1
|
Sun J, Wu Z, Jiao J, Wei H, Yang X, Liu T, Zhao J, Yang C, Xu W, Zhou Z, Wang T, Xiao J. Comparisons of clinical characteristics, treatments, and outcomes among different pathological subtypes of chondrosarcoma in the spine. J Neurooncol 2024:10.1007/s11060-024-04823-y. [PMID: 39276177 DOI: 10.1007/s11060-024-04823-y] [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: 07/21/2024] [Accepted: 09/04/2024] [Indexed: 09/16/2024]
Abstract
INTRODUCTION Spinal chondrosarcoma exhibits higher invasiveness and a worse prognosis compared to chondrosarcoma in the extremities. The prognosis and therapeutic plan vary greatly among different pathological subtypes of chondrosarcoma. This study aimed to analyze the differences in clinical characteristics, molecular features, therapeutic effects, and prognostic factors among the subtypes of chondrosarcoma in the spine. METHODS A retrospective review was conducted on 205 patients with spinal chondrosarcoma. The clinical features and immunohistochemical (IHC) markers were compared among the pathological subtypes of chondrosarcoma grade 1, grade 2, grade 3, mesenchymal chondrosarcoma (MCS), dedifferentiated chondrosarcoma (DCS), and clear cell chondrosarcoma (CCCS). Chondrosarcoma grade 1/2/3 are collectively referred to as conventional chondrosarcoma (CCS) for multivariate survival analysis. Univariate and multivariate analyses were performed to investigate independent prognostic factors for overall survival (OS) and recurrence-free survival (RFS) in patients with spinal chondrosarcoma. Furthermore, independent prognostic factors for OS and RFS were identified in CCS and MCS. RESULTS MCS patients were younger than the other subtypes. Patients with chondrosarcoma grade 1/2 had better OS than those with chondrosarcoma grade 3, MCS and DCS, while only chondrosarcoma grade 1 patients showed better RFS than chondrosarcoma grade 2/3, MCS and DCS patients. Ki-67 index was higher in chondrosarcoma grade 3, MCS and DCS than chondrosarcoma grade 1/2. The comparison of IHC markers further highlighted the overexpression of P53/MDM2 in MCS and DCS. Gross total resection, including en-bloc and piecemeal resection, significantly improved OS and RFS for CCS patients, while only en-bloc resection significantly improved the prognosis of MCS patients. Chemotherapy appeared to be important for the OS of MCS patients. CONCLUSION P53/MDM2 pathway was upregulated in MCS and DCS compared to chondrosarcoma grade 1/2. Radical tumor resection is crucial for the treatment of spinal chondrosarcoma, while MCS patients require further comprehensive treatments perioperatively.
Collapse
Affiliation(s)
- Jian Sun
- Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Naval Medical University, #415 Fengyang Road, Shanghai, 200003, China
- Wuxi School of Medicine, Jiangnan University, 1800 Lihu Avenue, Wuxi, 214122, Jiangsu, China
| | - Zhipeng Wu
- Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Naval Medical University, #415 Fengyang Road, Shanghai, 200003, China
| | - Jian Jiao
- Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Naval Medical University, #415 Fengyang Road, Shanghai, 200003, China
| | - Haifeng Wei
- Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Naval Medical University, #415 Fengyang Road, Shanghai, 200003, China
| | - Xinghai Yang
- Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Naval Medical University, #415 Fengyang Road, Shanghai, 200003, China
| | - Tielong Liu
- Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Naval Medical University, #415 Fengyang Road, Shanghai, 200003, China
| | - Jian Zhao
- Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Naval Medical University, #415 Fengyang Road, Shanghai, 200003, China
| | - Cheng Yang
- Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Naval Medical University, #415 Fengyang Road, Shanghai, 200003, China
| | - Wei Xu
- Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Naval Medical University, #415 Fengyang Road, Shanghai, 200003, China
| | - Zhenhua Zhou
- Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Naval Medical University, #415 Fengyang Road, Shanghai, 200003, China.
| | - Ting Wang
- Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Naval Medical University, #415 Fengyang Road, Shanghai, 200003, China.
| | - Jianru Xiao
- Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Naval Medical University, #415 Fengyang Road, Shanghai, 200003, China.
