06/2014] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The aim of this study was to identify prognostic indicators of survival in patients with locally recurrent soft tissue sarcoma (STS) through a long-term follow-up. METHODS We retrospectively assessed the relationship between post-recurrence survival (PRS) and potential prognostic factors in 135 patients who had experienced local recurrence, which was suitable for further surgical treatment. The median follow-up time after initial recurrence was 12.3 years (95% confidence interval (CI): 10.4-14.2 years). RESULTS The 5-year estimate of the PRS rate was 53.1% (95% CI: 44.3-61.2%) for the entire series. Patients with negative margins after the final surgery experienced improved survival compared with patients with positive margins (5-year survival: 46.7% (35.2-57.5%) vs 35.5% (23.4-47.8%); P=0.01). In a multivariate analysis, the significant prognostic indicators for PRS were histologic grade, tumour site, time to initial recurrence, the number of recurrences and the surgical margin status attained at the last resection. CONCLUSIONS Complete surgical resection with microscopically clear margins is desirable in patients with locally recurrent STS. However, when achieving clear surgical margins will require major functional impairment of the extremity, a radical surgical approach should be weighed for the patient in each case.
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13
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The impact of lymph node disease in extremity soft-tissue sarcomas: a population-based analysis. Am J Surg 2013; 206:289-95. [DOI: 10.1016/j.amjsurg.2012.10.043] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 08/22/2012] [Accepted: 10/04/2012] [Indexed: 11/23/2022]
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14
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Tran QNH, Kim AC, Gottschalk AR, Wara WM, Phillips TL, O'donnell RJ, Weinberg V, Haas-Kogan DA. Clinical outcomes of intraoperative radiation therapy for extremity sarcomas. Sarcoma 2011; 2006:91671. [PMID: 17040093 PMCID: PMC1557794 DOI: 10.1155/srcm/2006/91671] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Purpose. Radiation of extremity lesions, a key component of limb-sparing therapy, presents particular challenges, with
significant risks of toxicities. We sought to explore the
efficacy of intraoperative radiation therapy (IORT) in the
treatment of soft tissue sarcomas of the extremities.
Patients. Between 1995 and 2001, 17 patients received
IORT for soft tissue sarcomas of the extremities. Indications for
IORT included recurrent tumors in a previously radiated field or
tumors adjacent to critical structures. Results. Gross
total resections were achieved in all 17 patients. Two patients
experienced locoregional relapses, six patients recurred at
metastatic sites, and one patient died without recurrence.
Thirty-six month estimates for locoregional control, disease free
survival, and overall survival were 86%, 50%, and 78%,
respectively. IORT was extremely well tolerated, with no
toxicities referable to IORT. Conclusions. For patients
with soft tissue sarcomas of the extremities, IORT used as a boost
to EBRT provides excellent local control, with limited acute
toxicities.
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Abstract
BACKGROUND Established prognostic factors influencing survival in soft tissue sarcomas include tumor stage, histopathologic grade, size, depth, and anatomic site. The presence of tumor near or at the margin of resection increases the risk of local recurrence but whether a positive surgical margin or local recurrence affect overall survival is controversial. QUESTIONS/PURPOSES We explored the impact of microscopic margin on local recurrence, metastasis, and overall survival in patients with intermediate- to high-grade soft tissue sarcomas of the extremities. We then determined whether local recurrence decreases overall survival. METHODS We retrospectively reviewed the medical records of 248 patients who had soft tissue sarcomas of the extremities treated surgically from 1995 to 2008. We estimated survival, local recurrence, and distant metastasis and examined factors potentially influencing these outcomes. The minimum followup was 0.4 years (median, 4.4 years; range, 0.4-13 years). RESULTS The 5-year cumulative incidence of local recurrence was 4.1%. Patients who presented with positive margins or a margin of 2 mm or less had a worse survival than patients who had margins of greater than 2 mm and wide margins (5-year survival, 47% versus 70% and 72%). In addition to surgical margin, developing metastasis, tumor response of less than 90% necrosis, high histopathologic grade, high AJCC stage (Stage III), increasing age, and male gender were associated with decreased overall survival. Local recurrence independently predicted decreased overall survival. CONCLUSIONS Microscopic surgical margin and local recurrence after surgical treatment should be included as risk factors predicting decreased overall survival for intermediate- to high-grade soft tissue sarcomas of the extremities.
