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Ipponi E, Bechini E, Cordoni M, Gentili F, Cosseddu F, D'Arienzo A, Andreani L. Myxoid Liposarcomas of the Thigh: Pre-Operative Presentation, Clinical Outcomes, and Functional Results of Surgical Treatment. Healthcare (Basel) 2024; 12:1718. [PMID: 39273742 PMCID: PMC11395618 DOI: 10.3390/healthcare12171718] [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: 07/28/2024] [Revised: 08/14/2024] [Accepted: 08/27/2024] [Indexed: 09/15/2024] Open
Abstract
Myxoid liposarcomas are malignant soft-tissue sarcomas whose treatment represents a challenge, even for the most experienced surgeon. In this study, we report on our experience with the treatment of myxoid liposarcomas of the thigh. Our retrospective analysis included myxoid liposarcomas of the thigh treated with surgical resection between 2016 and 2022. Resection margins, complications, local recurrences, and metastases were recorded. The oncological outcome of each case was evaluated at their latest follow-up. Adjuvant therapies were administered according to the ESMO guidelines. Functionality was assessed with the MSTS score before surgery and at the patients' latest follow-up. Thirty cases (ten high-grade and 20 low-grade) were included. The mean diameter was 11.8 cm. Twenty-four cases had wide margins (80%) and six (20%) were marginal. Five cases (60% marginal) had local recurrences (17%). Marginal resection was associated with a higher risk of local recurrence (p = 0.041). Three cases with high-grade tumors (10%) developed metastases. At the patients' latest follow-up, their mean MSTS score had risen from 22.9 to 27.3. While tumor grade influences the risk of metastases, the quality of resection margins can determine the local recurrence rate. An adequate surgery can lead to good post-operative functional outcomes.
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Affiliation(s)
- Edoardo Ipponi
- Department of Orthopedics and Trauma Surgery, University of Pisa, 56126 Pisa, Italy
| | - Elena Bechini
- Department of Orthopedics and Trauma Surgery, University of Pisa, 56126 Pisa, Italy
| | - Martina Cordoni
- Department of Orthopedics and Trauma Surgery, University of Pisa, 56126 Pisa, Italy
| | - Fabrizia Gentili
- Department of Orthopedics and Trauma Surgery, University of Pisa, 56126 Pisa, Italy
| | - Fabio Cosseddu
- Department of Orthopedics and Trauma Surgery, University of Pisa, 56126 Pisa, Italy
| | - Antonio D'Arienzo
- Department of Orthopedics and Trauma Surgery, University of Pisa, 56126 Pisa, Italy
| | - Lorenzo Andreani
- Department of Orthopedics and Trauma Surgery, University of Pisa, 56126 Pisa, Italy
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Mericli AF, Elmorsi R, Camacho L, Hassan A, Krijgh DD, Tilney G, Lyu H, Traweek RS, Witt RG, Roubaud MS, Roland CL. When to ditch the ladder and take the elevator: The Anderson SArcoma Risk of Complications (A-SARC) score to guide reconstructive decision-making in extremity soft tissue sarcoma patients. J Surg Oncol 2024; 129:1456-1465. [PMID: 38623064 DOI: 10.1002/jso.27646] [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: 01/23/2024] [Revised: 03/27/2024] [Accepted: 04/04/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND The reconstructive ladder relies mostly on defect size and depth to determine reconstructive technique, however, in actuality, many more variables ultimately inform reconstructive decision making, especially regarding extremity soft tissue sarcoma (eSTS) defects. The purpose of this study was to describe eSTS patients who will most optimally benefit from an advanced method of reconstruction (defined as a pedicled regional flap or free flap) and to create a simple risk assessment scale that can be employed in clinical practice. STUDY DESIGN A single-institution retrospective cohort study examined patients undergoing resection of soft tissue sarcoma affecting the upper or lower extremities between 2016 and 2021. We categorized patients who required a pedicled or free flap as having had advanced reconstruction, and all other techniques were considered simple reconstruction. A regression was used to create a risk scale to guide reconstructive decision-making. RESULTS The following variables were identified as independent predictors of complications and used to create our risk scale: lower extremity tumor location, preoperative radiotherapy, tumor bed excision, male sex, hypertension, and tumor volume. Intermediate and high-risk patients reconstructed using simple techniques had significantly greater overall complication rates compared to those reconstructed with advanced techniques. Major complications were significantly greater in low-risk patients reconstructed with advanced techniques. CONCLUSIONS To minimize postoperative wound complications, low-risk patients should receive simple methods of reconstruction, whereas high-risk patients should be reconstructed using advanced techniques.