| |
Collapse
|
2
|
Tsukamoto S, Mavrogenis AF, Nitta Y, Righi A, Masunaga T, Honoki K, Fujii H, Kido A, Tanaka Y, Tanaka Y, Errani C. A Systematic Review of Adjuvant Chemotherapy in Localized Dedifferentiated Chondrosarcoma. Curr Oncol 2024; 31:566-578. [PMID: 38275833 PMCID: PMC10813944 DOI: 10.3390/curroncol31010040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/12/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
Dedifferentiated chondrosarcoma (DDCS) is a high-grade subtype of chondrosarcoma with the bimorphic histological appearance of a conventional chondrosarcoma component with abrupt transition to a high-grade, non-cartilaginous sarcoma. DDCS can be radiographically divided into central and peripheral types. Wide resection is currently the main therapeutic option for localized DDCS. Moreover, the effectiveness of adjuvant chemotherapy remains controversial. Therefore, we performed a systematic review of available evidence to evaluate the effect of adjuvant chemotherapy on localized DDCS. The purpose was to compare the 5-year survival rate among patients treated with surgery plus adjuvant chemotherapy or surgery alone for localized DDCS. The search was conducted in PubMed, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) databases. Of the 217 studies shortlisted, 11 retrospective non-randomized studies (comprising 556 patients with localized DDCS) were selected. The 5-year survival rates were similar between the two treatment groups (28.2% (51/181) vs. 24.0% (90/375), respectively). The overall pooled odds ratio was 1.25 (95% confidence interval: 0.80-1.94; p = 0.324), and heterogeneity I2 was 2%. However, when limited to peripheral DDCS, adjuvant chemotherapy was associated with prolonged survival (p = 0.03). Due to the paucity of included studies and the absence of prospective comparative studies, no conclusions can be drawn regarding the effectiveness or ineffectiveness of adjuvant chemotherapy for localized DDCS.
Collapse
Affiliation(s)
- Shinji Tsukamoto
- Department of Orthopaedic Surgery, Nara Medical University, 840, Shijo-cho, Kashihara 634-8521, Japan; (T.M.); (K.H.); (H.F.); (Y.T.)
| | - Andreas F. Mavrogenis
- First Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, 41 Ventouri Street, Holargos, 15562 Athens, Greece;
| | - Yuji Nitta
- Department of Diagnostic Pathology, Nara Medical University, 840, Shijo-cho, Kashihara 634-8521, Japan;
| | - Alberto Righi
- Department of Pathology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Rizzoli Orthopaedic Institute, Via di Barbiano 1/10, 40136 Bologna, Italy;
| | - Tomoya Masunaga
- Department of Orthopaedic Surgery, Nara Medical University, 840, Shijo-cho, Kashihara 634-8521, Japan; (T.M.); (K.H.); (H.F.); (Y.T.)
| | - Kanya Honoki
- Department of Orthopaedic Surgery, Nara Medical University, 840, Shijo-cho, Kashihara 634-8521, Japan; (T.M.); (K.H.); (H.F.); (Y.T.)
| | - Hiromasa Fujii
- Department of Orthopaedic Surgery, Nara Medical University, 840, Shijo-cho, Kashihara 634-8521, Japan; (T.M.); (K.H.); (H.F.); (Y.T.)
| | - Akira Kido
- Department of Rehabilitation Medicine, Nara Medical University, 840, Shijo-cho, Kashihara 634-8521, Japan;
| | - Yuu Tanaka
- Department of Rehabilitation Medicine, Wakayama Professional University of Rehabilitation, 3-1, Minamoto-cho, Wakayama 640-8222, Japan;
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, 840, Shijo-cho, Kashihara 634-8521, Japan; (T.M.); (K.H.); (H.F.); (Y.T.)
| | - Costantino Errani
- Department of Orthopaedic Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Rizzoli Orthopaedic Institute, Via Pupilli 1, 40136 Bologna, Italy;
| |
Collapse
|
3
|
Xin B, Bai G, Gao P, Huang X, Liu T. PRISMA-the 100 most-cited articles on chondrosarcoma recurrence: A bibliometric analysis. Medicine (Baltimore) 2023; 102:e36525. [PMID: 38115278 PMCID: PMC10727679 DOI: 10.1097/md.0000000000036525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/16/2023] [Accepted: 11/17/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Chondrosarcoma (CHS) is highly prone to recurrence and has become the most common malignant bone tumor in adults. The authors aim to identify and analyze the top 100 most-cited articles in this field, enabling researchers to quickly grasp the research focus and progress in the area of chondrosarcoma recurrence. METHODS A search in the Web of Science database yielded a total of 305 articles related to CHS recurrence between 2013 and 2022. Filtering was done based on the titles and abstracts of the articles in the list, and the top 100 most-cited articles were selected. The following information were analyzed using bibliometric methods: article title, first author, year of publication, journal of publication, total citations, country, institution, and keywords. RESULTS Among the selected 100 articles, the most frequently cited one has 224 citations. The most commonly appearing journals, institutions, and countries are as follows: "Clinical Orthopaedics Related Research" (5 times); Fudan University, University of Texas System, and Royal Orthopaedic Hospital (4 times each), with China and the USA cited the most (21 times each). The year 2018 is the most productive year (17 articles). About 97 first authors contributed one article each, and 3 had 2 articles each. Among all 229 keywords, the top 3 in frequency are CHS (20%), recurrence (4%), and surgery (3%). Twenty article topics are related to surgical treatment. CONCLUSION Research on CHS recurrence is citation-rich but focuses more on treatments than understanding mechanisms, indicating a need for deeper mechanistic exploration for treatment breakthroughs in the future.