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Engellau J. Prognostic factors in soft tissue sarcomaTissue microarray for immunostaining, the importance of whole-tumor sections and time-dependence. ACTA ACUST UNITED AC 2009. [DOI: 10.1080/03008820410001887] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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17
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Soft Tissue Sarcoma. Surgery 2008. [DOI: 10.1007/978-0-387-68113-9_99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Farshadpour F, Schaapveld M, Suurmeijer AJH, Wymenga ANM, Otter R, Hoekstra HJ. Soft tissue sarcoma: why not treated? Crit Rev Oncol Hematol 2005; 54:77-83. [PMID: 15780909 DOI: 10.1016/j.critrevonc.2004.10.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2004] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Soft tissue sarcomas (STS) are uncommon malignancies and elderly STS patients have been reported to receive less definitive treatment compared to young STS patients. The present study was performed to investigate whether withholding treatment was based on disease specific aspects, patients' general health condition, comorbidity or a combination of these. METHODS Patients with primary STS, registered by the Comprehensive Cancer Center North-Netherlands (CCCN) from 1989 to 1999, were analyzed retrospectively with regard to the inclusion-criteria: no primary anti-tumor treatment. RESULTS From 1989 to 1999, 620 patients (including 56 Kaposi sarcoma) were registered with primary STS. Seventy-six patients (13%) were registered as untreated. Nineteen patients were excluded. Records of 57 patients, median age 71 years (range 23-92, 40 patients > or =65 years, 17 patients < 65 years) were examined. The reasons for no treatment were irresectability of the sarcoma (65%), metastatic disease (11%), comorbidity (4%), poor general health (5%), death prior to therapy (7%) and refusal of therapy (3%) (motivation not documented in 5%). CONCLUSIONS Thirteen percent of all STS patients within the CCCN region were not treated, 70% of these patients were elderly. Withholding treatment was mostly disease-related (76%), e.g. irresectable retroperitoneal STS or metastatic disease; for 19% of the patients, it was related to their poor general health. The decision to refrain from cancer treatment was justifiable in all these STS patients.
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Affiliation(s)
- F Farshadpour
- Department of Surgical Oncology, Groningen University Hospital, Groningen, The Netherlands
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Liberti M, Perugia G, Masala D, Teodonio S, Di Viccaro D, Iaboni L. Myxoid Liposarcoma of the Spermatic Cord. Urologia 2005. [DOI: 10.1177/039156030507200144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The myxoid liposarcoma, a rare form of spermatic cord liposarcoma, is a neoplasia of adult men which arise from adipose tissue, with a slow and subdolous growth, showing good prognosis and low incidence of local or distant recurrence. The case came at our attention is the sixteenth described in literature. Orchifunicolectomy is the gold standard therapy, although in some cases in which this kind of surgery is not radical, adjuvant inguinal or retroperithoneal and pelvic nodes radiotherapy should be taken in consideration.