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Affiliation(s)
- Alexander F Mericli
- Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Rami Elmorsi
- Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Luis Camacho
- Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Abbas Hassan
- Division of Plastic Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - David D Krijgh
- Department of Plastic, Reconstructive, and Hand Surgery, University Medical Center Utrecht, the Netherlands
| | - Gordon Tilney
- Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Heather Lyu
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Raymond S Traweek
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Russell G Witt
- Department of Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Margaret S Roubaud
- Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Christina L Roland
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Shan J, Lv S, Li H, Wang D, Zhang X, Liu W. A comparative study between two methods of delivery of chemotherapeutic agent in patients with bone and soft tissue sarcoma of lower extremity. BMC Musculoskelet Disord 2023; 24:317. [PMID: 37087416 PMCID: PMC10122285 DOI: 10.1186/s12891-023-06417-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 04/10/2023] [Indexed: 04/24/2023] Open
Abstract
BACKGROUND We aimed to compare the effects of peripherally inserted central catheters (PICC) and implantable venous access devices (TIVADs) in terms of complications and shoulder function in patients with malignant bone and soft tissue tumors of the lower extremities. METHODS We analyzed 65 cases of TIVADs (chest wall) and 65 cases of PICC at the orthopedic department of the Fourth Hospital of Hebei Medical University between June 2019 and December 2021, which were diagnosed with malignant bone tumors or soft tissue tumors of the lower extremities (tumors had to be relatively sensitive to chemotherapy), received regular chemotherapy, with ≥ 14 cycles (42 weeks). The two groups were compared in terms of catheter indwelling time, catheter-related complications, Constant-Murley shoulder function score, and displacement of the position of the catheter end on the catheterization side. RESULTS Compared to the PICC group, at six months after catheterization, the TIVADs group reported better outcomes for catheter indwelling time, catheter-related complications, and Constant-Murley score for the catheterization-side shoulder joint (p < 0.05). The TIVADs group also reported less displacement of the catheter end position after 180° abduction of the catheterization-side shoulder joint (p < 0.05). CONCLUSIONS Compared with PICC, TIVADs can prolong catheter indwelling time, reduce catheter-related complications, and maintain shoulder joint function, which makes it an ideal venous-access approach when providing chemotherapy to patients with malignant bone and soft tissue tumors of the lower extremities.
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Affiliation(s)
- Jing Shan
- Department of Orthopedics, The Fourth Hospital of Hebei Medical University, Hebei Provincial Cancer Institute, Shijiazhuang, Hebei, China.
| | - Sumei Lv
- Department of Orthopedics, The Fourth Hospital of Hebei Medical University, Hebei Provincial Cancer Institute, Shijiazhuang, Hebei, China
| | - Haihong Li
- Department of Orthopedics, Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Donglai Wang
- Department of Orthopedics, The Fourth Hospital of Hebei Medical University, Hebei Provincial Cancer Institute, Shijiazhuang, Hebei, China
| | - Xiaoyu Zhang
- Department of Orthopedics, The Fourth Hospital of Hebei Medical University, Hebei Provincial Cancer Institute, Shijiazhuang, Hebei, China
| | - Wei Liu
- Department of Orthopedics, The Fourth Hospital of Hebei Medical University, Hebei Provincial Cancer Institute, Shijiazhuang, Hebei, China
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Lemma J, Jäämaa S, Repo JP, Santti K, Salo J, Blomqvist CP, Sampo MM. Local relapse of soft tissue sarcoma of the extremities or trunk wall operated on with wide margins without radiation therapy. BJS Open 2023; 7:7146315. [PMID: 37115652 PMCID: PMC10144696 DOI: 10.1093/bjsopen/zrac172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 12/07/2022] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND The quality of surgical margins is the most important factor affecting local control in soft tissue sarcoma (STS). Despite this, there is no universally accepted consensus on the definition of an adequate surgical margin or on which patients should be offered radiation therapy. This study focuses on local control and its prognostic factors in patients with trunk wall and extremity STS. METHODS Adult patients with a final diagnosis of trunk wall or extremity STS referred to a single tertiary referral centre between August 1987 and December 2016 were identified from a prospective institutional database. Patients were treated according to a protocol instituted in 1987. The classification of surgical margins and indications for radiation therapy were based on anatomy and strict definition of surgical margins as metric distance to the resection border. Local treatment was defined as adequate if patients received either surgery with wide margins alone or marginal surgery combined with radiation therapy. Margins were considered wide if the tumour was excised with pathological margins greater than 2.5 cm or with an uninvolved natural anatomical barrier. After treatment, patients were followed up with local imaging and chest X-ray: 5 years for high-grade STS, 10 years for low-grade STS. RESULTS A total of 812 patients were included with a median follow-up of 5.8 (range 0.5-19.5) years. Forty-four patients had a grade 1 tumour: there were no instances of recurrence in this group thus they were excluded from further analysis. Five-year local control in the 768 patients with grade 2-3 STS was 90.1 per cent in patients receiving adequate local treatment according to the protocol. Altogether, 333 patients (43.4 per cent) were treated with wide surgery alone and their 5-year local control rate was 91.1 per cent. Among patients treated with wide surgery alone, deep location was the only factor adversely associated with local relapse risk in multivariable analysis; 5-year local control was 95.3 per cent in superficial and 88.3 per cent in deep-sited sarcomas (hazards ratio 3.154 (95% c.i. 1.265 to 7.860), P = 0.014). CONCLUSION A high local control rate is achievable with surgery alone for a substantial proportion of patients with STS of the extremities or superficial trunk wall.