Collapse
Affiliation(s)
- Baoquan Xin
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Department of Orthopedic Oncology, Changzheng Hospital, Navy Medical University, Shanghai, China
| | - Guangjian Bai
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Department of Orthopedic Oncology, Changzheng Hospital, Navy Medical University, Shanghai, China
| | - Pan Gao
- Department of Orthopedic Oncology, Changzheng Hospital, Navy Medical University, Shanghai, China
- Anhui University of Science & Technology, Medical school, Huainan, China
| | - Xing Huang
- Department of Orthopedics, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
| | - Tielong Liu
- Department of Orthopedic Oncology, Changzheng Hospital, Navy Medical University, Shanghai, China
| |
Collapse
|
4
|
Zając W, Dróżdż J, Kisielewska W, Karwowska W, Dudzisz-Śledź M, Zając AE, Borkowska A, Szumera-Ciećkiewicz A, Szostakowski B, Rutkowski P, Czarnecka AM. Dedifferentiated Chondrosarcoma from Molecular Pathology to Current Treatment and Clinical Trials. Cancers (Basel) 2023; 15:3924. [PMID: 37568740 PMCID: PMC10417069 DOI: 10.3390/cancers15153924] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
Dedifferentiated chondrosarcoma (DDCS) is a rare subtype of chondrosarcoma, a primary cartilaginous malignant neoplasm. It accounts for up to 1-2% of all chondrosarcomas and is generally associated with one of the poorest prognoses among all chondrosarcomas with the highest risk of metastasis. The 5-year survival rates range from 7% to 24%. DDCS may develop at any age, but the average presentation age is over 50. The most common locations are the femur, pelvis humerus, scapula, rib, and tibia. The standard treatment for localised disease is surgical resection. Most patients are diagnosed in unresectable and advanced stages, and chemotherapy for localised and metastatic dedifferentiated DDCS follows protocols used for osteosarcoma.
Collapse
Affiliation(s)
- Weronika Zając
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska Curie National Research Institute of Oncology, 02-781 Warsaw, Poland (M.D.-Ś.); (A.E.Z.); (A.B.); (B.S.); (P.R.)
- Faculty of Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Julia Dróżdż
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska Curie National Research Institute of Oncology, 02-781 Warsaw, Poland (M.D.-Ś.); (A.E.Z.); (A.B.); (B.S.); (P.R.)
- Faculty of Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Weronika Kisielewska
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska Curie National Research Institute of Oncology, 02-781 Warsaw, Poland (M.D.-Ś.); (A.E.Z.); (A.B.); (B.S.); (P.R.)
- Faculty of Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Weronika Karwowska
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska Curie National Research Institute of Oncology, 02-781 Warsaw, Poland (M.D.-Ś.); (A.E.Z.); (A.B.); (B.S.); (P.R.)
- Faculty of Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Monika Dudzisz-Śledź
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska Curie National Research Institute of Oncology, 02-781 Warsaw, Poland (M.D.-Ś.); (A.E.Z.); (A.B.); (B.S.); (P.R.)
| | - Agnieszka E. Zając
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska Curie National Research Institute of Oncology, 02-781 Warsaw, Poland (M.D.-Ś.); (A.E.Z.); (A.B.); (B.S.); (P.R.)
| | - Aneta Borkowska
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska Curie National Research Institute of Oncology, 02-781 Warsaw, Poland (M.D.-Ś.); (A.E.Z.); (A.B.); (B.S.); (P.R.)
| | - Anna Szumera-Ciećkiewicz
- Department of Pathology, Maria Sklodowska Curie National Research Institute of Oncology, 02-781 Warsaw, Poland;
| | - Bartłomiej Szostakowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska Curie National Research Institute of Oncology, 02-781 Warsaw, Poland (M.D.-Ś.); (A.E.Z.); (A.B.); (B.S.); (P.R.)