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Affiliation(s)
- M. Liberti
- Dipartimento di Urologia “U. Bracci”, Università degli Studi di Roma “La Sapienza”, Roma
| | - G. Perugia
- Dipartimento di Urologia “U. Bracci”, Università degli Studi di Roma “La Sapienza”, Roma
| | - D. Masala
- Dipartimento di Urologia “U. Bracci”, Università degli Studi di Roma “La Sapienza”, Roma
| | - S. Teodonio
- Dipartimento di Urologia “U. Bracci”, Università degli Studi di Roma “La Sapienza”, Roma
| | - D. Di Viccaro
- Dipartimento di Urologia “U. Bracci”, Università degli Studi di Roma “La Sapienza”, Roma
| | - L. Iaboni
- Dipartimento di Urologia “U. Bracci”, Università degli Studi di Roma “La Sapienza”, Roma
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Engellau J, Persson A, Bendahl PO, Akerman M, Domanski HA, Bjerkehagen B, Lilleng P, Weide J, Rydholm A, Alvegård TA, Nilbert M. Expression profiling using tissue microarray in 211 malignant fibrous histiocytomas confirms the prognostic value of Ki-67. Virchows Arch 2004; 445:224-30. [PMID: 15309631 DOI: 10.1007/s00428-004-1065-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2004] [Accepted: 05/30/2004] [Indexed: 11/25/2022]
Abstract
The tissue microarray technology is a high-throughput technique that allows studies of multiple markers in large tumor materials. We performed immunohistochemical profiling using tissue microarray and immunostaining for Ki-67, p53, bcl-2, CD44, cyclin A and Pgp in a series of 211 malignant fibrous histiocytomas (MFHs) with correlation to prognosis. Tissue from 50 local recurrences and 20 metastases was available for comparison with the primary tumors. In univariate analysis, Ki-67 was the only immunohistochemical marker significantly correlated with metastasis with a hazard ratio of 1.9. Multivariate analysis, with tumor size, depth, necrosis, vascular invasion, mitotic rate and Ki-67 expression, revealed an independent prognostic value of tumor size and Ki-67. Local recurrences did not differ from the corresponding primary tumors, whereas metastases showed a trend for upregulation of cyclin A and Pgp. In this large series of MFHs, a tumor size greater than 8 cm and a Ki-67 index of more than 20% were strong and independent prognostic factors for metastasis. In contrast, p53, bcl-2, CD44, cyclin A and Pgp, which have previously been suggested as prognostic factors in soft tissue sarcomas, did not show such correlations. Hence, we suggest that proliferation, as measured by Ki-67 index, should be considered as a prognostic marker in clinical management of pleomorphic soft tissue sarcomas.
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Affiliation(s)
- Jacob Engellau
- Department of Oncology, Jubileum Institution, Lund University, 22185 Lund, Sweden.
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Engellau J, Anderson H, Rydholm A, Bauer HCF, Hall KS, Gustafson P, Akerman M, Meis-Kindblom J, Alvegård TA, Nilbert M. Time dependence of prognostic factors for patients with soft tissue sarcoma: a Scandinavian Sarcoma Group Study of 338 malignant fibrous histiocytomas. Cancer 2004; 100:2233-9. [PMID: 15139069 DOI: 10.1002/cncr.20254] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Prognostic factors for metastasis in soft tissue sarcoma govern decisions regarding adjuvant treatment. However, the significance of initial tumor-related prognostic factors over time is largely unknown. METHODS The current study included 338 patients with malignant fibrous histiocytoma (MFH) of the extremities or the trunk wall whose tumors were reviewed by the Scandinavian Sarcoma Pathology Review Group. Of these 338 patients, 329 (97%) had high-grade tumors. The median follow-up period was 7 years. Metastases occurred in 110 of 338 of patients after a median follow-up period of 14 months, with roughly one-third (32 of 110) occurring after 2 years. The authors investigated the prognostic significance of tumor size, tumor depth, histologic grade, microscopic tumor necrosis, vascular invasion, mitotic rate, and local tumor recurrence at various time intervals using metastases as an endpoint. RESULTS On univariate analysis, all investigated factors were found to be correlated with metastases for the entire follow-up period and also for the first 2 years of follow-up; beyond this time point, only size, tumor depth, and local recurrence were significant. On multivariate analysis, necrosis and local tumor recurrence were significant for the entire follow-up duration and also for the first 2 years of follow-up, whereas only tumor depth and local recurrence were significant beyond 2 years of follow-up. For all initial factors, the annual metastasis risks in the high-risk and low-risk groups converged to < 0.1 after 2 years and to near 0 after 5 years. CONCLUSIONS Prognostic factors for metastasis in MFH were time dependent. The predictive value of the initial prognostic factors was limited to the first 2 years of follow-up. The lack of observed prognostic value beyond 2 years of follow-up probably was attributable to heterogeneity within risk categories as a result of measurement errors and unknown biologic variations.
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Affiliation(s)
- Jacob Engellau
- Department of Oncology, The Jubileum Institute, Lund University, Lund, Sweden.
