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van der Laan P, van der Graaf WTA, van den Broek D, van Boven H, Heeres BC, Schrage Y, Haas RL, Steeghs N, van Houdt WJ. Interleukin-6 in relation to early recurrence in primary, localized soft tissue sarcoma: An addition for existing risk classification systems? EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108530. [PMID: 39083882 DOI: 10.1016/j.ejso.2024.108530] [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: 04/17/2024] [Revised: 06/13/2024] [Accepted: 07/03/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Several inflammatory markers have gained interest as prognostic factors for cancer. The aim of this study is to evaluate the inflammatory markers interleukin-6 (IL-6), C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) as predictive markers for aggressive behavior and early recurrences in primary, localized soft tissue sarcoma (STS). METHODS 115 STS patients were retrospectively reviewed. IL-6 and CRP blood levels, NLR and PLR were obtained prior to treatment. Early recurrence was defined as disease relapse (local or distant) within the first year after surgery. Cox regression analysis was used to identify prognostic factors for early recurrence. RESULTS IL-6 elevation was associated with a higher tumor grade, increased size, tumor necrosis and a higher mitotic count. NLR elevation was associated with a higher tumor grade, PLR elevation with a larger tumor size. Early recurrences were found in 24 patients (21 %). Univariable analysis revealed that tumor grade (p = 0.029), tumor size (p = 0.030, >10 cm vs < 5 cm), tumor depth (p = 0.036), necrosis on imaging (p = 0.008), mitotic count (p = 0.045, ≥20 mitoses vs 0-9 mitoses), and IL-6 level (p = 0.044) were associated with early recurrence. The factors age at diagnosis, tumor location, necrosis at pathology, (neo)adjuvant radio- or chemotherapy, resection margin, CRP level, NLR and PLR were not related to early disease recurrence. CONCLUSIONS Increased inflammatory markers in STS are associated with an aggressive phenotype. STS patients with elevation of IL-6 may be at risk for early disease recurrence.
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Affiliation(s)
- P van der Laan
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands.
| | - W T A van der Graaf
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - D van den Broek
- Department of Laboratory Medicine, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - H van Boven
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - B C Heeres
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Y Schrage
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - R L Haas
- Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Radiotherapy, Leiden University Medical Centre, Leiden, the Netherlands
| | - N Steeghs
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - W J van Houdt
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands.
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Mick P, Rohner M, Renkawitz T, Lehner B, Geisbüsch A, Tsitlakidis S, Hariri M, Deisenhofer J, Müller M, Doll J. From Benign Lipoma to G3 Liposarcoma: Contrast-Enhanced Ultrasound Reveals Tumor Microperfusion and Indicates Malignancy. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:1472-1478. [PMID: 38955624 DOI: 10.1016/j.ultrasmedbio.2024.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 04/27/2024] [Accepted: 05/31/2024] [Indexed: 07/04/2024]
Abstract
OBJECTIVE Lipomatous soft tissue tumors (STT), ranging from benign lipomas to malignant liposarcomas, require accurate differentiation for timely treatment. Complementary to MRI, Contrast-enhanced ultrasound (CEUS) is emerging as a promising tool, providing insight into tumor microperfusion in real-time. This study aims to explore the potential of preoperative CEUS in differentiating benign lipomatous tumors from malignant liposarcoma subtypes. METHODS Eighty-seven patients with lipomatous STT scheduled for surgery were enrolled. Clinical and MRI assessments were conducted to obtain general tumor characteristics. CEUS was used for a standardized tumor perfusion evaluation. Perfusion analysis included peak enhancement, rise time, wash-in perfusion index, and wash-out rate, reflecting the perfusion kinetics. Histopathological results were obtained for every STT and compared to perfusion characteristics. RESULTS In total, 48 lipoma, 23 ALT and 11 liposarcoma were identified. Significant differences in tumor microperfusion were demonstrated, with higher perfusion levels indicating higher malignancy (Peak enhancement [a.u.] of Lipoma: 145 ± 238; ALT: 268 ± 368; Liposarcoma: 3256 ± 4333; p (ALT vs. Liposarcoma) < 0.001). A perfusion-based identification of a benign lipoma or ALT versus sarcoma resulted in a positive predictive value of 93%. Patient-related factors (age, gender, BMI, ASA score, smoking status) had no significant impact on the CEUS-based perfusion parameters. CONCLUSION Our study suggests CEUS as a capable non-invasive tool for improving preoperative assessment of lipomatous STT. It can assist in the distinction between benign and malignant STT, accelerating treatment decisions and enhancing patient outcomes. Significant correlations between CEUS-derived parameters and malignancy highlight its risk assessment potential.
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Affiliation(s)
- Paul Mick
- Department for Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany.
| | - Marie Rohner
- Department for Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Tobias Renkawitz
- Department for Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Burkhard Lehner
- Department for Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas Geisbüsch
- Department for Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefanos Tsitlakidis
- Department for Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Mustafa Hariri
- Department for Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Julian Deisenhofer
- Department for Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Michelle Müller
- Department for Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Julian Doll
- Department for Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany
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Hikmet RG, Klug TE, Gade SD, Sandfeld-Paulsen B, Aggerholm-Pedersen N. A Retrospective Study of 291 Patients With Head and Neck Sarcomas: Treatment, Outcomes, and Prognostic Factors. Clin Oncol (R Coll Radiol) 2024; 36:409-419. [PMID: 38744596 DOI: 10.1016/j.clon.2024.04.009] [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: 09/25/2023] [Revised: 04/10/2024] [Accepted: 04/24/2024] [Indexed: 05/16/2024]
Abstract
AIMS Sarcomas constitute a group of rare malignant neoplasms, commonly subcategorized into soft tissue sarcomas (STS) and bone sarcomas. This study aims to describe the treatment modalities and outcome of head and neck sarcoma (HNS) patients in western Denmark and to identify prognostic factors for overall survival and recurrence in HNS patients. MATERIALS AND METHODS The Aarhus sarcoma registry, The National Danish Sarcoma Database, and the Danish National Pathology Registry were used to identify HNS adult patients diagnosed between 1979 and 2022. RESULTS Altogether, 291 patients were included in this study. The prevalent histological subtypes were undifferentiated pleomorphic sarcoma (16%; 48/291) and leiomyosarcoma (15%; 44/291) for STS patients (n = 230) and chondrosarcoma (10%; 28/291) and osteosarcoma (7%; 19/291) for bone sarcoma patients (n = 61). Surgery with curative intent was performed in 71% (164/230) and 70% (43/61) of STS and bone sarcoma patients, respectively. Clear resection was achieved in 59% (97/164) of STS patients and 44% (19/43) of bone sarcoma patients. Eighty-nine patients relapsed (STS n = 66, bone sarcoma n = 23) after a median time of 2.7/5.5 years for STS/bone sarcoma patients. The five-year overall survival rates were 45% for STS patients and 66% for bone sarcoma patients. The following factors were significantly, negatively associated with overall survival in STS patients: Age (hazard ratio (HR)) = 1.02, p < 0.001), tumour size ≥5 cm (HR = 1.75, p = 0.003), metastatic disease (HR = 3.17, p < 0.001), high grade tumour (HR = 2.24, p = 0.004), previous cancer (HR = 2.84, p < 0.001), and high Aarhus composite biomarker score (ACBS) (HR = 4.56, p = 0.001). For relapse in STS patients, higher tumour grade (HR = 3.19, p = 0.014), intralesional margins (HR = 2.84, p < 0.001), ≥2 previous cancers (HR = 3.00, p = 0.004), and high ACBS (HR = 3.29, p = 0.047), were negatively associated. For bone sarcomas only higher age (HR = 1.02, p = 0.049) and intralesional margins (HR = 2.91, p = 0.042) were significant negative factors for overall survival. CONCLUSION Multiple prognostic factors for overall survival and relapse were identified, especially for STS patients.
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Affiliation(s)
- R G Hikmet
- Faculty of Health, Aarhus University, Vennelyst Boulevard 4 8000 Aarhus C, Denmark.
| | - T E Klug
- Faculty of Health, Aarhus University, Vennelyst Boulevard 4 8000 Aarhus C, Denmark; Department of Otorhinolaryngology, Head & Neck Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99 8200 Aarhus N, Denmark
| | - S D Gade
- Faculty of Health, Aarhus University, Vennelyst Boulevard 4 8000 Aarhus C, Denmark; Department of Otorhinolaryngology, Head & Neck Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99 8200 Aarhus N, Denmark
| | - B Sandfeld-Paulsen
- Department of Clinical Biochemistry, Viborg Regional Hospital, Heibergs Alle 5A 8800 Viborg, Denmark; Department of Clinical Medicine, Aarhus University, Vennelyst Boulevard 4 8000 Aarhus C, Denmark
| | - N Aggerholm-Pedersen
- Department of Clinical Medicine, Aarhus University, Vennelyst Boulevard 4 8000 Aarhus C, Denmark; Department of Experimental Oncology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99 8200 Aarhus N, Denmark; Department of Clinical Oncology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99 8200 Aarhus N, Denmark
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Michot A, Lagarde P, Lesluyes T, Darbo E, Neuville A, Baud J, Perot G, Bonomo I, Maire M, Michot M, Coindre JM, Le Loarer F, Chibon F. Analysis of the Peritumoral Tissue Unveils Cellular Changes Associated with a High Risk of Recurrence. Cancers (Basel) 2023; 15:3450. [PMID: 37444560 DOI: 10.3390/cancers15133450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/22/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND The management of soft-tissue sarcoma (STS) relies on a multidisciplinary approach involving specialized oncological surgery combined with other adjuvant therapies to achieve optimal local disease control. Purpose and Results: Genomic and transcriptomic pseudocapsules of 20 prospective sarcomas were analyzed and revealed to be correlated with a higher risk of recurrence after surgery. CONCLUSIONS A peritumoral environment that has been remodeled and infiltrated by M2 macrophages, and is less expressive of healthy tissue, would pose a significant risk of relapse and require more aggressive treatment strategies.