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska Curie National Research Institute of Oncology, 02-781 Warsaw, Poland (M.D.-Ś.); (A.E.Z.); (A.B.); (B.S.); (P.R.)
| | - Anna M. Czarnecka
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska Curie National Research Institute of Oncology, 02-781 Warsaw, Poland (M.D.-Ś.); (A.E.Z.); (A.B.); (B.S.); (P.R.)
| |
Collapse
|
5
|
Wen H, Gong FJ, Xi JM. Primary dedifferentiated chondrosarcoma of the lung with a 4-year history of breast cancer: A case report. World J Clin Cases 2023; 11:3022-3028. [PMID: 37215415 PMCID: PMC10198077 DOI: 10.12998/wjcc.v11.i13.3022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/03/2023] [Accepted: 03/31/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Primary dedifferentiated chondrosarcoma (DDCS) of the lung is extremely rare and has a poor prognosis, especially in patients with a history of carcinomas and related treatment. Herein, we report a case of primary DDCS of the lung in a patient with a 4-year history of breast cancer and related treatment.
CASE SUMMARY A 49-year-old woman was admitted to our hospital with complaints of headache, dizziness, slurred speech, and dyskinesia in May 2021. Computed tomography (CT) examinations showed multiple nodules in the brain, vertebral body, and both lungs with multiple enlarged lymph nodes in the right hilum and mediastinum, which were considered metastases of breast cancer. No obvious mass was discovered in the right hilum. After several months of related administration, the patient's headache disappeared, and her condition improved. However, new problems of asthma, dyspnea, cough, and restricted activity appeared in late November 2021. Although the CT scan indicated that the lesions in the brain, lung, and vertebral body had shrunk or disappeared, a soft tissue density lesion appeared in her right hilum and blocked the bronchial lumen. To relieve her dyspnea, part of the mass was resected, and a stent was placed via fiberoptic bronchoscopy. Following a complete pathological examination of the tumor, it was confirmed to be a primary DDCS of the lung. The patient then received two rounds of systemic chemotherapy with a regimen of cisplatin + ifosfamide + doxorubicin hydrochloride liposome, palliative radiotherapy for the tumor in her right lung, and four cycles of systemic chemotherapy and targeted therapy with a regimen of temozolomide combined with bevacizumab successively. She was in stable condition after the completion of the systemic chemotherapy and targeted therapy but underwent rapid progression after lung radiotherapy. The CT examinations showed multiple nodules in the brain and in both lungs, and the tumor in the right hilum was increased in size.
CONCLUSION This case revealed a rare primary DDCS of the lung with a medical history of breast cancer, meaning a worse prognosis and making it more difficult to treat.
Collapse
Affiliation(s)
- Huan Wen
- Department of Pathology, Hunan Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Changsha 410006, Hunan Province, China
| | - Feng-Jie Gong
- Department of Radiology, Hunan Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Changsha 410006, Hunan Province, China
| | - Jian-Min Xi
- Department of Pathology, Hunan Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Changsha 410006, Hunan Province, China
| |
Collapse
|
6
|
Bui N, Dietz H, Farag S, Hirbe AC, Wagner MJ, Van Tine BA, Ganjoo K, Jones RL, Keedy VL, Davis EJ. A Retrospective Multi-Institutional Cohort Analysis of Clinical Characteristics and Outcomes in Dedifferentiated Chondrosarcoma. Cancers (Basel) 2023; 15:cancers15092617. [PMID: 37174084 PMCID: PMC10177459 DOI: 10.3390/cancers15092617] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Dedifferentiated chondrosarcoma (DDCS) is a rare subset of chondrosarcoma. It is an aggressive neoplasm characterized by a high rate of recurrent and metastatic disease with overall poor outcomes. Systemic therapy is often used to treat DDCS; however, the optimal regimen and timing are not well defined, with current guidelines recommending following osteosarcoma protocols. METHODS We conducted a multi-institutional retrospective analysis of clinical characteristics and outcomes of patients with DDCS. Between 1 January 2004 and 1 January 2022, the databases from five academic sarcoma centers were reviewed. Patient and tumor factors, including age, sex, tumor size, site, location, the treatments rendered, and survival outcomes, were collected. RESULTS Seventy-four patients were identified and included in the analysis. Most patients presented with localized disease. Surgical resection was the mainstay of therapy. Chemotherapy was used predominantly in the metastatic setting. Partial responses were low (n = 4; 9%) and occurred upon treatment with doxorubicin with cisplatin or ifosfamide and single-agent pembrolizumab. For all other regimens, stable disease was the best response. Prolonged stable disease occurred with the use of pazopanib and immune checkpoint inhibitors. CONCLUSIONS DDCS has poor outcomes and conventional chemotherapy has limited benefit. Future studies should focus on defining the possible role of molecularly targeted therapies and immunotherapy in the treatment of DDCS.