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Zagars GK, Ballo MT, Pisters PWT, Pollock RE, Patel SR, Benjamin RS. Prognostic factors for disease-specific survival after first relapse of soft-tissue sarcoma: Analysis of 402 patients with disease relapse after initial conservative surgery and radiotherapy. Int J Radiat Oncol Biol Phys 2003; 57:739-47. [PMID: 14529779 DOI: 10.1016/s0360-3016(03)00714-4] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To document the prognostic factors for survival of patients with soft-tissue sarcoma sustaining a first relapse after definitive treatment. METHODS AND MATERIALS The clinicopathologic features, relapse patterns, and disease-specific survival rates for 402 consecutive patients sustaining a first relapse of sarcoma after combined surgery and radiotherapy were retrospectively reviewed. Factors affecting disease-specific survival after relapse were evaluated with univariate and multivariate techniques. RESULTS The median follow-up after relapse was 6.8 years. The overall disease-specific survival rate was 25%, 19%, and 16% at 5, 10, and 15 years, respectively, after the first relapse. The median survival duration was 21 months. Patients with an isolated local recurrence had a 5- and 10-year disease-specific survival rate of 48% and 46%, respectively, and those with an initial metastatic relapse had a disease-specific survival rate of 16% and 10%, respectively (p < 0.001). For isolated local recurrences, the independent determinants of survival were (favorable feature first) the primary tumor site (extremity and superficial trunk vs. head and neck and deep trunk); tumor grade (low and intermediate vs. high); time to recurrence (>12 vs. <or =12 months); and initial tumor size (<or =5 vs. >5 cm). Although the development of subsequent metastasis was the major cause of death, a significant fraction of patients died of uncontrolled primary tumor. For patients presenting with metastasis as the first relapse, the time to metastasis was the major determinant of survival (>12 vs. < or =12 months). Long-term salvage was largely confined to patients who could and did undergo resection of relapsed disease, either local or metastatic. CONCLUSION On the whole, patients whose sarcoma relapses fare poorly. However, select subgroups are potentially salvageable. Patients with an isolated local recurrence at sites other than the head and neck and deep trunk have a reasonable prospect for satisfactory outcome. Surgical resection of recurrences and metastases appears to play a major role in potential salvage.
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Affiliation(s)
- Gunar K Zagars
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
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Zagars GK, Ballo MT, Pisters PWT, Pollock RE, Patel SR, Benjamin RS. Preoperative vs. postoperative radiation therapy for soft tissue sarcoma: a retrospective comparative evaluation of disease outcome. Int J Radiat Oncol Biol Phys 2003; 56:482-8. [PMID: 12738324 DOI: 10.1016/s0360-3016(02)04510-8] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE Radiation (XRT) is a proven component in the treatment of soft tissue sarcoma. However, there is little evidence regarding the relative effectiveness of preoperative vs. postoperative XRT. This retrospective study addresses the relative effectiveness of disease control by these two treatment sequences. METHODS AND MATERIALS A total of 517 patients (246 treated with postoperative XRT, and 271 treated with preoperative XRT) with nonmetastatic sarcoma were evaluated for disease outcome and late complications using univariate and multivariate techniques. RESULTS With a median follow-up of 6 years, overall local control was 81% and 78% at 5 and 10 years, respectively. Although local control appeared superior with preoperative XRT (83% at 10 years) compared with postoperative XRT (72%), multivariate analysis revealed that this difference could be entirely explained by the unequal distribution of prognostic factors between the two groups, and there was no evidence that treatment sequence independently determined local control. There were no differences in nodal or metastatic relapse between the two treatments, and disease-specific survival was not significantly different. There was a slightly higher incidence of late XRT-related complications among those treated with postoperative XRT (10-year incidence of 9% vs. 5%, p = 0.03). CONCLUSIONS This study found no evidence for differences in disease outcome attributable to the use of either pre- or postoperative XRT. There was a slight increase in long-term complications with postoperative XRT, likely due to the higher doses used in this sequence.