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Affiliation(s)
- Audrey Michot
- Bordeaux Institute of Oncology, BRIC U1312, INSERM, 33000 Bordeaux, France
- Institut Bergonié, Centre de Lutte Contre le Cancer de Bordeaux, 33076 Bordeaux, France
- Department of Biopathology, Bergonié Institute, Université Victor Segalen Site Carreire, Bordeaux 2, 33076 Bordeaux, France
| | - Pauline Lagarde
- Institut Bergonié, Centre de Lutte Contre le Cancer de Bordeaux, 33076 Bordeaux, France
- Department of Biopathology, Bergonié Institute, Université Victor Segalen Site Carreire, Bordeaux 2, 33076 Bordeaux, France
| | - Tom Lesluyes
- Institut Bergonié, Centre de Lutte Contre le Cancer de Bordeaux, 33076 Bordeaux, France
| | - Elodie Darbo
- Bordeaux Institute of Oncology, BRIC U1312, INSERM, 33000 Bordeaux, France
- Department of Biopathology, Bergonié Institute, Université Victor Segalen Site Carreire, Bordeaux 2, 33076 Bordeaux, France
| | - Agnès Neuville
- Institut Bergonié, Centre de Lutte Contre le Cancer de Bordeaux, 33076 Bordeaux, France
| | - Jessica Baud
- Bordeaux Institute of Oncology, BRIC U1312, INSERM, 33000 Bordeaux, France
| | - Gaëlle Perot
- OncoSarc, INSERM U1037, Cancer Research Center in Toulouse (CRCT), 31000 Toulouse, France
- Department of Pathology, Institut Claudius Régaud, IUCT-Oncopole, 31000 Toulouse, France
| | - Iris Bonomo
- Institut Bergonié, Centre de Lutte Contre le Cancer de Bordeaux, 33076 Bordeaux, France
| | - Mathilde Maire
- Institut Bergonié, Centre de Lutte Contre le Cancer de Bordeaux, 33076 Bordeaux, France
| | - Maxime Michot
- Institut Bergonié, Centre de Lutte Contre le Cancer de Bordeaux, 33076 Bordeaux, France
| | - Jean-Michel Coindre
- Institut Bergonié, Centre de Lutte Contre le Cancer de Bordeaux, 33076 Bordeaux, France
- Department of Biopathology, Bergonié Institute, Université Victor Segalen Site Carreire, Bordeaux 2, 33076 Bordeaux, France
| | - François Le Loarer
- Bordeaux Institute of Oncology, BRIC U1312, INSERM, 33000 Bordeaux, France
- Institut Bergonié, Centre de Lutte Contre le Cancer de Bordeaux, 33076 Bordeaux, France
- Department of Biopathology, Bergonié Institute, Université Victor Segalen Site Carreire, Bordeaux 2, 33076 Bordeaux, France
| | - Frédéric Chibon
- OncoSarc, INSERM U1037, Cancer Research Center in Toulouse (CRCT), 31000 Toulouse, France
- Department of Pathology, Institut Claudius Régaud, IUCT-Oncopole, 31000 Toulouse, France
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Goyal S, Rangankar V, Deshmukh S, Prabhu A, S J. MRI Evaluation of Soft Tissue Tumors and Tumor-Like Lesions of Extremities. Cureus 2023; 15:e37047. [PMID: 37153328 PMCID: PMC10154641 DOI: 10.7759/cureus.37047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2023] [Indexed: 04/05/2023] Open
Abstract
AIM The current study aimed to evaluate the use of magnetic resonance imaging (MRI) in the diagnosis of extremity soft tissue tumors and tumor-like abnormalities. METHODS This prospective observational study of 71 patients with soft tissue lesions of extremities was conducted at a tertiary hospital and teaching center in western India after obtaining Institutional Ethical Committee (IEC) clearance. All patients underwent an MRI of the region of interest on Siemens Magnetom Vida 3 Tesla MRI (Erlangen, Germany). MRI findings and diagnosis were correlated clinically and with histopathological examination. RESULTS A total of 71 patients (49 males and 22 females) in the age group of six to 90 years were included in our study. Out of 44 patients with soft tissue tumors, the most common lesion was neurofibroma (18.1%), followed by lipoma and undifferentiated sarcoma (9.1% each). Liposarcoma, myxoid liposarcoma, giant cell tumor of the tendon, pigmented villonodular synovitis, and schwannoma were seen in 4.5% of patients each. The soft tissue tumor-like lesions were seen in 27 (38%) patients, the most common being slow-flow vascular malformation, which was seen in 9/27 (33%) patients. The second most common pathology was actinomycosis, seen in four (14.8%) patients. Out of 44 patients with soft tissue tumors, 27 (61.4%) were benign and 17 (38.6%) were malignant. Tumor size of more than 5 cm was more commonly seen in malignant tumors (70.5%) than benign tumors (40.7%). The smooth margin was more common in benign tumors (70.3), while most malignant tumors (70.5%) had irregular or lobulated margins. Heterogenous enhancement was more common in malignant tumors (82.3%) than benign tumors (62.9). The odds of a benign histopathological diagnosis for a tumor suspected to be benign by MRI were 93.75 times higher than the odds of a benign histopathological diagnosis for a tumor suspected to be malignant by MRI. CONCLUSION MRI is extremely useful in the evaluation of different soft tissue masses and helps in evaluating the characteristics of the masses, their extent and relationship to surrounding structures, and bone destruction, multiplicity, composition, and enhancement pattern. The systematic imaging analysis approach helps to differentiate a benign lesion from a malignant lesion and also in differentiating various soft tissue tumor mimics.
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Guadagnolo BA, Bassett RL, Mitra D, Farooqi A, Hempel C, Dorber C, Willis T, Wang WL, Ratan R, Somaiah N, Benjamin RS, Torres KE, Hunt KK, Scally CP, Keung EZ, Satcher RL, Bird JE, Lin PP, Moon BS, Lewis VO, Roland CL, Bishop AJ. Hypofractionated, 3-week, preoperative radiotherapy for patients with soft tissue sarcomas (HYPORT-STS): a single-centre, open-label, single-arm, phase 2 trial. Lancet Oncol 2022; 23:1547-1557. [PMID: 36343656 PMCID: PMC9817485 DOI: 10.1016/s1470-2045(22)00638-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/30/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The standard preoperative radiotherapy regimen of 50 Gy delivered in 25 fractions for 5 weeks for soft tissue sarcomas results in excellent local control, with major wound complications occurring in approximately 35% of patients. We aimed to investigate the safety of a moderately hypofractionated, shorter regimen of radiotherapy, which could be more convenient for patients. METHODS This single-centre, open-label, single-arm, phase 2 trial (HYPORT-STS) was done at a single tertiary cancer care centre (MD Anderson Cancer Center, Houston, TX, USA). We administered preoperative radiotherapy to a dose of 42·75 Gy in 15 fractions of 2·85 Gy/day for 3 weeks (five fractions per week) to adults (aged ≥18 years) with non-metastatic soft tissue sarcomas of the extremities or superficial trunk and an Eastern Cooperative Oncology Group performance status of 0-3. The primary endpoint was a major wound complication occurring within 120 days of surgery. Major wound complications were defined as those requiring a secondary operation, or operations, under general or regional anaesthesia for wound treatment; readmission to the hospital for wound care; invasive procedures for wound care; deep wound packing to an area of wound measuring at least 2 cm in length; prolonged dressing changes; repeat surgery for revision of a split thickness skin graft; or wet dressings for longer than 4 weeks. We analysed our primary outcome and safety in all patients who enrolled. We monitored safety using a Bayesian, one-arm, time-to-event stopping rule simulator comparing the rate of major wound complications at 120 days post-surgery among study participants with the historical rate of 35%. This trial is registered with ClinicalTrials.gov, NCT03819985, recruitment is complete, and follow-up continues. FINDINGS Between Dec 18, 2018, and Jan 6, 2021, we assessed 157 patients for eligibility, of whom 120 were enrolled and received hypofractionated preoperative radiotherapy. At no time did the stopping rule computation indicate that the trial should be stopped early for lack of safety. Median postoperative follow-up was 24 months (IQR 17-30). Of 120 patients, 37 (31%, 95% CI 24-40) developed a major wound complication at a median time of 37 days (IQR 25-59) after surgery. No patient had acute radiation toxicity (during radiotherapy or within 4 weeks of the radiotherapy end date) of grade 3 or worse (Common Terminology Criteria for Adverse Events [CTCAE] version 4.0) or an on-treatment serious adverse event. Four (3%) of 115 patients had late radiation toxicity (≥6 months post-surgery) of at least grade 3 (CTCAE or Radiation Therapy Oncology Group/European Organisation for Research and Treatment of Cancer Late Radiation Morbidity Scoring Scheme): femur fractures (n=2), lymphoedema (n=1), and skin ulceration (n=1). There were no treatment-related deaths. INTERPRETATION Moderately hypofractionated preoperative radiotherapy delivered to patients with soft tissue sarcomas was safe and could therefore be a more convenient alternative to conventionally fractionated radiotherapy. Patients can be counselled about these results and potentially offered this regimen, particularly if it facilitates care at a sarcoma specialty centre. Results on long-term oncological, late toxicity, and functional outcomes are awaited. FUNDING The National Cancer Institute.
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Affiliation(s)
| | - Roland L Bassett
- Department of Biostatistics, MD Anderson Cancer Center, Houston, TX, USA
| | - Devarati Mitra
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Ahsan Farooqi
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Caroline Hempel
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Courtney Dorber
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Tiara Willis
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Wei-Lien Wang
- Department of Pathology, MD Anderson Cancer Center, Houston, TX, USA
| | - Ravin Ratan
- Department of Sarcoma Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Neeta Somaiah
- Department of Sarcoma Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Robert S Benjamin
- Department of Sarcoma Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Keila E Torres
- Department of Surgical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Kelly K Hunt
- Department of Surgical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | | | - Emily Z Keung
- Department of Surgical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Robert L Satcher
- Department of Orthopaedic Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Justin E Bird
- Department of Orthopaedic Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Patrick P Lin
- Department of Orthopaedic Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Bryan S Moon
- Department of Orthopaedic Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Valerae O Lewis
- Department of Orthopaedic Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Christina L Roland
- Department of Surgical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Andrew J Bishop
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
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Impact of time to first relapse on long-term outcome in adult retroperitoneal sarcoma patients after radical resection. Int J Clin Oncol 2022; 27:1487-1498. [PMID: 35763227 PMCID: PMC9393154 DOI: 10.1007/s10147-022-02205-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/06/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Local recurrence of primary retroperitoneal sarcoma (RPS) is one of the major causes of treatment failure and death. We attempted to assess the effects of time to local recurrence (TLR) on the survival after recurrence (SAR) and overall survival (OS) of RPS. METHODS Included in this study were 224 patients who underwent R0 resection for primary RPS at our institution between January 2000 and December 2020, 118 of whom had local recurrence. Based on the median TLR (19.8 months), patients were divided into two groups: early local recurrence (ELR < 20 months) and late local recurrence (LLR > 20 months). The Kaplan-Meier method was employed to calculate the local recurrence-free survival (LRFS), SAR and OS. Univariate and multivariate analyses were conducted to explore the prognostic value of TLR. RESULTS The median follow-up time was 60.5 months for the entire cohort and 58.5 months for the recurrence cohort. There were 60 (50.8%) patients in the ELR group and 58 (49.2%) in the LLR group. The ELR group exhibited a worse SAR (29.2 months vs. 73.4 months, P < 0.001), OS (41.8 months vs. 120.9 months, P < 0.001), and a lower 5-year OS rate (35.9% vs. 73.2%, P = 0.004) than the LLR group. Furthermore, multivariate analysis indicated that TLR was an independent prognostic indicator for SAR (P = 0.014) and OS (P < 0.001). CONCLUSIONS In patients with RPS, ELR after R0 resection presents adverse effects on OS and SAR than those with LLR, and TLR could serve as a promising predictor for OS and SAR.
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Sedaghat S, Ravesh MS, Sedaghat M, Meschede J, Jansen O, Both M. Does the primary soft-tissue sarcoma configuration predict configuration of recurrent tumors on magnetic resonance imaging? Acta Radiol 2022; 63:642-651. [PMID: 33853376 DOI: 10.1177/02841851211008381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Soft-tissue sarcomas (STS) are rare malignancies of the soft tissue. PURPOSE To assess whether the magnetic resonance imaging (MRI) configuration of primary STS can predict the configuration of a recurring tumor and whether the MRI configuration of multiple recurrences differs in one and the same patient. MATERIAL AND METHODS Thirty-nine patients with histologically proven recurrent STS were included in this retrospective study and underwent pre- and post-treatment MRI. Three main configurations of primary and recurrent tumors were identified: polycyclic/multilobulated; ovoid/nodular; and streaky. RESULTS Sixty recurrent lesions were detected: 34 ovoid/nodular; 15 polycyclic/multilobulated; and 11 streaky. Five recurrences were multifocal and eight were bifocal. Of 39 patients, 28 (71.8%) presented one recurrence within the MRI follow-up period (P = 0.006); in 10 patients (25.6%), up to three different configurations of recurring STS were identified in one patient. Recurrences of polycyclic/multilobulated primaries were mostly ovoid/nodular (48%; P = 0.003) or polycyclic/multilobulated (37%; P = 0.014), and recurring ovoid/nodular STS significantly most often showed the same configuration as the primary tumor (85%; P < 0.001). Primary STS with a streaky configuration recurred in all three configurations in roughly equal proportions. Homogeneity/heterogeneity and tumor borders are significantly associated with the configuration of recurrences. CONCLUSION Primary STS configuration may help predict recurrent tumor configuration when the primary STS had a polycyclic/multilobulated or ovoid/nodular configuration. However, recurrent STS configuration can also differ from primary STS configuration, especially when the primary STS had a streaky configuration, rendering recurrent STS difficult to predict. Different configurations of recurrent STS in one and the same patient are common.