Collapse
Affiliation(s)
- Nam Bui
- Stanford Cancer Institute, Palo Alto, CA 94304, USA
| | - Hilary Dietz
- Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Sheima Farag
- Institute of Cancer Research, Royal Marsden Hospital, London SW3 6JJ, UK
| | - Angela C Hirbe
- Siteman Cancer Center, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Michael J Wagner
- Fred Hutchinson Cancer Center, University of Washington, Seattle, WA 98109, USA
| | - Brian A Van Tine
- Siteman Cancer Center, Washington University in St. Louis, St. Louis, MO 63110, USA
| | | | - Robin L Jones
- Institute of Cancer Research, Royal Marsden Hospital, London SW3 6JJ, UK
| | - Vicki L Keedy
- Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | | |
Collapse
|
7
|
Hung YP, Chebib I, Bredella MA, Berner EA, Taylor-Black Q, Choy E, Cote GM, Chen YL, MacDonald SM, Schwab JH, Raskin KA, Newman ET, Selig MK, Deshpande V, Hornick JL, Lozano-Calderón SA, Nielsen GP. Prognostic Significance of Percentage and Size of Dedifferentiation in Dedifferentiated Chondrosarcoma. Mod Pathol 2023; 36:100069. [PMID: 36788104 DOI: 10.1016/j.modpat.2022.100069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 11/17/2022] [Accepted: 12/11/2022] [Indexed: 01/11/2023]
Abstract
Dedifferentiated chondrosarcoma is rare, aggressive, and microscopically bimorphic. How pathologic features such as the amounts of dedifferentiation affect prognosis remains unclear. We evaluated the percentages and sizes of dedifferentiation in a consecutive institutional series of dedifferentiated chondrosarcomas from 1999 to 2021. The statistical analysis included cox proportional hazard models and log-rank tests. Of the 67 patients (26 women, 41 men; age, 39 to >89 [median 61] years; 2 with Ollier disease), 58 presented de novo; 9 were identified with conventional chondrosarcomas 0.6-13.2 years (median, 5.5 years) prior. Pathologic fracture and distant metastases were noted in 27 and 7 patients at presentation. The tumors involved the femur (n = 27), pelvis (n = 22), humerus (n = 7), tibia (n = 4), scapula/ribs (n = 4), spine (n = 2), and clivus (n = 1). In the 56 resections, the tumors ranged in size from 3.5 to 46.0 cm (median, 11.5 cm) and contained 1%-99.5% (median, 70%) dedifferentiated components that ranged in size from 0.6 to 24.0 cm (median, 7.3 cm). No correlation was noted between total size and percentage of dedifferentiation. The dedifferentiated components were typically fibrosarcomatous or osteosarcomatous, whereas the associated cartilaginous components were predominantly grade 1-2, rarely enchondromas or grade 3. The entire cohort's median overall survival and progression-free survival were 11.8 and 5.4 months, respectively. In the resected cohort, although the total size was not prognostic, the percentage of dedifferentiation ≥20% and size of dedifferentiation >3.0 cm each predicted worse overall survival (9.9 vs 72.5 months; HR, 3.76; 95% CI, 1.27-11.14; P = .02; 8.7 vs 58.9 months; HR, 3.03; 95% CI, 1.21-7.57; P = .02, respectively) and progression-free survival (5.3 vs 62.1 months; HR, 3.05; 95% CI, 1.13-8.28; P = .03; 5.3 vs 56.6 months; HR, 2.50; 95% CI, 1.06-5.88; P = .04, respectively). In conclusion, both the percentages and sizes of dedifferentiation were better prognostic predictors than total tumor sizes in dedifferentiated chondrosarcomas, highlighting the utility of their pathologic evaluations.