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Affiliation(s)
- Gunar K Zagars
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
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Zagars GK, Ballo MT. Significance of dose in postoperative radiotherapy for soft tissue sarcoma. Int J Radiat Oncol Biol Phys 2003; 56:473-81. [PMID: 12738323 DOI: 10.1016/s0360-3016(02)04573-x] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE For soft tissue sarcoma, adjuvant postoperative radiotherapy improves the local control rate over surgery alone. However, the issue of a dose-control relationship is controversial and was addressed in this study. METHODS AND MATERIALS We retrospectively reviewed the records of 775 consecutive patients who received postoperative external beam radiotherapy and used univariate and multivariate analysis to determine whether a dose-control relationship exists for the whole group and for specific high-risk subgroups. RESULTS With a median follow-up of 12.3 years, overall local control rates were 82%, 80%, and 79% at 5, 10, and 15 years. Factors adverse for local control were positive resection margins; tumor location in the head and neck and deep trunk; presentation with locally recurrent disease; patient age >64 years; histopathologic subtype of malignant fibrous histiocytoma, neurogenic sarcoma or epithelioid sarcoma; and tumor size >10 cm. In multivariate analysis, radiation dose > or = 64 Gy vs. <64 Gy independently correlated with improved local control. Significant interactions were noted between increased effectiveness of a higher dose and presentation with locally recurrent disease, with head and neck and deep trunk tumor sites, and with positive or uncertain resection margins such that local control was specifically improved under these circumstances with doses on the order of 64-68 Gy compared with doses on the order of 60 Gy. Higher dose, however, did not completely abrogate the adverse effect of positive margins. CONCLUSION After gross total resection, soft tissue sarcoma with features predictive of a higher than average local recurrence rate benefited from doses of 64-68 Gy compared with 60 Gy.
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Affiliation(s)
- Gunar K Zagars
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
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Zagars GK, Ballo MT, Pisters PWT, Pollock RE, Patel SR, Benjamin RS, Evans HL. Prognostic factors for patients with localized soft-tissue sarcoma treated with conservation surgery and radiation therapy: an analysis of 1225 patients. Cancer 2003; 97:2530-43. [PMID: 12733153 DOI: 10.1002/cncr.11365] [Citation(s) in RCA: 492] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Prognostic factors for patients with soft-tissue sarcoma who are treated with conservative surgery and radiation are documented poorly. METHODS The clinicopathologic features and disease outcome for 1225 patients with localized sarcoma who were treated with conservative surgery and radiation were reviewed retrospectively. Actuarial univariate and multivariate statistical methods were used to determine significant prognostic factors for local control, metastatic recurrence, and disease specific survival. RESULTS The median follow-up of surviving patients was 9.5 years. The respective local control rates at 5 years, 10 years, and 15 years were 83%, 80%, and 79%. Factors predictive of local recurrence were positive or uncertain resection margins; tumors located in the head and neck and the deep trunk; presentation with local recurrence; patient age > 64 years; malignant fibrous histiocytoma, neurogenic sarcoma. or epithelioid sarcoma histopathology; tumor measuring > 10 cm in greatest dimension; and high pathologic grade. Freedom from metastasis at 5 years, 10 years, and 15 years was 71%, 68%, and 66%, respectively. Factors that were predictive of metastatic recurrence were high tumor grade; large tumor size (> 5 cm); and leiomyosarcoma, rhabdomyosarcoma, synovial sarcoma, or epithelioid sarcoma. The respective disease specific survival rates at 5 years, 10 years, and 15 years were 73%, 68%, and 65%. Adverse factors for disease specific survival were high tumor grade; large tumor size (> 5 cm); tumors located in the head and neck and deep trunk; rhabdomyosarcoma, epithelioid sarcoma, or clear cell sarcoma; patient age > 64 years; and positive or uncertain resection margins. CONCLUSIONS Soft-tissue sarcoma comprises a heterogeneous group of diseases. Prognostic factors for local recurrence, metastatic recurrence, lymph node recurrence, disease free survival, and disease specific survival are different, and optimal treatment strategies need to take this complexity into account.
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Affiliation(s)
- Gunar K Zagars
- Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA
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Abstract
Over the past decade, there has been significant emphasis on the elucidation of clinicopathologic prognostic factors in STS. This has allowed for identification of the "high-risk" patient at presentation. Molecular factors may further refine the identification of high-risk patients. Setting-related prognostic factors are often amenable to change, and all STS patients should probably be referred for specialty consultation before treatment so that they can benefit from optimal diagnostic, therapeutic, and multidisciplinary approaches. The ongoing pursuit of prognostic issues should also recognize the dynamic nature of prognosis course in a patient's disease.