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Affiliation(s)
- Jasmiini Lemma
- Comprehensive Cancer Center, Helsinki University Hospital (HUH) and University of Helsinki, Helsinki, Finland
| | - Sari Jäämaa
- Comprehensive Cancer Center, Helsinki University Hospital (HUH) and University of Helsinki, Helsinki, Finland
| | - Jussi P Repo
- Department of Orthopedics and Traumatology, Unit of Musculoskeletal Disease, Tampere University Hospital and University of Tampere, Tampere, Finland
| | - Kirsi Santti
- Comprehensive Cancer Center, Helsinki University Hospital (HUH) and University of Helsinki, Helsinki, Finland
| | - Juho Salo
- Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Carl P Blomqvist
- Comprehensive Cancer Center, Helsinki University Hospital (HUH) and University of Helsinki, Helsinki, Finland
| | - Mika M Sampo
- HUSLAB Department of Pathology, University of Helsinki, Helsinki, Finland
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A Newly Established Cuproptosis-Associated Long Non-Coding RNA Signature for Predicting Prognosis and Indicating Immune Microenvironment Features in Soft Tissue Sarcoma. JOURNAL OF ONCOLOGY 2022; 2022:8489387. [PMID: 35847354 PMCID: PMC9279026 DOI: 10.1155/2022/8489387] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 06/01/2022] [Accepted: 06/07/2022] [Indexed: 12/16/2022]
Abstract
Cuproptosis, a new type of programmed cell death, is involved in the development and progression of malignancies. The study of cuproptosis-associated long non-coding RNAs (lncRNAs) in soft tissue sarcomas (STSs) is however limited. There is also uncertainty regarding the prognostic accuracy of cuproptosis-associated lncRNAs in STSs and their relationship to the tumor immune microenvironment. The aim of this study was to determine the prognostic significance of cuprotosis-associated lncRNAs in STSs and their relationship to the tumor immune microenvironment. Transcriptomic and clinical data from patients with STSs were obtained through The Cancer Genome Atlas (TCGA). Overall, 259 patients were randomly allocated to a training group or a testing group. In the training group, a cuproptosis-associated lncRNA signature was constructed, and the signature was verified in the testing group. On the basis of risk scores and clinical features, we later developed a hybrid nomogram. We also performed functional and tumor immune microenvironment analysis based on the cuproptosis-associated lncRNA signature. A signature of 5 cuproptosis-associated lncRNAs was created. Based on this signature, we categorized STS patients into high-risk and low-risk groups. The study showed that patients at high risk had a worse prognosis than those at low risk. A nomogram was then constructed combining clinical characteristics with the risk scores, and it was shown to have credible predictive power. Functional enrichment and tumor immune microenvironmental analyses showed that high-risk STSs tend to be immunologically sensitive tumors. In our study, we found a cuproptosis-associated lncRNAs signature, which serves as an independent prognostic indicator. Cuproptosis-associated lncRNAs may play a role in the tumor immune microenvironment, which might be a therapeutic target for patients with STSs.
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Kask G, Barner-Rasmussen I. ASO Author Reflection: Demographic Conditions are the Major Determinants for Functional Outcome and Quality of Life in Lower Extremity Soft Tissue Sarcoma Patients. Ann Surg Oncol 2021; 28:6906-6907. [PMID: 33651213 PMCID: PMC8460492 DOI: 10.1245/s10434-021-09781-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 02/05/2021] [Indexed: 12/04/2022]
Affiliation(s)
- Gilber Kask
- Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland. .,Unit of Musculoskeletal Surgery, Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland.
| | - Ian Barner-Rasmussen
- Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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