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Affiliation(s)
- Sam Sedaghat
- Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
- Institute of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Bergmannsheil, Bochum, Germany
| | - Mona Salehi Ravesh
- Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Maya Sedaghat
- Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
- Institute of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Bergmannsheil, Bochum, Germany
| | - Jens Meschede
- Institute of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Bergmannsheil, Bochum, Germany
- Department for Radiology and Neuroradiology, Klinikum Dortmund, Germany
| | - Olav Jansen
- Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Marcus Both
- Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
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Hutchinson ID, Ata A, DiCaprio MR. Is Metformin Use Associated with Prolonged Overall Survival in Patients with Soft Tissue Sarcoma? A SEER-Medicare Study. Clin Orthop Relat Res 2022; 480:735-744. [PMID: 34779790 PMCID: PMC8923596 DOI: 10.1097/corr.0000000000002045] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 10/18/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Metformin, an oral drug used to treat patients with diabetes, has been associated with prolonged survival in patients with various visceral carcinomas. Although the exact mechanisms are unknown, preclinical translational studies demonstrate that metformin may impair tumor cellular metabolism, alter matrix turnover, and suppress oncogenic signaling pathways. Currently used chemotherapeutic agents have not been very successful in the adjuvant setting or for treating patients with metastatic sarcomas. We wanted to know whether metformin might be associated with improved survival in patients with a soft tissue sarcoma. QUESTIONS/PURPOSES In patients treated for a soft tissue sarcoma, we asked: (1) Is there an association between metformin use and longer survival? (2) How does this association differ, if at all, among patients with and without the diagnosis of diabetes? METHODS The Surveillance, Epidemiology, and End Results-Medicare (SEER-Medicare) database was used to identify patients with a diagnosis of soft tissue sarcoma from 2007 to 2016. Concomitant medication use was identified using National Drug Codes using the Medicare Part D event files. This database was chosen because of the large number of captured sarcoma patients, availability of tumor characteristics, and longitudinal linkage of Medicare data. A total of 14,650 patients were screened for inclusion. Patients with multiple malignancies, diagnosis at autopsy, or discrepant linkage to the Medicare database were excluded. Overall, 4606 patients were eligible for the study: 598 patients taking metformin and 4008 patients not taking metformin. A hazard of mortality (hazard ratio) was analyzed comparing patients taking metformin with those patient groups not taking metformin and expressed in terms of a 95% confidence interval. Cox regression analysis was used to control for patient-specific, disease-specific, and treatment-specific covariates. RESULTS Having adjusted for disease-, treatment-, and patient-specific characteristics, patients taking metformin experienced prolonged survival compared with all patients not taking metformin (HR 0.76 [95% CI 0.66 to 0.87]). Associated prolonged survival was also seen when patients taking metformin were compared with those patients not on metformin irrespective of a diabetes diagnosis (HR 0.79 [95% CI 0.66 to 0.94] compared with patients with a diagnosis of diabetes and HR 0.77 [95% CI 0.67 to 0.89] compared with patients who did not have a diagnosis of diabetes). CONCLUSION Without suggesting causation, we found that even after controlling for confounding variables such as Charlson comorbidity index, tumor grade, size, stage, and surgical/radiation treatment modalities, there was an association between metformin use and increased survival in patients with soft tissue sarcoma. When considered separately, this association persisted in patients not on metformin with and without a diabetes diagnosis. Although metformin is not normally prescribed to patients who do not have a diabetes diagnosis, these data support further study, and if these findings are substantiated, it might lead to the performance of multicenter, prospective clinical trials about the use of metformin as an adjuvant therapy for the treatment of soft tissue sarcoma in patients with and without a preexisting diabetes diagnosis. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Ian D. Hutchinson
- Division of Orthopaedic Surgery, Albany Medical Center, Albany, NY, USA
- Department of Surgery, Albany Medical Center, Albany, NY, USA
| | - Ashar Ata
- Department of Surgery, Albany Medical Center, Albany, NY, USA
| | - Matthew R. DiCaprio
- Division of Orthopaedic Surgery, Albany Medical Center, Albany, NY, USA
- Department of Surgery, Albany Medical Center, Albany, NY, USA
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10
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Fujibuchi T, Imai H, Kidani T, Morino T, Miura H. Serum lactate dehydrogenase levels predict the prognosis of patients with soft tissue sarcoma. Mol Clin Oncol 2022; 16:65. [PMID: 35154705 PMCID: PMC8822601 DOI: 10.3892/mco.2022.2498] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 01/12/2022] [Indexed: 11/08/2022] Open
Abstract
Several studies have reported the prognostic factors for soft tissue sarcoma. Although serum lactate dehydrogenase (LDH) levels are associated with poor prognosis in several types of cancer, their role in soft tissue sarcomas remains unclear. Therefore, the present study evaluated the association between serum LDH levels and the clinical characteristics and prognosis of soft tissue sarcoma. A total of 103 patients diagnosed with primary soft tissue sarcoma between 2003 and 2019 were retrospectively examined, and the association between serum LDH levels at the first visit and clinical characteristics were analysed. In high-grade soft tissue sarcoma, the association between survival and clinical characteristics, including stratified LDH levels, was also analysed. Serum LDH levels were stratified (>253 and ≤253 IU/l) according to the standard values used at our institution. High serum LDH levels were significantly associated with the presence of metastasis and histological grade (P<0.001 and 0.040, respectively). In both the univariate and multivariate analyses, disease-specific survival (DSS) was significantly worse in patients with high-grade soft tissue sarcoma and high serum LDH levels than in patients with normal serum LDH levels (univariate analysis: P=0.025; multivariate analysis: Hazard ratio, 4.60; 95% confidence interval, 1.16-18.2; P=0.030). In conclusion, high serum LDH levels at the first visit predicted the presence of distant metastasis, high histological grade and worse DSS in patients with high-grade soft tissue sarcoma. Therefore, in patients with high serum LDH levels at the first visit, these risks should be considered during pretreatment examinations and post-treatment follow-up.
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Affiliation(s)
- Taketsugu Fujibuchi
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Toon, Ehime 791-0295, Japan
| | - Hiroshi Imai
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Toon, Ehime 791-0295, Japan
| | - Teruki Kidani
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Toon, Ehime 791-0295, Japan
| | - Tadao Morino
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Toon, Ehime 791-0295, Japan
| | - Hiromasa Miura
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Toon, Ehime 791-0295, Japan
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11
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Wu M, Hu Y, Hang J, Peng X, Mao C, Ye X, Li A. Qualitative and Quantitative Contrast-Enhanced Ultrasound Combined with Conventional Ultrasound for Predicting the Malignancy of Soft Tissue Tumors. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:237-247. [PMID: 34782165 DOI: 10.1016/j.ultrasmedbio.2021.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 10/05/2021] [Accepted: 10/07/2021] [Indexed: 06/13/2023]
Abstract
This study was aimed at evaluating the performance of perfusion patterns and the quantitative parameters of contrast-enhanced ultrasound (CEUS) in the detection of soft tissue tumors (STTs) and establishing a US workflow for STTs to improve patient management. Conventional ultrasound (US) and CEUS data were retrospectively collected from 156 soft tissue masses. Six perfusion patterns (P1-P6) were applied for CEUS qualitative analysis. Multivariate logistic regression was used to evaluate the performance of conventional US and qualitative and quantitative CEUS in distinguishing benign and malignant STTs. The malignancy rates of P1-P6 in STTs were 0%, 50.0%, 9.1%, 33.3%, 73.4% and 61.0%, respectively. For "non-P1" STTs, the predictive model combining quantitative CEUS parameters with conventional US features, including margin (odds ratio [OR] = 4.490, p = 0.000), vascular density (OR = 2.307, p = 0.013), 50% wash-out intensity (OR = 1.904, p = 0.032) and 50% wash-out time (OR = 1.031, p = 0.019), performed favorably in predicting malignancy, with an accuracy of 81.0% and an area under the receiver operating characteristic curve of 0.868. Furthermore, a US workflow for the detection of STTs based on conventional US and CEUS was established. CEUS with qualitative and quantitative analyses could be an effective tool for STT diagnosis. The US workflow in this study may improve the management of STT patients.
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Affiliation(s)
- Mengjie Wu
- Department of Ultrasound, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yu Hu
- Department of Ultrasound, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jing Hang
- Department of Ultrasound, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiaojing Peng
- Department of Ultrasound, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Cuilian Mao
- Department of Ultrasound, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xinhua Ye
- Department of Ultrasound, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ao Li
- Department of Ultrasound, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
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12
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Deep learning radiomic nomogram to predict recurrence in soft tissue sarcoma: a multi-institutional study. Eur Radiol 2021; 32:793-805. [PMID: 34448928 DOI: 10.1007/s00330-021-08221-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/19/2021] [Accepted: 07/15/2021] [Indexed: 02/01/2023]
Abstract
OBJECTIVES To evaluate the performance of a deep learning radiomic nomogram (DLRN) model at predicting tumor relapse in patients with soft tissue sarcomas (STS) who underwent surgical resection. METHODS In total, 282 patients who underwent MRI and resection for STS at three independent centers were retrospectively enrolled. In addition, 113 of the 282 patients received additional contrast-enhanced MRI scans. We separated the participants into a development cohort and an external test cohort. The development cohort consisted of patients from one center and the external test cohort consisted of patients from two other centers. Two MRI-based DLRNs for prediction of tumor relapse after resection of STS were established. We universally tested the DLRNs and compared them with other prediction models constructed by using widespread adopted predictors (i.e., staging systems and Ki67) instead of radiomics features. RESULTS The DLRN1 model incorporated plain MRI-based radiomics signature into the clinical data, and the DLRN2 model integrated radiomics signature extracted from plain and contrast-enhanced MRI with the clinical predictors. Across both study sets, the two MRI-based DLRNs had relatively better prognostic capability (C index ≥ 0.721 and median AUC ≥ 0.746; p < 0.05 compared with most other models and predictors) and less opportunity for prediction error (integrated Brier score ≤ 0.159). The decision curve analysis indicates that the DLRNs have greater benefits than staging systems, Ki67, and other models. We selected appropriate cutoff values for the DLRNs to divide STS recurrence into three risk strata (low, medium, and high) and calculated those groups' cumulative risk rates. CONCLUSION The DLRNs were shown to be a reliable and externally validated tool for predicting STS recurrence by comparing with other prediction models. KEY POINTS • The prediction of a high recurrence rate of STS before emergence of local recurrence can help to determine whether more active treatment should be implemented. • Two MRI-based DLRNs for prediction of tumor relapse were shown to be a reliable and externally validated tool for predicting STS recurrence. • We used the DLRNs to divide STS recurrence into three risk strata (low, medium, and high) to facilitate more targeted postoperative management in the clinic.
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13
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Dammerer D, VAN Beeck A, Schneeweiss V, Schwabegger A. Follow-up Strategies for Primary Extremity Soft-tissue Sarcoma in Adults: A Systematic Review of the Published Literature. In Vivo 2021; 34:3057-3068. [PMID: 33144410 DOI: 10.21873/invivo.12140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/14/2020] [Accepted: 09/21/2020] [Indexed: 01/22/2023]
Abstract
AIM Follow-up strategies for primary extremity soft-tissue sarcomas (eSTS) in adults were evaluated in a systematic review of the published literature. MATERIAL AND METHODS The published literature was reviewed using PubMed. Of 136,646 studies published between 1985 and 2019, 78 original articles met the inclusion criteria. Articles were selected on the basis of the PRISMA guidelines. The selected articles were then cross-searched to identify further publications. August 1, 2019 was used as the concluding date of publication. RESULTS A variety of follow-up schedules have been reported in recently published literature. Two official guidelines have been approved by international societies. The guidelines distinguish between high- and low-grade STS, but mention a wide range of follow-up intervals. Established tools of follow-up include computed tomograph, X-rays of the chest, and magnetic resonance imaging of the primary tumor site in addition to clinical observation and physical examination. CONCLUSION Further research will be needed to establish evidence-based guidelines and schedules for follow-up strategies in patients with eSTS.