Collapse
Affiliation(s)
- Yin P Hung
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Center for Sarcoma and Connective Tissue Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts.
| | - Ivan Chebib
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Center for Sarcoma and Connective Tissue Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Miriam A Bredella
- Center for Sarcoma and Connective Tissue Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts; Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Emily A Berner
- Department of Orthopedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Quinn Taylor-Black
- Department of Orthopedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Edwin Choy
- Center for Sarcoma and Connective Tissue Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts; Division of Hematology Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Gregory M Cote
- Center for Sarcoma and Connective Tissue Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts; Division of Hematology Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Yen-Lin Chen
- Center for Sarcoma and Connective Tissue Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts; Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Shannon M MacDonald
- Center for Sarcoma and Connective Tissue Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts; Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Joseph H Schwab
- Center for Sarcoma and Connective Tissue Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts; Department of Orthopedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Kevin A Raskin
- Center for Sarcoma and Connective Tissue Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts; Department of Orthopedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Erik T Newman
- Center for Sarcoma and Connective Tissue Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts; Department of Orthopedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Martin K Selig
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Vikram Deshpande
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Center for Sarcoma and Connective Tissue Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Jason L Hornick
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Santiago A Lozano-Calderón
- Center for Sarcoma and Connective Tissue Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts; Department of Orthopedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - G Petur Nielsen
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Center for Sarcoma and Connective Tissue Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| |
Collapse
|
8
|
Bytnar JA, Lin J, Moncur JT, Shriver CD, Zhu K. Cancers of unknown primary: Survival by histologic type, demographic features, and treatment in the U.S. Military Health System. Cancer Epidemiol 2023; 82:102316. [PMID: 36571909 DOI: 10.1016/j.canep.2022.102316] [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: 08/11/2022] [Revised: 12/09/2022] [Accepted: 12/14/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Cancers of unknown primary (CUP), a group of heterogenous metastatic cancers lacking a known primary site, have poor prognosis. This study compared survival of CUP by histologic type, patient characteristics, and treatment in the U.S. Military Health System (MHS), which provides universal care to its members. METHODS Patients histologically diagnosed with CUP were identified from the U.S. Department of Defense (DoD)'s Automated Central Tumor Registry. Median survival with 95 % confidence intervals was calculated for demographic and treatment variables by histologic type. A multivariable accelerated failure time model estimated time ratios and 95 % confidence intervals. RESULTS The study included 3358 CUP patients. The most prevalent CUP in this study was well- and moderately-differentiated adenocarcinomas. Median survival varied by histologic type with squamous cell carcinoma having the longest at 25.1 months and poorly-differentiated carcinomas having the shortest at 3.0 months. For each histologic type, survival was generally similar by sex and active-duty status although women with well- and moderately-differentiated adenocarcinoma had longer survival than their male counterparts. Younger patients tended to have longer survival than those aged 65 years or older. Generally, there were no racial differences in survival except poorer survival for Black patients than White patients in the group of other histologic types. Patients with chemotherapy and radiation treatment generally had improved survival whereas patients with squamous cell carcinoma who received chemotherapy had shorter survival than those without. CONCLUSION Survival generally did not differ between racial groups, which may be related to equal healthcare access despite racial background. Further studies are warranted to better understand how survival in the MHS compares with that in the general U.S. POPULATION
Collapse
Affiliation(s)
- Julie A Bytnar
- John P. Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Jie Lin
- John P. Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA; Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Joel T Moncur
- The Joint Pathology Center, National Capital Region Medical Directorate, Defense Health Agency, Silver Spring, MD, USA
| | - Craig D Shriver
- John P. Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Department of Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Kangmin Zhu
- John P. Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA; Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
| |
Collapse
|
9
|
Gazendam A, Ghert M. What’s New in Musculoskeletal Tumor Surgery. J Bone Joint Surg Am 2022; 104:2131-2144. [PMID: 37010478 DOI: 10.2106/jbjs.22.00811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | - Michelle Ghert
- McMaster University, Hamilton, Ontario, Canada
- Hamilton Health Sciences, Hamilton, Ontario, Canada
| |
Collapse
|
10
|
Xie T, Sun Y, Han X, Zhang J. The clinicopathological characteristics and prognosis of young patients with chondrosarcoma of bone. Front Surg 2022; 9:926008. [PMID: 36132200 PMCID: PMC9484535 DOI: 10.3389/fsurg.2022.926008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 08/16/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose Clinicopathologic characteristics and treatment outcomes for young patients (less than 40 years) with chondrosarcoma of bone are rarely documented. The purpose of this study is to determine the clinicopathological characteristics and identify the survival predictors for this rare population. Patients and Methods We used the Surveillance, Epidemiology, and End Results (SEER) database to identify young patients with chondrosarcoma of bone between 1973 and 2016. Univariate and multivariate Cox regression analyses were conducted to determine the independent risk factors. Kaplan-Meier method was used to intuitively show the survival difference stratified by different treatments. Results A total of 1312 eligible young patients with chondrosarcoma of bone were analyzed this study. The mean age at diagnosis was 28.5 ± 0.2 years old (ranging from 1 to 40 years). 51.1% of cases were located in the extremity. More than two-thirds of patients (71.4%) were high grade. The majority of the patients (92.0%) received surgery, only 11.8% of patients received radiotherapy, and only 10.4% of patients received chemotherapy. The 5-year overall survival (OS) and cancer-specific survival (CSS) rates of this cohort were 88.5% and 89.1%, respectively. According to the results of multivariate analysis, nine variables were significantly correlated with OS and CSS, including gender, year of diagnosis, tumor site, tumor grade, tumor subtype, distant metastasis, tumor size, surgery, and chemotherapy. Conclusion Young patients with chondrosarcoma of bone experienced better prognosis. Surgery was significantly correlated with increased survival, while chemotherapy was significantly correlated with decreased survival. Radiotherapy was not a meaningful survival predictor of young patients with chondrosarcoma of bone. Prospective clinical trials are needed in the future to determine the effect of radiotherapy and chemotherapy on prognosis of those patients.