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Affiliation(s)
- Brian O'Sullivan
- Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, 610 University Avenue, Toronto, Ontario, M5G 2M9, Canada.
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Oda Y, Tamiya S, Oshiro Y, Hachitanda Y, Kinukawa N, Iwamoto Y, Tsuneyoshi M. Reassessment and clinicopathological prognostic factors of malignant fibrous histiocytoma of soft parts. Pathol Int 2002; 52:595-606. [PMID: 12406189 DOI: 10.1046/j.1440-1827.2002.01399.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Recently, the category of malignant fibrous histiocytoma (MFH) has been under discussion and new entities resembling MFH have appeared. To clarify the recent situation regarding MFH, we reassessed previously diagnosed MFH cases in accordance with the most up-to-date diagnostic criteria, which included allied tumors. We carefully reassessed 428 cases that had been diagnosed in our institute during the past 28 years. Moreover, we searched for clinicopathological prognostic factors among the cases that were finally diagnosed as MFH. Among the 428 cases, 138 cases had their diagnoses changed. The revised cases included 78 leiomyosarcomas (57%; ordinary leiomyosarcoma, 45 cases; pleomorphic leiomyosarcoma, 23 cases; myxoid leiomyosarcoma, 10 cases), 12 liposarcomas (9%; pleomorphic liposarcoma, 11 cases; dedifferentiated liposarcoma, one case), seven dermatofibrosarcoma protuberans (5%), six unclassified sarcomas (4%), five primary or metastatic carcinomas (4%), four low-grade fibromyxoid sarcomas (3%), four inflammatory myofibroblastic tumors (3%), three rhabdomyosarcomas (2%), three malignant peripheral nerve sheath tumors (2%), three acral myxoinflammatory fibroblastic sarcomas (2%) and two atypical fibroxanthomas (1.5%). Among the 1974 soft tissue sarcomas registered in our institute, MFH (428 cases) had been the most common sarcoma, followed by liposarcoma, leiomyosarcoma and rhabdomyosarcoma. However, after reassessment, leiomyosarcoma proved to be the most common soft tissue sarcoma (322 cases), followed by 290 MFH, 273 liposarcomas and 202 rhabdomyosarcomas. Among these 290 cases finally diagnosed as MFH, survival data were available in 189 cases. Tumor location in the abdominal cavity, the retroperitoneum or the head and neck (P = 0.0024), tumor size of 5 cm or more (P < 0.0001), deep tumor location (P < 0.0001), high histological grade (grade 3) based on the French Federation of Cancer Centers' grading system (P = 0.0007), and high stage (stage III or IV) based on the American Joint Committee on Cancer (AJCC) staging system (P < 0.0001) were significantly worse prognostic factors by univariate analysis. In multivariate analysis, deep tumor location and high AJCC stage were independent adverse prognostic factors. We conclude that leiomyosarcoma is the most important differential diagnosis for MFH, especially pleomorphic leiomyosarcoma from storiform-pleomorphic type and myxoid leiomyosarcoma from myxoid type. Tumor depth and AJCC stage are the most important predictive prognostic factors in MFH.
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Affiliation(s)
- Yoshinao Oda
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Oliveira AM, Scheithauer BW, Salomao DR, Parisi JE, Burger PC, Nascimento AG. Primary sarcomas of the brain and spinal cord: a study of 18 cases. Am J Surg Pathol 2002; 26:1056-63. [PMID: 12170093 DOI: 10.1097/00000478-200208000-00011] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Primary sarcomas of the central nervous system are exceedingly rare. We reviewed the clinicopathologic features of 18 primary central nervous system sarcomas diagnosed from 1959 through 1999. Median age at diagnosis of the nine female and nine male patients was 28 years (range 3-63 years). Median tumor size was 4 cm (range 1.3-8 cm). Fifteen tumors arose in the cerebrum (83%), two in the cerebellum, and one in the spinal cord. Histopathologically, the most common tumor types included fibrosarcoma (six), malignant fibrous histiocytoma (five), and undifferentiated sarcoma (three). Immunohistochemical and ultrastructural studies supported the histologic diagnosis in 17 and six cases, respectively. All patients had subtotal to gross total tumor resection; 16 also received radiotherapy and/or chemotherapy. Twelve tumors (67%) were high-grade. Follow-up was obtained in all instances (median 2.3 years). Nine patients died of the disease, eight with high-grade tumors. Survival at 5 years for patients with high-grade tumors was 28% compared with 83% for those with low-grade neoplasms (p = 0.03). Primary central nervous system sarcomas most often affect young and middle-aged adults. Most involve the cerebrum and show fibrous, "fibrohistiocytic," or no specific differentiation. The prognosis for high-grade sarcomas seems better than that for glioblastoma multiforme.