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Affiliation(s)
- Dietmar Dammerer
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Viktoria Schneeweiss
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Anton Schwabegger
- Department of Plastic Surgery, Medical University of Innsbruck, Innsbruck, Austria
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Zhang L, Akiyama T, Fukushima T, Iwata S, Tsuda Y, Takeshita K, Kawai A, Tanaka S, Kobayashi H. Prognostic factors and impact of surgery in patients with metastatic soft tissue sarcoma at diagnosis: A population-based cohort study. Jpn J Clin Oncol 2021; 51:918-926. [PMID: 33774673 DOI: 10.1093/jjco/hyab033] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/17/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Approximately 10% of the patients with soft tissue sarcoma show metastasis at initial diagnosis, and hence, poorer prognosis. However, the prognostic factors and whether definitive surgery for the primary lesion improves overall survival, especially when complete resection of metastasis is difficult, remain unclear. METHODS This retrospective analysis was based on the Bone and Soft Tissue Tumor Registry in Japan. Patients with soft tissue sarcoma having metastasis at diagnosis were enrolled, excluding those with Ewing's sarcoma, rhabdomyosarcoma and several other sarcomas with unique behavior and treatment strategies. Overall survival was estimated using the Kaplan-Meier method and compared among the common histologic subtypes. Multivariate analysis with the Cox regression model was used to identify the prognostic factors. RESULTS In total, 1184 patients were included, with a median follow-up duration of 10 months (range: 1-83). The median overall survival was 21 months (95% confidence interval: 18.2-23.8). The multivariate analyses indicated that tumor size, grade and histologic subtypes significantly correlated with overall survival. Moreover, surgery for the primary lesion, in addition to surgery for metastases and chemotherapy, showed significant association with better survival. CONCLUSIONS The prognostic factors in patients with metastatic soft tissue sarcoma at diagnosis are generally similar to those in patients with localized disease. The overall survival in patients differed significantly according to histologic subtype. Surgical resection of primary lesions, especially those with a wide margin, may be an independent prognostic factor. Further studies are needed identify which subgroup of patients would benefit the most from primary lesion surgery.
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Affiliation(s)
- Liuzhe Zhang
- Department of Orthopedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Toru Akiyama
- Department of Orthopedic Surgery, Jichi Medical University, Saitama Medical Center, Saitama, Japan
| | - Takashi Fukushima
- Department of Orthopedic Surgery, Jichi Medical University, Saitama Medical Center, Saitama, Japan
| | - Shintaro Iwata
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, Tokyo, Japan
| | - Yusuke Tsuda
- Department of Orthopedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Katsushi Takeshita
- Department of Orthopedic Surgery, Jichi Medical University, Tochigi, Japan
| | - Akira Kawai
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Kobayashi
- Department of Orthopedic Surgery, The University of Tokyo, Tokyo, Japan
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Cao S, Li J, Yang K, Zhang J, Xu J, Feng C, Li H. Development and validation of a novel prognostic model for long-term overall survival in liposarcoma patients: a population-based study. J Int Med Res 2021; 48:300060520975882. [PMID: 33296604 PMCID: PMC7731721 DOI: 10.1177/0300060520975882] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective To construct and validate a clinically accurate and histology-specific nomogram to predict overall survival (OS) among liposarcoma (LPS) patients. Methods We retrospectively screened eligible patients with LPS diagnosed between 2004 and 2015 from the Surveillance, Epidemiology, and End Results database. We screened independent predictors for the nomogram using univariate and multivariate analyses. We then evaluated the prognostic accuracy of the nomogram by receiver operating characteristic (ROC) curve analysis and Harrell’s concordance index. The prognostic performances of the nomogram and the American Joint Committee on Cancer (AJCC) seventh edition staging system were compared using integrated discrimination improvement (IDI), net reclassification improvement (NRI), and decision curve analyses (DCA). Results A novel nomogram was developed using independent prognostic variables, which exhibited excellent predictive performances for 3- and 5-year OS according to ROC curves. The C-index proved that the proposed nomogram had better prognostic accuracy for LPS than the traditional AJCC system, while the NRI, IDI, and DCA of the nomogram indicated better clinical net benefit. Conclusions The proposed nomogram can predict 3- and 5-year OS of LPS patients with reliable accuracy and may thus help clinicians to develop appropriate clinical therapies and counseling strategies to prolong the life expectancy of these patients.
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Affiliation(s)
- Shuai Cao
- Department of Orthopedics, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Jie Li
- Department of Orthopedics, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Kai Yang
- Department of Orthopedics, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Jun Zhang
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Jiawei Xu
- Department of Orthopedics, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Chaoshuai Feng
- Department of Orthopedics, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Haopeng Li
- Department of Orthopedics, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Haopeng Li, Department of Orthopedics, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710004, China.
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Tetta C, Rocca M, Salone M, Longhi A, Ferrari C, Londero F, Parise G, Parise O, Giugliano A, Maessen JG, La Meir M, Gelsomino S. Predictors of lung recurrence and disease-specific mortality after pulmonary metastasectomy for soft tissue sarcoma. Surg Oncol 2021; 37:101532. [PMID: 33639455 DOI: 10.1016/j.suronc.2021.101532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/06/2020] [Accepted: 02/07/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND We identified prognostic factors in a 30-year series of STS treated at a single Institution, using an advanced statistical approach. METHODS From June 1988 to July 2019, 164 patients were referred to Rizzoli Orthopedic Hospital, Bologna, Italy) for STS lung metastasectomy (LMTS). The endpoints were lung metastasis recurrence (LMR) and lung metastasis-specific mortality (LMSM). The analysis included directed acyclic graphs, cubic splines, and a competing risk model in order to minimize bias. RESULTS The 10- and 15- year LMR cumulative incidence were 0.77 (0.76-0.78) whereas 10- and 15- year freedom from LMSM were 0.60 [0.51-0.70] and 0.56 [0.47-0.67], respectively. The malignant peripheral nerve sheath tumor (MPNST) histotype (SHR 4.12 [2.05-8.27]), a disease-free interval (DFI) up to 68 months (HR from 2 [1.7-2.2] to 1.5 [1.1-1.9]) and a LM size ≥4 mm (3.1 [2.1-4.4]) predicted LMR. Myxofibrosarcoma (HR 2.52[1.64-3.86]), synovial sarcoma (2.53[1.22-5.23]), adjuvant chemotherapy (2.01[1.11-3.61]), DFI between 2 months and 20 months (HR from 1.5 [1.1-2.3] to 1.3 [1.1-1.7] and primary tumor size a primary tumor size comprised between 3.6 cm and 10 cm predicted LMSM. A sharp increase in LMSM was observed with a tumor size from ≥20 cm. CONCLUSIONS Our analysis corrected by potential confounders allowed us to identify specific histotypes and DFI intervals as predictors of both LMR and LMSM. Tumor size adjuvant chemotherapy adversely affected LM-related survival. Our findings need to be confirmed by larger randomized studies.
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Affiliation(s)
| | | | | | | | | | - Francesco Londero
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Center, the Netherlands
| | - Gianmarco Parise
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Center, the Netherlands
| | - Orlando Parise
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Center, the Netherlands
| | | | - Jos G Maessen
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Center, the Netherlands
| | - Mark La Meir
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Center, the Netherlands
| | - Sandro Gelsomino
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Center, the Netherlands.
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Collaud S, Stork T, Dirksen U, Pöttgen C, Hegedüs B, Schildhaus HU, Bauer S, Aigner C. Surgical Treatment for Primary Chest Wall Sarcoma: A Single-Institution Study. J Surg Res 2020; 260:149-154. [PMID: 33340868 DOI: 10.1016/j.jss.2020.11.078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 11/04/2020] [Accepted: 11/15/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Primary sarcomas of the chest wall are rare aggressive tumors. Surgery is part of the multimodal treatment. We describe our institutional patient cohort and evaluate prognostic factors. METHODS All patients who had curative intent surgery for primary chest wall sarcoma from 2004 to 2019 were retrospectively reviewed. Impact on survival-calculated from the date of surgery until last follow-up- was assessed for the following variables: age, gender, type of resection, size, grading, stage, completeness of resection, and neoadjuvant and adjuvant therapy. RESULTS Twenty-three patients (15 males, 65%) with a median age of 54 y (4 to 82) were included. Most common histology was chondrosarcoma (n = 5, 22%). Seven patients (30%) received neoadjuvant and 13 patients (57%) received adjuvant treatment. R0 resection was achieved in 83%. Extended chest wall resection was performed in 14 patients (61%), including lung (n = 13, 57%), diaphragm (n = 2, 9%) and pericardium (n = 1, 4%). Morbidity and 90-day mortality were 23% and 0%, respectively. Three- and 5-year overall survival was 53% and 35%, respectively. R0 resection was predictor of overall survival (P = 0.029). Tumor grade and extended resections were predictors for recurrence (P = 0.034 and P = 0.018, respectively). CONCLUSIONS Surgical resection of primary chest wall sarcoma is a safe procedure even when extended resection is required.
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Affiliation(s)
- Stéphane Collaud
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Center Essen, Essen, Germany
| | - Theresa Stork
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Center Essen, Essen, Germany
| | - Uta Dirksen
- Department of Pediatrics III, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Center Essen, Essen, Germany
| | - Christoph Pöttgen
- Department of Radiation Oncology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Center Essen, Essen, Germany
| | - Balazs Hegedüs
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
| | - Hans-Ulrich Schildhaus
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Center Essen, Essen, Germany
| | - Sebastian Bauer
- Department of Oncology, University of Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Center Essen, Essen, Germany
| | - Clemens Aigner
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Center Essen, Essen, Germany.
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Noebauer-Huhmann IM, Chaudhary SR, Papakonstantinou O, Panotopoulos J, Weber MA, Lalam RK, Albtoush OM, Fueger BJ, Szomolanyi P, Grieser T, Bloem JL. Soft Tissue Sarcoma Follow-up Imaging: Strategies to Distinguish Post-treatment Changes from Recurrence. Semin Musculoskelet Radiol 2020; 24:627-644. [PMID: 33307581 DOI: 10.1055/s-0040-1721464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Soft tissue sarcomas encompass multiple entities with differing recurrence rates and follow-up intervals. The detection of recurrences and their differentiation from post-therapeutic changes is therefore complex, with a central role for the clinical radiologist. This article describes approved recommendations. Prerequisite is a precise knowledge of the current clinical management and surgical techniques. We review recurrence rates and treatment modalities. An adequate imaging technique is paramount, and comparison with previous imaging is highly recommended. We describe time-dependent therapy-related complications on magnetic resonance imaging compared with the spectrum of regular post-therapeutic changes. Early complications such as seromas, hematomas, and infections, late complications such as edema and fibrosis, and inflammatory pseudotumors are elucidated. The appearance of recurrences and radiation-associated sarcomas is contrasted with these changes. This systematic approach in follow-up imaging of soft tissue sarcoma patients will facilitate the differentiation of post-therapeutic changes from recurrences.