Collapse
Affiliation(s)
- Tao Xie
- Department of Orthopedic Surgery, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuanyuan Sun
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiao Han
- Department of Orthopedic Surgery, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jian Zhang
- Department of Orthopedic Surgery, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Correspondence: Jian Zhang
| |
Collapse
|
11
|
Yan L, Gao N, Ai F, Zhao Y, Kang Y, Chen J, Weng Y. Deep learning models for predicting the survival of patients with chondrosarcoma based on a surveillance, epidemiology, and end results analysis. Front Oncol 2022; 12:967758. [PMID: 36072795 PMCID: PMC9442032 DOI: 10.3389/fonc.2022.967758] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAccurate prediction of prognosis is critical for therapeutic decisions in chondrosarcoma patients. Several prognostic models have been created utilizing multivariate Cox regression or binary classification-based machine learning approaches to predict the 3- and 5-year survival of patients with chondrosarcoma, but few studies have investigated the results of combining deep learning with time-to-event prediction. Compared with simplifying the prediction as a binary classification problem, modeling the probability of an event as a function of time by combining it with deep learning can provide better accuracy and flexibility.Materials and methodsPatients with the diagnosis of chondrosarcoma between 2000 and 2018 were extracted from the Surveillance, Epidemiology, and End Results (SEER) registry. Three algorithms—two based on neural networks (DeepSurv, neural multi-task logistic regression [NMTLR]) and one on ensemble learning (random survival forest [RSF])—were selected for training. Meanwhile, a multivariate Cox proportional hazards (CoxPH) model was also constructed for comparison. The dataset was randomly divided into training and testing datasets at a ratio of 7:3. Hyperparameter tuning was conducted through a 1000-repeated random search with 5-fold cross-validation on the training dataset. The model performance was assessed using the concordance index (C-index), Brier score, and Integrated Brier Score (IBS). The accuracy of predicting 1-, 3-, 5- and 10-year survival was evaluated using receiver operating characteristic curves (ROC), calibration curves, and the area under the ROC curves (AUC).ResultsA total of 3145 patients were finally enrolled in our study. The mean age at diagnosis was 52 ± 18 years, 1662 of the 3145 patients were male (53%), and mean survival time was 83 ± 67 months. Two deep learning models outperformed the RSF and classical CoxPH models, with the C-index on test datasets achieving values of 0.832 (DeepSurv) and 0.821 (NMTLR). The DeepSurv model produced better accuracy and calibrated survival estimates in predicting 1-, 3- 5- and 10-year survival (AUC:0.895-0.937). We deployed the DeepSurv model as a web application for use in clinical practice; it can be accessed through https://share.streamlit.io/whuh-ml/chondrosarcoma/Predict/app.py.ConclusionsTime-to-event prediction models based on deep learning algorithms are successful in predicting chondrosarcoma prognosis, with DeepSurv producing the best discriminative performance and calibration.