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Affiliation(s)
- Andre M Oliveira
- Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota 55905, U.S.A
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Lartigau E, Kantor G, Taieb S, Vilain MO, Ceugnart L, Lagarde P, Penel N, Depadt G. [Definitions of target volumes in soft tissue sarcomas of the extremities]. Cancer Radiother 2001; 5:695-703. [PMID: 11715321 DOI: 10.1016/s1278-3218(01)00120-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Soft tissue sarcomas of the extremities are currently treated with more conservative and functional approaches, combining surgery, radiotherapy and chemotherapy. The role of external beam radiotherapy and brachytherapy has been defined through randomised studies performed in the 80's and 90's. However, the ubiquity of tumour location for these tumours makes difficult a systematic definition of local treatments. Tumour volume definition is based on pre and post surgical imaging (MRI) and on described pathological report. The clinical target volume will take into account quality of the resection and anatomical barriers and will be based on an anatomy and not only on safety margins around the tumour bed. General rules for this irradiation (doses, volumes) and principal results will be presented.
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Affiliation(s)
- E Lartigau
- Département de radiothérapie, centre Oscar-Lambret, rue F. Combemale, 59000 Lille, France.
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Ballo MT, Zagars GK, Pisters PW, Feig BW, Patel SR, von Eschenbach AC. Spermatic cord sarcoma: outcome, patterns of failure and management. J Urol 2001; 166:1306-10. [PMID: 11547063 DOI: 10.1016/s0022-5347(05)65758-8] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE We evaluate the outcome, clarify the patterns of failure and suggest treatment strategies for sarcoma in the spermatic cord. MATERIALS AND METHODS Between 1956 and 1998, 32 patients with spermatic cord sarcoma were treated at M. D. Anderson Cancer Center. A retrospective review of disease outcome, patterns of relapse and patient survival was performed. RESULTS Histological subtypes of sarcoma were malignant fibrous histiocytoma in 12 patients, leiomyosarcoma in 6, liposarcoma in 8 and other subtypes in 6. All except 2 patients underwent radical orchiectomy with or without additional resection to achieve negative margins. Margins were microscopically negative in 29 cases and positive in 3. There were 3 patients who received adjuvant radiation to the surgical site. With a median followup of 9 years the 10 and 15-year actuarial local control, distant metastasis-free and overall survival rates were 72% and 61%, 85% and 85%, and 63% and 52%, respectively. The major pattern of failure was local recurrence that occurred in 8 of the 12 patients in whom disease relapsed and was the sole site of relapse in 7. Pelvic nodes had relapsed in 2 patients and para-aortic nodes in 1. Hematogenous metastases had developed in 4 patients. Of the 7 cases of disease that recurred locally only 3 were salvaged. No relapse occurred in the 3 patients treated with combined surgery and radiation. CONCLUSIONS Spermatic cord sarcoma has a high propensity for local recurrence after surgery. Nodal relapse is less frequent than commonly believed. Because of the relatively high local failure rate seen in surgery alone and durable local control noted in 3 patients treated with surgery plus radiotherapy, combined modality treatment should be considered in those with spermatic cord sarcoma who are believed to be at high risk for local failure.