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Affiliation(s)
- Iris-M Noebauer-Huhmann
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Snehansh R Chaudhary
- Department of Clinical Radiology, Aintree University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | | | - Joannis Panotopoulos
- Department of Orthopedics and Trauma-Surgery, Medical University of Vienna, Vienna, Austria
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany
| | - Radhesh K Lalam
- Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, United Kingdom
| | - Omar M Albtoush
- Department of Radiology, University of Jordan, and Department of Radiology, King Hussein Cancer Center, Amman, Jordan
| | - Barbara J Fueger
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Pavol Szomolanyi
- High Field MR Center, Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Thomas Grieser
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Augsburg, Germany
| | - Johan L Bloem
- Department of radiology, Leiden University Medical Center, Leiden, The Netherlands
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Liang Y, Guo T, Hong D, Xiao W, Zhou Z, Zhang X. Time to Local Recurrence as a Predictor of Survival in Patients With Soft Tissue Sarcoma of the Extremity and Abdominothoracic Wall. Front Oncol 2020; 10:599097. [PMID: 33251152 PMCID: PMC7672181 DOI: 10.3389/fonc.2020.599097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/09/2020] [Indexed: 12/02/2022] Open
Abstract
Objective The purpose of this retrospective study was to identify the prognostic significance of time to local recurrence (TLR) with regard to overall survival (OS) and survival after local recurrence (SAR) in patients with soft tissue sarcoma (STS) of the extremity and abdominothoracic wall. Methods We identified 477 patients who underwent R0 resection for localized STS of the extremity and abdominothoracic wall, from January 1995 to December 2016, of whom 190 patients developed local recurrence as their first recurrent event. Based on TLR, patients were divided into two groups: early local recurrence (ELR, <12 months) and late local recurrence (LLR, ≥12 months). The Kaplan–Meier method and Cox regression analysis were used to estimate the OS and SAR, and to identify factors associated with patient outcomes. Results The median follow-up time for the entire cohort was 118.4 months, and was 118.5 months for the 190 patients who developed local recurrence. Deep tumor location (HR 1.73, 95% CI 1.27–2.37, P = 0.001) and tumor grade ≥2 (G2 vs. G1: HR 1.75, 95% CI 1.21–2.53, G3 vs. G1: HR 2.57, 95% CI 1.66–3.98, P < 0.001) were associated with a higher rate of local recurrence. There were 99 patients in the ELR group and 91 in the LLR group, with a median TLR of 10.8 months for the entire cohort. Patients from the ELR group had a shorter OS and a lower 5-year OS rate than the LLR group. Univariate and multivariate analyses demonstrated TLR as an independent prognostic factor for SAR and OS, in addition to tumor grade. Also, surgical treatment and absence of metastasis after local recurrence were associated with longer SAR. Conclusions In patients with STS of the extremity and abdominothoracic wall, ELR after R0 resection indicated a worse prognosis than those with LLR, and TLR can be considered an independent prognostic factor for OS and SAR. Furthermore, local recurrence was significantly influenced by the depth and the histopathological grading of the primary tumor, and reoperation after local recurrence could improve survival, which means salvage surgery may still be the preferred treatment when there are surgical indications after recurrence.
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Affiliation(s)
- Yao Liang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Gastric Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Tianhui Guo
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Medical Melanoma and Sarcoma, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Dongchun Hong
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Medical Melanoma and Sarcoma, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Wei Xiao
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Medical Melanoma and Sarcoma, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Zhiwei Zhou
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Gastric Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xing Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Medical Melanoma and Sarcoma, Sun Yat-sen University Cancer Center, Guangzhou, China
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20
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Mahyudin F, Edward M, Basuki MH, Basrewan Y, Hernugrahanto KD, Wahyudiputra AG. Analysis of prognostic factors in soft tissue sarcoma: Cancer registry from a single tertiary hospital in Indonesia. A retrospective cohort study. Ann Med Surg (Lond) 2020; 57:257-263. [PMID: 32884743 PMCID: PMC7453062 DOI: 10.1016/j.amsu.2020.07.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/24/2020] [Accepted: 07/26/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Soft tissue sarcoma is one cause of mortality in adult malignancies. This tumor is rare, persistent, and highly-recurrent. Many patients are came in late stage. It is important to identify a prognostic tool that is reliable, easily obtainable, and widely applicable. The aim of this study is to investigate and analyze the prognostic value of clinicopathological and biomarker factors in patients with soft tissue sarcoma. METHODS This retrospective study extracts data from the musculoskeletal tumor registry from January 2012 to December 2018 in a single tertiary hospital. Eighty patients with diagnosis of soft tissue sarcoma were included. Preoperative modified Glasgow Prognostic Score, Neutrophils/Lymphocytes Ratio, Hemoglobin, serum lactate dehydrogenase data were analyzed along with demographic, clinical, radiological and histopathological data. The relationship between variables on overall survival, distant metastasis, and local recurrence were evaluated using univariate and multivariate Cox regression. RESULTS On univariate analysis, there was significant relationship between hemoglobin, Neutrophils/Lymphocytes Ratio and modified Glasgow Prognostic Score with overall survival (p = 0.031, HR = 1.99; p = 0.04, HR = 1.129; and p = 0.044, HR = 3.89). A significant relationship was found between age and soft tissue sarcoma stage with distant metastasis (p = 0.046, HR = 1.95; and p = 0.00, HR = 3.22). In addition, we also found significant relationship between surgical margin with local recurrence (p = 0.018, OR = 3.44). However, on multivariate analysis the independent prognostic factor for overall survival was only modified Glasgow Prognostic Score (HR = 2.138; p = 0.011). Stage IIIA (HR = 5.32; p = 0.005) and IIIB (HR = 13.48; p = 0.00) were independent prognostic for distant metastasis. Surgical margin was independently associated with local recurrence (HR = 14.84; p = 0.001). CONCLUSION Modified Glasgow Prognostic Score can be used as prognostic tool of overall survival in soft tissue sarcoma patients. Moreover, stage of STS and surgical margin can be used as a prognostic factor for distant metastasis and local recurrence of soft tissue sarcoma respectively.
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Affiliation(s)
- Ferdiansyah Mahyudin
- Department of Orthopedics & Traumatology, Faculty of Medicine, Universitas Airlangga / Dr. Soetomo General Hospital, Jl. Rungkut Mapan FD-2, Surabaya, East Java, Indonesia
| | - Mouli Edward
- Department of Orthopedics & Traumatology, Faculty of Medicine, Universitas Airlangga / Dr. Soetomo General Hospital, Jl. Rungkut Mapan FD-2, Surabaya, East Java, Indonesia
| | - Muhammad Hardian Basuki
- Department of Orthopedics & Traumatology, Faculty of Medicine, Universitas Airlangga / Dr. Soetomo General Hospital, Jl. Rungkut Mapan FD-2, Surabaya, East Java, Indonesia
| | - Yunus Basrewan
- Department of Orthopedics & Traumatology, Faculty of Medicine, Universitas Airlangga / Dr. Soetomo General Hospital, Jl. Rungkut Mapan FD-2, Surabaya, East Java, Indonesia
| | - Kukuh Dwiputra Hernugrahanto
- Department of Orthopedics & Traumatology, Faculty of Medicine, Universitas Airlangga / Dr. Soetomo General Hospital, Jl. Rungkut Mapan FD-2, Surabaya, East Java, Indonesia
| | - Adhinanda Gema Wahyudiputra
- Department of Orthopedics & Traumatology, Faculty of Medicine, Universitas Airlangga / Dr. Soetomo General Hospital, Jl. Rungkut Mapan FD-2, Surabaya, East Java, Indonesia
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21
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Hamada S, Nishida Y, Takanari K, Ota T, Urakawa H, Ikuta K, Sakai T, Tsukushi S, Kamei Y, Ishiguro N. Functional evaluation following deltoid muscle resection in patients with soft tissue sarcoma. Jpn J Clin Oncol 2020; 50:772-778. [PMID: 32249309 DOI: 10.1093/jjco/hyaa039] [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: 01/15/2020] [Revised: 02/25/2020] [Accepted: 03/05/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The present study aimed to determine functional outcomes in patients undergoing deltoid muscle resection for soft tissue sarcoma. METHODS Between 2002 and 2014, 18 patients with soft tissue sarcoma of the shoulder who underwent wide resection including the deltoid muscle, and were followed up for more than 12 months, were retrospectively included in the study. In all, 11 patients were male and 7 were female. The median age was 59 years, median follow-up duration was 37 months. The extent of resection of deltoid muscle, with or without rotator cuff damage, reconstruction methods, adjuvant therapy, oncological outcomes, and the International Society of Limb Salvage (ISOLS) score as functional outcomes were analyzed. RESULTS Six patients underwent total resection, and twelve underwent partial resections of deltoid muscle. The rotator cuff was resected in four patients. Soft tissue reconstruction was performed in 17 patients using a pedicled latissimus dorsi muscle flap. Two local recurrences and three distant metastases occurred during follow-up. Median overall survival was 72 months. The mean ISOLS score was 25.0 points (±4.6points). Univariate analysis revealed that there was no significant difference in ISOLS score regarding the extent of deltoid muscle resection. Multivariate analysis identified only combined resection of the rotator cuff as a significant prognostic factor for poor functional outcomes (P < 0.001). CONCLUSIONS The extent of resection of the deltoid muscle might not affect the functional outcomes determined by ISOLS score. If the rotator cuff is resected concurrently, satisfactory functional outcomes might not be obtained.
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Affiliation(s)
- Shunsuke Hamada
- Department of Orthopedic Surgery, Nagoya University Graduate School and School of Medicine, Nagoya, Japan.,Department of Orthopedic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yoshihiro Nishida
- Department of Orthopedic Surgery, Nagoya University Graduate School and School of Medicine, Nagoya, Japan.,Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
| | - Keisuke Takanari
- Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School and School of Medicine, Nagoya, Japan
| | - Takehiro Ota
- Department of Orthopedic Surgery, Nagoya Memorial Hospital, Nagoya, Japan
| | - Hiroshi Urakawa
- Department of Orthopedic Surgery, Nagoya University Graduate School and School of Medicine, Nagoya, Japan.,Department of Clinical Oncology and Chemotherapy, Nagoya University Hospital, Nagoya, Japan
| | - Kunihiro Ikuta
- Department of Orthopedic Surgery, Nagoya University Graduate School and School of Medicine, Nagoya, Japan.,Department of Genome Medical Center, Nagoya University Hospital, Nagoya, Japan
| | - Tomohisa Sakai
- Department of Orthopedic Surgery, Nagoya University Graduate School and School of Medicine, Nagoya, Japan
| | - Satoshi Tsukushi
- Department of Orthopedic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yuzuru Kamei
- Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School and School of Medicine, Nagoya, Japan
| | - Naoki Ishiguro
- Department of Orthopedic Surgery, Nagoya University Graduate School and School of Medicine, Nagoya, Japan
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22
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Qi L, Wan L, Ren X, Zhang W, Tu C, Li Z. The Role of Chemotherapy in Extraskeletal Osteosarcoma: A Propensity Score Analysis of the Surveillance Epidemiology and End Results (SEER) Database. Med Sci Monit 2020; 26:e925107. [PMID: 32792473 PMCID: PMC7446278 DOI: 10.12659/msm.925107] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 05/15/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Incidence of extraskeletal osteosarcoma (ESOS) is extremely low and the prognosis remains unclear. We conducted this study to explore prognostic factors and the role of chemotherapy in ESOS. MATERIAL AND METHODS We screened data from the Surveillance Epidemiology and End Results (SEER) database (1975-2016). Three hundred ten patients with ESOS were included and 49.4% (107/310) of them underwent chemotherapy. We performed logistic regression analysis to investigate potential factors determining selection of chemotherapy. An inverse probability of treatment weighting (IPTW) and propensity score matching (PSM)-adjusted Kaplan-Meier curve was created and log-rank test and Cox regression analysis were performed to compare overall survival (OS) and cancer-specific survival (CSS) in patients treated with and without chemotherapy. Subgroup analysis also was conducted based on age, tumor site, stage, size, and surgery. RESULTS Chemotherapy in ESOS was not associated with improved OS in the unmatched cohort (HR, 0.764; 95% CI, 0.555-1.051; p=0.098). The insignificant treatment effect of chemotherapy was also noted in IPTW-adjusted (HR, 0.737; 95% CI, 0.533-1.021; p=0.066) and PSM-adjusted (HR, 0.804; 95% CI, 0.552-1.172; p=0.257) Cox regression analysis. The insignificant treatment effect was consistent across all subgroups and there was no significant heterogeneity of chemotherapy effect (all p for interaction >0.05). CONCLUSIONS The study suggested that chemotherapy has no significant benefit on prognosis of patients with ESOS. These findings should be considered when making treatment decisions about patients with ESOS.