Collapse
Affiliation(s)
- Lizhao Yan
- Department of Hand Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Nan Gao
- Department of Hand Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fangxing Ai
- Department of Hand Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yingsong Zhao
- Department of Orthopaedics, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu Kang
- Department of Hand Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jianghai Chen
- Department of Hand Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Jianghai Chen, ; Yuxiong Weng,
| | - Yuxiong Weng
- Department of Hand Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Jianghai Chen, ; Yuxiong Weng,
| |
Collapse
|
12
|
Bläsius F, Delbrück H, Hildebrand F, Hofmann UK. Surgical Treatment of Bone Sarcoma. Cancers (Basel) 2022; 14:cancers14112694. [PMID: 35681674 PMCID: PMC9179414 DOI: 10.3390/cancers14112694] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/22/2022] [Accepted: 05/24/2022] [Indexed: 12/24/2022] Open
Abstract
Bone sarcomas are rare primary malignant mesenchymal bone tumors. The three main entities are osteosarcoma, chondrosarcoma, and Ewing sarcoma. While prognosis has improved for affected patients over the past decades, bone sarcomas are still critical conditions that require an interdisciplinary diagnostic and therapeutic approach. While radiotherapy plays a role especially in Ewing sarcoma and chemotherapy in Ewing sarcoma and osteosarcoma, surgery remains the main pillar of treatment in all three entities. After complete tumor resection, the created bone defects need to be reconstructed. Possible strategies are implantation of allografts or autografts including vascularized bone grafts (e.g., of the fibula). Around the knee joint, rotationplasty can be performed or, as an alternative, the implantation of (expandable) megaprostheses can be performed. Challenges still associated with the implantation of foreign materials are aseptic loosening and infection. Future improvements may come with advances in 3D printing of individualized resection blades/implants, thus also securing safe tumor resection margins while at the same time shortening the required surgical time. Faster osseointegration and lower infection rates may possibly be achieved through more elaborate implant surface structures.
Collapse
Affiliation(s)
- Felix Bläsius
- Department of Orthopaedic, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074 Aachen, Germany; (F.B.); (H.D.); (F.H.)
- Centre for Integrated Oncology Aachen Bonn Köln Düsseldorf (CIO), 52074 Aachen, Germany
| | - Heide Delbrück
- Department of Orthopaedic, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074 Aachen, Germany; (F.B.); (H.D.); (F.H.)
- Centre for Integrated Oncology Aachen Bonn Köln Düsseldorf (CIO), 52074 Aachen, Germany
| | - Frank Hildebrand
- Department of Orthopaedic, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074 Aachen, Germany; (F.B.); (H.D.); (F.H.)
- Centre for Integrated Oncology Aachen Bonn Köln Düsseldorf (CIO), 52074 Aachen, Germany
| | - Ulf Krister Hofmann
- Department of Orthopaedic, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074 Aachen, Germany; (F.B.); (H.D.); (F.H.)
- Centre for Integrated Oncology Aachen Bonn Köln Düsseldorf (CIO), 52074 Aachen, Germany
- Correspondence: ; Tel.: +49-(0)241-80-89350
| |
Collapse
|
13
|
LeBrun DG. CORR Insights®: Is Chemotherapy Associated with Improved Overall Survival in Patients with Dedifferentiated Chondrosarcoma? A SEER Database Analysis. Clin Orthop Relat Res 2022; 480:759-761. [PMID: 34870951 PMCID: PMC8923591 DOI: 10.1097/corr.0000000000002066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/05/2021] [Indexed: 01/31/2023]
|
14
|
Challenges of Systemic Therapy Investigations for Bone Sarcomas. Int J Mol Sci 2022; 23:ijms23073540. [PMID: 35408900 PMCID: PMC8998654 DOI: 10.3390/ijms23073540] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/03/2022] [Accepted: 03/17/2022] [Indexed: 02/04/2023] Open
Abstract
Bone sarcoma is a rare component of malignant solid tumors that accounts for only ~0.2% of malignancies. Bone sarcomas present various histological types, and genomic mutations differ markedly by the histological types. Although there are vast mutations in various bone sarcomas, most of them are non-actionable, and even potential targetable mutations that are actionable targets in other malignancies have not shown the appropriate responses in clinical trials for bone sarcomas. Investigations of new systemic therapy, including molecular targeted therapies for bone sarcomas, have thus not progressed like those for other solid tumors. Another problem is that high rates of pediatric/adolescent and young adult patients have bone sarcomas such as osteosarcoma, and patient recruitment for clinical trials (especially randomized trials) is challenging. For pediatric patients, evaluations of tolerability and appropriate dose modifications of new drugs are needed, as their findings could provide the threshold for investigating new drugs for bone sarcomas. To solve these problems, improvements in registry systems, real world data, and pediatric extrapolation have been attempted. We review the issues regarding targeted drug investigations for bone sarcomas, focusing on the current clinical evidence and efforts to resolve these issues.
Collapse
|