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Affiliation(s)
- M T Ballo
- Department of Radiation Oncology, the University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
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Stojadinovic A, Jaques DP, Leung DH, Healey JH, Brennan MF. Amputation for recurrent soft tissue sarcoma of the extremity: indications and outcome. Ann Surg Oncol 2001; 8:509-18. [PMID: 11456050 DOI: 10.1007/s10434-001-0509-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Limb salvage after primary site failure of extremity soft tissue sarcoma is a challenging problem. Amputation may be the most effective treatment option in selected patients with local recurrence. We compared the outcome of patients treated with amputation versus limb-sparing surgery (LSS) for locally recurrent extremity sarcoma. METHODS From 1982 to 2000, 1178 patients with localized primary extremity sarcoma underwent LSS. Of these, 204 (17%) developed local recurrence. Eighteen (9%) required major amputation and the remainder underwent LSS, of which 34 were selected for matched-pair analysis according to established prognostic variables. Rates of recurrence or death were estimated by the Kaplan-Meier method. Following adjustment for prognostic variables, a Mantel-Haenszel test was used to compare the outcome between the two treatment groups. RESULTS Patients in each group were well matched. All patients had high-grade tumors deep to the fascia. Median time to local recurrence was similar for both groups. Median follow-up was 95 months. Amputation was associated with a significant improvement in local control of disease (94% vs. 74%; P = .04). We observed no difference in disease-free (P = .48), disease-specific (P = .74), or overall survival (P = .93) between the two groups. Median postrecurrence survival was 20 months and 5-year OS was 36% for the entire study group. CONCLUSIONS Limb-sparing treatment achieves local control in the majority of recurrent extremity sarcomas for which amputation is infrequently indicated. Amputation improves local disease control but not survival under these circumstances.
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Affiliation(s)
- A Stojadinovic
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA
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Bertucio CS, Wara WM, Matthay KK, Ablin AR, Johnston JO, O'Donnell RJ, Weinberg V, Haas-Kogan DA. Functional and clinical outcomes of limb-sparing therapy for pediatric extremity sarcomas. Int J Radiat Oncol Biol Phys 2001; 49:763-9. [PMID: 11172960 DOI: 10.1016/s0360-3016(00)01415-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE To determine the clinical and functional outcomes of children undergoing limb-sparing therapy for extremity sarcomas. METHODS AND MATERIALS We retrospectively reviewed 30 patients, age < or = 21 years, who were treated between l979 and l998 with external beam radiotherapy as a component of limb-sparing therapy for primary sarcomas of the extremity at UCSF. Included were patients for whom complete follow-up and functional outcome assessments were available. We assessed the patterns of failure, overall survival, disease-free survival, local control, and limb function. RESULTS At a median follow-up of 3 years, 12 of the 30 patients recurred: 3 locally, 8 distantly, and 1 with synchronous local and distant disease as site of first progression. Eighteen patients were alive with no evidence of disease. The median overall survival was 10 years, with a median disease-free survival of 8 years. Functional outcome assessment revealed 15 patients retained excellent, 12 good, 1 fair, and 2 poor limb function. CONCLUSION In pediatric patients receiving limb-sparing therapy, 90% maintained excellent or good limb function without compromising survival, demonstrating the validity of limb preservation in children with extremity sarcomas.
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Affiliation(s)
- C S Bertucio
- Department of Radiation Oncology, University of California-San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143-0226, USA
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Komdeur R, Plaat BEC, Hoekstra HJ, Molenaar WM, Hollema H, van den Berg E, Mastik MF, van der Graaf WTA. Expression of P-glycoprotein, multidrug resistance-associated protein 1, and lung resistance-related protein in human soft tissue sarcomas before and after hyperthermic isolated limb perfusion with tumor necrosis factor-? and melphalan. Cancer 2001. [DOI: 10.1002/1097-0142(20010515)91:10<1940::aid-cncr1217>3.0.co;2-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Abstract
A multidisciplinary approach that includes active participation by a radiologist is beneficial for optimal diagnostic evaluation and treatment of soft-tissue sarcomas. Recent advances in diagnostic imaging include a better understanding of the practical roles of ultrasonography, computed tomography, and magnetic resonance imaging in the evaluation of primary and recurrent soft-tissue sarcomas. The potential role of positron emission tomography scanning and dynamic magnetic resonance imaging in the evaluation of soft-tissue sarcomas has been preliminarily evaluated. The clinically practical utility of radiologic imaging in the evaluation of soft-tissue sarcomas is discussed, and ongoing research is briefly reviewed.
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Affiliation(s)
- D G Varma
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Box 057, Houston, TX 77030, USA.
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