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Affiliation(s)
- Lin Qi
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
- Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Changsha, Hunan, P.R. China
| | - Lu Wan
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
- Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Changsha, Hunan, P.R. China
- Vaccine and Immunotherapy Center, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, U.S.A
| | - Xiaolei Ren
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
- Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Changsha, Hunan, P.R. China
| | - Wenchao Zhang
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
- Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Changsha, Hunan, P.R. China
| | - Chao Tu
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
- Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Changsha, Hunan, P.R. China
| | - Zhihong Li
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
- Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Changsha, Hunan, P.R. China
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23
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Tokumoto H, Akita S, Kubota Y, Mitsukawa N. Effect of unplanned excision of soft tissue sarcomas on skin defects and reconstructive procedures. J Plast Surg Hand Surg 2020; 54:372-376. [PMID: 32734802 DOI: 10.1080/2000656x.2020.1799817] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Unplanned excision (UE) is defined as a procedure wherein a surgeon operates a tumor resection without appropriate preoperative diagnostic modalities and without the intent to achieve tumor-free margins. Generally, the reconstruction rate after UE is higher than that after planned excision (PE). The present study aimed to investigate how the reconstructive procedure and size of skin defect could be influenced. We reviewed the cases of 442 patients who underwent the resection of soft tissue sarcoma. Patients were stratified into two groups (UE vs. PE). We compared the histologic grade, skin defect, reconstructive procedures, depth of the reconstruction layer. For superficial reconstructions, we also compared procedures involving skin graft-only or flap. 105 cases (23.8%) were UE. Histologic grade in PE was significantly higher (p = .024). The reconstruction rate and size of skin defect in UE was significantly higher (76.2% vs. 27.3%, p < .001) and larger (124.5 cm2 vs. 65.7 cm2, p < .001). The rate of deep layer reconstruction was significantly higher in PE (7.5% vs. 26.1%, p = .001). In superficial reconstructions, 18 (24.3%) skin graft-only procedures were performed in UE and 15 (22.1%) in PE, all other superficial reconstructive procedures involved flap, and there was no significant difference (p = .45). Skin defects were 1.9 times larger after UE than PE. UE did not affect the superficial reconstructive procedure.
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Affiliation(s)
- Hideki Tokumoto
- Department of Plastic and Reconstructive Surgery, Chiba Cancer Center Hospital, Chiba, Japan
| | - Shinsuke Akita
- Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, Chiba University, Chiba, Japan
| | - Yoshitaka Kubota
- Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, Chiba University, Chiba, Japan
| | - Nobuyuki Mitsukawa
- Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, Chiba University, Chiba, Japan
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24
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Fischer C, Krix M, Weber MA, Loizides A, Gruber H, Jung EM, Klauser A, Radzina M, Dietrich CF. Contrast-Enhanced Ultrasound for Musculoskeletal Applications: A World Federation for Ultrasound in Medicine and Biology Position Paper. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:1279-1295. [PMID: 32139152 DOI: 10.1016/j.ultrasmedbio.2020.01.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/23/2020] [Accepted: 01/24/2020] [Indexed: 06/10/2023]
Abstract
This World Federation for Ultrasound in Medicine and Biology position paper reviews the diagnostic potential of ultrasound contrast agents for clinical decision-making and provides general advice for optimal contrast-enhanced ultrasound performance in musculoskeletal issues. In this domain, contrast-enhanced ultrasound performance has increasingly been investigated with promising results, but still lacks everyday clinical application and standardized techniques; therefore, experts summarized current knowledge according to published evidence and best personal experience. The goal was to intensify and standardize the use and administration of ultrasound contrast agents to facilitate correct diagnoses and ultimately to improve the management and outcomes of patients.
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Affiliation(s)
- Christian Fischer
- Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Ultrasound Center, HTRG-Heidelberg Trauma Research Group, Heidelberg University Hospital, Heidelberg, Germany.
| | | | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany
| | - Alexander Loizides
- Department of Radiology, Ultrasound Center, Innsbruck Medical University, Innsbruck, Austria
| | - Hannes Gruber
- Department of Radiology, Ultrasound Center, Innsbruck Medical University, Innsbruck, Austria
| | | | - Andrea Klauser
- Department of Radiology, Ultrasound Center, Innsbruck Medical University, Innsbruck, Austria
| | - Maija Radzina
- Diagnostic Radiology Institute, Riga Stradins University, Riga, Latvia
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25
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Subgroup analysis of older patients treated within the randomized phase 3 doxorubicin versus doxorubicin plus evofosfamide (SARC021) trial. J Geriatr Oncol 2020; 11:463-469. [DOI: 10.1016/j.jgo.2019.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 04/30/2019] [Accepted: 05/09/2019] [Indexed: 11/21/2022]
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26
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Fujibuchi T, Miyawaki J, Kidani T, Imai H, Miura H. Prediction of Soft Tissue Sarcoma from Clinical Characteristics and Laboratory Data. Cancers (Basel) 2020; 12:E679. [PMID: 32183216 PMCID: PMC7140089 DOI: 10.3390/cancers12030679] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/10/2020] [Accepted: 03/12/2020] [Indexed: 12/15/2022] Open
Abstract
The accurate diagnosis of soft tissue tumors may be difficult. Simple clinical characteristics or laboratory data that can predict tumor malignancy can be useful tools for diagnosing soft tissue tumors. Between 2003 and 2018, 588 patients with primary soft tissue tumors were retrospectively reviewed. Their clinical characteristics and laboratory data were evaluated to determine their association with the diagnosis of benign, intermediate, or malignant tumor. Multivariable analysis revealed that tumor size ≥ 5.6 cm (odds ratio (OR), 6.15; p < 0.001), white blood cell (WBC) count ≥ 5700/µL (OR, 2.49; p = 0.002), hemoglobin (Hb) count ≤ 12.4 g/dL (OR, 2.56; p = 0.004), C-reactive protein (CRP) level ≥ 0.17 mg/dL (OR, 2.64; p < 0.001), and lactate dehydrogenase (LDH) level ≥ 240 IU/L (OR, 4.94; p < 0.001) were significant predictive factors for sarcoma. The sensitivity and specificity in the presence of three or more predictive factors for detecting malignant tumors were 0.58 and 0.90 respectively, and it was an appropriate threshold with the maximum Youden's index of 0.49. Simple clinical and laboratory data were useful tools for predicting whether the tumor is malignant. Patients with soft tissue tumors that meet any three or more predictive factors should be referred to a specialist.
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Affiliation(s)
- Taketsugu Fujibuchi
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan; (J.M.); (T.K.); (H.I.); (H.M.)
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27
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Raedkjaer M, Maretty-Kongstad K, Baad-Hansen T, Safwat A, Mørk Petersen M, Keller J, Vedsted P. The association between socioeconomic position and tumour size, grade, stage, and mortality in Danish sarcoma patients - A national, observational study from 2000 to 2013. Acta Oncol 2020; 59:127-133. [PMID: 31702424 DOI: 10.1080/0284186x.2019.1686536] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Survival in sarcoma patients depends on a range of prognostic factors. An association between cancer survival and socioeconomic position is known for several other cancers. We therefore examined the relations between three socioeconomic factors and risk of presenting with known tumour related prognostic factors, and the overall mortality of the different socioeconomic and prognostic factors in 1919 patients diagnosed with sarcoma in Denmark 2000-2013.Material and methods: Patients with sarcoma in extremities or trunk wall aged 30 years or more at diagnosis were identified in the Danish Sarcoma Registry and linked on an individual level to Danish national registries. We obtained data on educational level, disposable income and cohabitation status. Odds ratios (ORs) were estimated for the association between the socioeconomic factors and grade, stage and tumour size. Hazard ratios (HRs) were estimated using Cox proportional hazard models.Results: In adjusted analyses, educational level, income and cohabitation status were not associated with high grade or dissiminated stage at time of diagnosis. However, living alone was statistically significantly associated with having a large soft tissue sarcoma (≥5 cm) at time of diagnosis (OR 1.51; CI1.12-2.03). The overall mortality was statistically significantly increased in the group of patients with ≤10 years of education (HR 1.27; CI 1.02-1.57), in patients with the 20% lowest income (HR 1.30; CI 1.00-1.67) and nearly in patients living alone (HR 1.16; CI 0.99-1.36).Conclusion: In this nationwide, multicentre, population-based study, soft tissue sarcoma patients living alone had greater risk of having a large tumour at time of diagnosis. Soft tissue and bone sarcoma patients with a short education, low income, or living alone, had a higher mortality. This might indicate that the social differences in mortality might be related to treatment aspects and the biology of the disease rather that the diagnostic process.
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Affiliation(s)
- Mathias Raedkjaer
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Orthopaedic Surgery, Rigshospitalet, University of Copenhagen, Denmark Copenhagen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Thomas Baad-Hansen
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Akmal Safwat
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Mørk Petersen
- Department of Orthopaedic Surgery, Rigshospitalet, University of Copenhagen, Denmark Copenhagen
| | - Johnny Keller
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Vedsted
- The Research Unit of General Practice, Aarhus University, Aarhus, Denmark
- Department of Clinical Medicine, Silkeborg Hospital, Aarhus University, Aarhus, Denmark
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28
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Smolle MA, van de Sande M, Callegaro D, Wunder J, Hayes A, Leitner L, Bergovec M, Tunn PU, van Praag V, Fiocco M, Panotopoulos J, Willegger M, Windhager R, Dijkstra SPD, van Houdt WJ, Riedl JM, Stotz M, Gerger A, Pichler M, Stöger H, Liegl-Atzwanger B, Smolle J, Andreou D, Leithner A, Gronchi A, Haas RL, Szkandera J. Individualizing Follow-Up Strategies in High-Grade Soft Tissue Sarcoma with Flexible Parametric Competing Risk Regression Models. Cancers (Basel) 2019; 12:cancers12010047. [PMID: 31877801 PMCID: PMC7017264 DOI: 10.3390/cancers12010047] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 12/15/2019] [Accepted: 12/19/2019] [Indexed: 12/13/2022] Open
Abstract
Currently, patients with extremity soft tissue sarcoma (eSTS) who have undergone curative resection are followed up by a heuristic approach, not covering individual patient risks. The aim of this study was to develop two flexible parametric competing risk regression models (FPCRRMs) for local recurrence (LR) and distant metastasis (DM), aiming at providing guidance on how to individually follow-up patients. Three thousand sixteen patients (1931 test, 1085 validation cohort) with high-grade eSTS were included in this retrospective, multicenter study. Histology (9 categories), grading (time-varying covariate), gender, age, tumor size, margins, (neo)adjuvant radiotherapy (RTX), and neoadjuvant chemotherapy (CTX) were used in the FPCRRMs and performance tested with Harrell-C-index. Median follow-up was 50 months (interquartile range: 23.3–95 months). Two hundred forty-two (12.5%) and 603 (31.2%) of test cohort patients developed LR and DM. Factors significantly associated with LR were gender, size, histology, neo- and adjuvant RTX, and margins. Parameters associated with DM were margins, grading, gender, size, histology, and neoadjuvant RTX. C-statistics was computed for internal (C-index for LR: 0.705, for DM: 0.723) and external cohort (C-index for LR: 0.683, for DM: 0.772). Depending on clinical, pathological, and patient-related parameters, LR- and DM-risks vary. With the present model, implemented in the updated Personalised Sarcoma Care (PERSARC)-app, more individualized prediction of LR/DM-risks is made possible.
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Affiliation(s)
- Maria Anna Smolle
- Department of Orthopaedics and Trauma, Medical University of Graz, 8036 Graz, Austria
| | - Michiel van de Sande
- Department of Orthopaedic Surgery, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands
| | - Dario Callegaro
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Jay Wunder
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, University of Toronto, Toronto, ON M5G IX5, Canada
| | - Andrew Hayes
- Department of Surgery, Royal Marsden Hospital NHS Foundation Trust, London SW3 6JJ, UK
| | - Lukas Leitner
- Department of Orthopaedics and Trauma, Medical University of Graz, 8036 Graz, Austria
| | - Marko Bergovec
- Department of Orthopaedics and Trauma, Medical University of Graz, 8036 Graz, Austria
| | - Per-Ulf Tunn
- Sarcoma Centre, HELIOS-Klinikum Berlin-Buch, 13125 Berlin, Germany
| | - Veroniek van Praag
- Department of Orthopaedic Surgery, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands
| | - Marta Fiocco
- Institute of Mathematics, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands
- Medical Statistics, Department of Biomedical Data Science, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Trial and Data Center, 3584 CT Utrecht, The Netherlands
| | - Joannis Panotopoulos
- Department of Orthopaedics and Traumatology, Medical University of Vienna, 1090 Vienna, Austria
| | - Madeleine Willegger
- Department of Orthopaedics and Traumatology, Medical University of Vienna, 1090 Vienna, Austria
| | - Reinhard Windhager
- Department of Orthopaedics and Traumatology, Medical University of Vienna, 1090 Vienna, Austria
| | - Sander P. D. Dijkstra
- Department of Orthopaedic Surgery, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands
| | - Winan J. van Houdt
- Department of Surgery, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
| | - Jakob M. Riedl
- Division of Clinical Oncology, Department of Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Michael Stotz
- Division of Clinical Oncology, Department of Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Armin Gerger
- Division of Clinical Oncology, Department of Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Martin Pichler
- Division of Clinical Oncology, Department of Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Herbert Stöger
- Division of Clinical Oncology, Department of Medicine, Medical University of Graz, 8036 Graz, Austria
| | | | - Josef Smolle
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, 8036 Graz, Austria
| | | | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, 8036 Graz, Austria
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Rick L. Haas
- Department of Radiotherapy, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands
- Department of Radiotherapy, The Netherlands Cancer Institute Amsterdam, 1066 CX Amsterdam, The Netherlands
- Correspondence: (R.L.H.); (J.S.); Tel.: +31-20-5122135 (R.L.H.); +43-316-385-13115 (J.S.)
| | - Joanna Szkandera
- Division of Clinical Oncology, Department of Medicine, Medical University of Graz, 8036 Graz, Austria
- Correspondence: (R.L.H.); (J.S.); Tel.: +31-20-5122135 (R.L.H.); +43-316-385-13115 (J.S.)
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Surgical resection margin classifications for high-grade pleomorphic soft tissue sarcomas of the extremity or trunk: definitions of adequate resection margins and recommendations for sampling margins from primary resection specimens. Mod Pathol 2019; 32:1421-1433. [PMID: 31053757 DOI: 10.1038/s41379-019-0278-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 03/29/2019] [Accepted: 03/30/2019] [Indexed: 12/13/2022]
Abstract
Adequacy of surgical resection margins for soft tissue sarcomas are poorly defined because of the various classifications and definitions used in prior studies of heterogeneous patient cohorts and inconsistent margin sampling protocols. Surgical resection margins of 166 primary, high-grade, pleomorphic sarcomas of the extremity or trunk were classified according to American Joint Committee on Cancer R and Musculoskeletal Tumor Society categories, as well as by metric distance and tissue composition. None of the cases were treated with neoadjuvant therapy. Multivariable competing risk regression models were evaluated and optimal surgical resection margins for each classification system were defined. Minimum safe tumor clearance was 5 mm without use of adjuvant radiotherapy and 1 mm with adjuvant radiotherapy. Predictive accuracy of margin classification systems was compared by area under receiver-operating characteristic curves generated from logistic regression of 2½-year local recurrence-free survival and other standard tests of diagnostic accuracy. The Musculoskeletal Tumor Society and margin distance classifications performed similarly, both of which showed higher sensitivity and negative predictive value compared to the American Joint Committee on Cancer R classification. The prognostic power of close or positive margins in prediction models significantly increased when six or more slides were submitted for assessment of surgical resection margins. Surgical resection margins for soft tissue sarcoma should be reported using the Musculoskeletal Tumor Society classification or metric distance to the closest resection margin. Musculoskeletal Tumor Society wide/radical margins or tumor clearances of 5 mm (without adjuvant radiotherapy) or 1 mm (with adjuvant radiotherapy) appear to define the minimum safe surgical resection margins necessary to decrease the likelihood of local recurrence of high-grade pleomorphic sarcomas of the extremity or trunk.
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Sekimizu M, Ogura K, Yasunaga H, Matsui H, Tanaka S, Inagaki K, Kawai A. Development of nomograms for prognostication of patients with primary soft tissue sarcomas of the trunk and extremity: report from the Bone and Soft Tissue Tumor Registry in Japan. BMC Cancer 2019; 19:657. [PMID: 31272407 PMCID: PMC6610844 DOI: 10.1186/s12885-019-5875-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 06/24/2019] [Indexed: 11/27/2022] Open
Abstract
Background The use of nomograms for prognostication of individual cancer patients has been recommended in order to facilitate precision medicine. However, models for patients with soft tissue sarcomas (STSs) are limited because of the rarity and heterogeneity of such cancers. In addition, no model has been developed on the basis of an Asian cohort. Here, we attempted to develop and internally validate nomograms for patients with localized STSs of the trunk and extremity. Methods This study retrospectively extracted 2827 patients with primary trunk and extremity STSs after definitive surgery using the Bone and Soft Tissue Tumor Registry, which is a nationwide sarcoma database in Japan. We developed three nomograms predicting the probability of local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS) and disease-specific survival (DSS) at 2 years after surgery, using the Cox multivariate model. The nomograms were internally validated for discrimination and calibration using bootstrap resampling and assessed for their clinical applicability by decision curve analysis (DCA). Results Local recurrence, distant metastasis and disease-specific death occurred in 241 patients (8.5%), 554 patients (19.6%) and 230 patients (8.1%), respectively. Histological diagnosis, grade and tumor size strongly influenced all three endpoints. The nomograms predicted accurately the probability of LRFS, DMFS and DSS (concordance index: 0.73, 0.70 and 0.75, respectively). DCA demonstrated that our nomograms had clinical applicability. Conclusion We have developed the first nomograms for STSs based on an Asian cohort. These nomograms allowed accurate prediction of LRFS, DMFS and DSS at 2 years after definitive surgery, and can be used as a guide by clinicians for appropriate follow-up and counseling of patients. Electronic supplementary material The online version of this article (10.1186/s12885-019-5875-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Masaya Sekimizu
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.,Department of Orthopaedic Surgery, Showa University, Tokyo, Japan
| | - Koichi Ogura
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan. .,Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan.
| | - Hideo Yasunaga
- Department of Health Economics and Epidemiology Research, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Health Economics and Epidemiology Research, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | | | - Akira Kawai
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
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A Meta-Analysis of the Association Between Radiation Therapy and Survival for Surgically Resected Soft-Tissue Sarcoma. Am J Clin Oncol 2019; 41:348-356. [PMID: 26886948 DOI: 10.1097/coc.0000000000000274] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Radiotherapy for soft-tissue sarcoma (STS) has been shown to reduce local recurrence, but without clear improvement in survival. We conducted a meta-analysis to study the association between radiotherapy and survival in patients undergoing surgery for STS. METHODS A systematic review was conducted from PubMed, EMBASE, Web of Science, and Cochrane databases. Our population of interest consisted of adults with primary extremity, chest wall, trunk, or back STS. Our metameters were either an odds or hazard ratio for mortality. A bias score was generated for each study based on margin status and grade. RESULTS Of 1044 studies, 30 met inclusion criteria for final analysis. The pooled odds ratio in patients receiving radiation was 0.94 (95% confidence interval [CI], 0.78-1.14). The pooled estimate of the hazards ratio in patients receiving radiation was 0.87 (95% CI, 0.73-1.03) overall and 0.65 (95% CI, 0.52-0.82) for studies judged to be at low risk of bias. Significant publication bias was not seen. CONCLUSIONS High-quality studies reporting adjusted hazard ratios are associated with improved survival in patients receiving radiotherapy for STS. Studies in which odds ratios are calculated from event data and those that do not report adjusted outcomes do not show the same association, likely due to confounding by indication.
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Use of Healthcare Services Two Years before Diagnosis in Danish Sarcoma Patients, 2000-2013. Sarcoma 2019; 2019:8108590. [PMID: 31205448 PMCID: PMC6530240 DOI: 10.1155/2019/8108590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/10/2019] [Accepted: 04/02/2019] [Indexed: 12/02/2022] Open
Abstract
Background Sarcoma is a rare type of cancer with nonspecific symptoms and uncertain aetiology. Thus, timely diagnosis of sarcomas is a clinical challenge. The aim of this study was to investigate the use of healthcare services 24 months preceding a sarcoma diagnosis compared to a matched cohort. Materials and Methods The study was a retrospective, population-based, matched cohort registry-study. Patients with sarcoma in Denmark in 2000–2013 were identified in the Danish Sarcoma Registry (n = 2167) and matched 1 : 10 on gender, age, and listed general practice. Using a binomial regression model, incidence rate ratios were calculated for face-to-face contacts in general practice, inpatient and outpatient visits, surgery, paraclinical examinations, and diagnostic imaging. Analyses were stratified for sarcoma subtypes, grade, stage, gender, and presence of comorbidity. Results The sarcoma patients had significantly increased incidence rate ratios in use of healthcare services compared to the matched cohort a year before their diagnoses. An increase in consultation rates was seen 11 months before diagnosis for inpatient visits, 9 months before diagnosis in general practice and outpatient visits, 8 months before diagnosis for paraclinical examinations, and 4 and 3 months before diagnosis for diagnostic imaging and surgery, respectively. There were no clinical significant differences in length of increased consultation rates between sarcoma type, stage, and grade. Sarcoma patients with comorbidity had persistently higher consultation rates compared to patients without comorbidity. Conclusions The use of healthcare services among sarcoma patients increased several months before diagnosis in all healthcare sectors. The results reveal a diagnostic time window and a potential to refer, diagnose, and treat sarcoma patients in a timelier manner.
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Serum Biomarkers as Prognostic Factors for Metastatic Sarcoma. Clin Oncol (R Coll Radiol) 2019; 31:242-249. [DOI: 10.1016/j.clon.2019.01.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 12/28/2018] [Accepted: 01/08/2019] [Indexed: 01/04/2023]
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Soft Tissue Sarcomas of the Thoracic Wall: More Prone to Higher Mortality, and Local Recurrence-A Single Institution Long-Term Follow-up Study. Int J Surg Oncol 2019; 2019:2350157. [PMID: 30956820 PMCID: PMC6425367 DOI: 10.1155/2019/2350157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/10/2019] [Accepted: 02/13/2019] [Indexed: 12/27/2022] Open
Abstract
Objectives This study aims to assess the impact of surgical margin and malignancy grade on overall survival (OS) and local recurrence free rate (LRFR) for soft tissue sarcomas (STS) of the thoracic wall. Methods This retrospective cohort study identified 88 patients, diagnosed and treated surgically for a nonmetastatic STS located in the thoracic wall between 1995 and 2013, using the population based and validated Aarhus Sarcoma Registry and Danish Sarcoma Registry. The Kaplan-Meier method was used to estimate OS and LRFR. Multivariate Cox analyses were used to determine prognostic factors for OS and LRFR. Results The 5-year OS was 55% (95% confidence interval (CI): 0.44-0.65) and 5-year LRFR was 77% (95% CI: 0.67-0.85). High malignancy grade and intralesional/marginal resection were identified as negative predictors for OS. High grade was the only prognostic factor associated with a lower LRFR. Conclusions In this large, single institution, study tumor grade was the key predictor for OS and LRFR. Surgical margin only statistically significantly influenced mortality, not local recurrence.
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Roulet S, Le Nail LR, Vaz G, Babinet A, Dumaine V, Sallot A, Rosset P. Free fillet lower leg flap for coverage after hemipelvectomy or hip disarticulation. Orthop Traumatol Surg Res 2019; 105:47-54. [PMID: 30595412 DOI: 10.1016/j.otsr.2018.10.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 08/26/2018] [Accepted: 10/18/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Tumor resection is the gold standard treatment for soft tissue and bone sarcomas. In the pelvis, this may require a hemipelvectomy that can compromise primary skin closure. Flaps are essential in this context; however the vascularization of potential pedicled flaps may have been removed during tumor excision. Using healthy tissue from the amputated limb as a free flap is an excellent coverage option. HYPOTHESIS The free fillet flap from an amputated lower limb is a simple and reliable coverage technique after hemipelvectomy or hip disarticulation. MATERIAL AND METHODS Seven patients were operated on at three specialty centers: six transpelvic amputations (external hemipelvectomy) and one hip disarticulation. In three cases, the flap consisted of the superficial posterior compartment of the calf area and in the three other cases, the lower leg compartments with the fibula and its intact periosteum. Complications were documented. RESULTS Clear resection margins were achieved in all patients. The mean follow-up at the final visit was 13 months (range, 6.5 to 21 months). Six patients had complications but only one resulted in loss of the flap. Four patients were able to be fitted with a hip prosthesis. DISCUSSION The free fillet flap from an amputated lower limb is a reliable coverage technique (86%) after hemipelvectomy or hip disarticulation. In the 16 cases previously reported in the literature, there were no wound-healing failures. Local flaps are often too fragile with insufficient muscular padding. This free flap is the preferred first-line technique as it spares other potential free flaps in case of failure without increasing the morbidity of a procedure that is already extensive. This coverage technique should be one the options considered after external hemipelvectomy. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- Steven Roulet
- Département de chirurgie orthopédique 2, centre hospitalo-universitaire Tours - faculté de medecine, université de Tours, 37000 Tours, France.
| | - Louis-Romée Le Nail
- Département de chirurgie orthopédique 2, centre hospitalo-universitaire Tours - faculté de medecine, université de Tours, 37000 Tours, France; Inserm UN UMR 1238, PhyOs, bone sarcomas and remodeling of calcified tissues, faculté de médecine de Nantes, 44000 Nantes, France
| | - Gualter Vaz
- Département de chirurgie oncologique, centre Léon-Bérard, 28, rue Laënnec, 69008 Lyon, France
| | - Antoine Babinet
- Département de chirurgie orthopédique et reconstructive, centre hospitalo-universitaire Cochin - Port Royal, 27, rue du Faubourg Saint-Jacque, 75014 Paris, France
| | - Valérie Dumaine
- Département de chirurgie orthopédique et reconstructive, centre hospitalo-universitaire Cochin - Port Royal, 27, rue du Faubourg Saint-Jacque, 75014 Paris, France
| | - Aurélie Sallot
- Département de chirurgie plastique et reconstructive, centre hospitalo-universitaire de Tours - faculté de médecine, université de Tours, 37000 Tours, France
| | - Philippe Rosset
- Département de chirurgie orthopédique 2, centre hospitalo-universitaire Tours - faculté de medecine, université de Tours, 37000 Tours, France; Inserm UN UMR 1238, PhyOs, bone sarcomas and remodeling of calcified tissues, faculté de médecine de Nantes, 44000 Nantes, France
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Mahjoub A, Morales-Restrepo A, Fourman MS, Mandell JB, Feiqi L, Hankins ML, Watters RJ, Weiss KR. Tumor Resection Guided by Intraoperative Indocyanine Green Dye Fluorescence Angiography Results in Negative Surgical Margins and Decreased Local Recurrence in an Orthotopic Mouse Model of Osteosarcoma. Ann Surg Oncol 2018; 26:894-898. [PMID: 30588559 PMCID: PMC6373227 DOI: 10.1245/s10434-018-07114-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Indexed: 12/19/2022]
Abstract
Background Surgical resection with negative margins is the foundation of extremity sarcoma management. Failure to achieve negative surgical margins can result in local recurrence (LR), a potentially devastating complication. Indocyanine green (ICG) is a US FDA-approved fluorophore previously used to guide carcinoma resections. We investigated the potential of ICG as an intraoperative guide during experimental sarcoma resection. Methods Fifty 6-week-old immunocompetent Balb/c female mice received left proximal tibia paraphyseal injections of 5 × 105 K7M2 murine osteosarcoma cells. Animals were separated into two groups (n = 25 each): (1) ICG-assisted surgical resection; and (2) no ICG-assisted resection. Resections were performed 4 weeks after primary tumor engraftment. All animals received 7.5 ug ICG via retro-orbital injection 12 h prior to surgery. ICG fluorescence measurements and clinical evaluations were performed 4 weeks after resection to detect LR. Results Eleven of 25 animals from each group developed gross tumors. Four weeks after resection, group 1 had 0/11 tumor recurrences, while group 2 had recurrences in 9/11 (81.8%) experimental mice (p < 0.0002) (Fig. 2). There was a 100% NPV in group 1, and no tumor recurrence with fluorescence-free margins after the primary surgery. Group 2 had a 100% positive predictive value for the development of an LR if any fluorescent signal was present at the surgical margin after resection. Conclusion Intraoperative ICG guidance led to reliably negative surgical margins and a diminished LR rate. Given the benign safety profile of ICG and its prior clinical success, these results could be immediately translatable to the clinical realm.
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Affiliation(s)
- Adel Mahjoub
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alejandro Morales-Restrepo
- Musculoskeletal Oncology Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mitchell S Fourman
- Musculoskeletal Oncology Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jonathan B Mandell
- Musculoskeletal Oncology Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lu Feiqi
- Musculoskeletal Oncology Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.,School of Medicine, Tsinghua University, Beijing, China
| | - Margaret L Hankins
- Musculoskeletal Oncology Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rebecca J Watters
- Musculoskeletal Oncology Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kurt R Weiss
- Musculoskeletal Oncology Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
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Willburger JCF, Kettelhack C, Fuchs B, Schaefer DJ, Osinga R. Giant myxoid liposarcoma of the gluteal region: case report of patient caused delay of surgical treatment and review of the literature. J Surg Case Rep 2018; 2018:rjy265. [PMID: 30310650 PMCID: PMC6174623 DOI: 10.1093/jscr/rjy265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 09/05/2018] [Accepted: 09/18/2018] [Indexed: 11/21/2022] Open
Abstract
Although adult soft tissue sarcoma is a rare disease, it needs individual treatment by an experienced, interdisciplinary team. We present an exceptional case of a 36-year-old woman suffering from a giant intermediate grade myxoid liposarcoma of the left buttock. She had been seen 4 years earlier but refused to undergo any treatment by then. Now suffering from a foul, ulcerating and superinfected tumor she agreed to surgical treatment. Despite delay, treatment could be performed according to the most up to date sarcoma guidelines which are discussed, including a brief review of the literature.
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Affiliation(s)
- Johanna C F Willburger
- Department of General Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Christoph Kettelhack
- Department of General Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Bruno Fuchs
- Center for Bone and Soft Tissue Sarcoma UZH, University of Zürich, Forchstrasse 340, CH-8008 Zürich, Switzerland
| | - Dirk J Schaefer
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Rik Osinga
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
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Outcome After Surgery for Extremity Soft Tissue Sarcoma in Patients Presenting With Metastasis at Diagnosis. Am J Clin Oncol 2018; 41:681-686. [DOI: 10.1097/coc.0000000000000346] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Johnson AC, Ethun CG, Liu Y, Lopez-Aguiar AG, Tran TB, Poultsides G, Grignol V, Howard JH, Bedi M, Gamblin TC, Tseng J, Roggin KK, Chouliaras K, Votanopoulos K, Cullinan D, Fields RC, Delman KA, Wood WC, Cardona K, Maithel SK. Studying a Rare Disease Using Multi-Institutional Research Collaborations vs Big Data: Where Lies the Truth? J Am Coll Surg 2018; 227:357-366.e3. [PMID: 29906615 DOI: 10.1016/j.jamcollsurg.2018.05.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/31/2018] [Accepted: 05/31/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Multi-institutional collaborations provide granularity lacking in epidemiologic data sets to enable in-depth study of rare diseases. For patients with superficial, high-grade soft tissue sarcomas of the trunk and extremity, the value of radiation therapy (RT) is not clear. We aimed to use the 7-institution US Sarcoma Collaborative (USSC) and the National Cancer Database (NCDB) to investigate this issue. STUDY DESIGN All adult patients with superficial truncal and extremity high-grade soft tissue sarcomas who underwent primary curative-intent resection from 2000 to 2016 at USSC institutions or were included in the NCDB from 2004 to 2013 were analyzed. Propensity score matching was performed. End points were locoregional recurrence-free survival (LRFS), overall survival (OS), and disease-specific survival (DSS). RESULTS Of 4,153 patients in the USSC, 169 patients with superficial high-grade tumors underwent primary curative-intent resection, 38% of which received RT. On multivariable Cox-regression analysis, RT was not associated with improved LRFS (p = 0.56), OS (p = 0.31), or DSS (p = 0.20). On analysis of 51 propensity score-matched pairs, RT was still not associated with increased LRFS, OS, or DSS. Analysis of 631 propensity score-matched pairs in the NCDB demonstrated improved 5-year OS rate associated with RT (80% vs 70%; p = 0.02). The LRFS and DSS rates were not evaluable. CONCLUSIONS Granular data afforded by collaborative research enables in-depth analysis of patient outcomes. The NCDB, although powered with large numbers, cannot assess many relevant outcomes (eg recurrence, DSS, or complications). In this study, the approaches yielded conflicting results. The USSC data suggested no value of radiation and the NCDB demonstrated improved OS, contradicting all randomized controlled trials in sarcoma. The pros and cons of either approach must be considered when applying results to clinical practice, and underscore the importance of randomized controlled trials.
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Affiliation(s)
- Aileen C Johnson
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Cecilia G Ethun
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Yuan Liu
- Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Alexandra G Lopez-Aguiar
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Thuy B Tran
- Department of Surgery, Stanford University Medical Center, Palo Alto, CA
| | - George Poultsides
- Department of Surgery, Stanford University Medical Center, Palo Alto, CA
| | - Valerie Grignol
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH
| | - J Harrison Howard
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH
| | - Meena Bedi
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - T Clark Gamblin
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Jennifer Tseng
- Department of Surgery, University of Chicago Medicine, Chicago, IL
| | - Kevin K Roggin
- Department of Surgery, University of Chicago Medicine, Chicago, IL
| | | | | | - Darren Cullinan
- Department of Surgery, Washington University School of Medicine, St Louis, MO
| | - Ryan C Fields
- Department of Surgery, Washington University School of Medicine, St Louis, MO
| | - Keith A Delman
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA
| | - William C Wood
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Kenneth Cardona
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Shishir K Maithel
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA.
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Müller DA, Beltrami G, Scoccianti G, Cuomo P, Totti F, Capanna R. Allograft Reconstruction of the Extensor Mechanism after Resection of Soft Tissue Sarcoma. Adv Orthop 2018; 2018:6275861. [PMID: 29951320 PMCID: PMC5987318 DOI: 10.1155/2018/6275861] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 03/30/2018] [Accepted: 04/18/2018] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Soft tissue tumors around the knee joint still pose problems for the excision and subsequent reconstruction. METHODS In the 6 included patients the soft tissue sarcoma has its base on the anterior surface of the extensor mechanism and expands towards the skin. The entire extensor apparatus (quadriceps tendon, patella, and patellar tendon) was resected and replaced by a fresh-frozen allograft. RESULTS The mean follow-up was 6.7 years (range: 2-12.4 years). In two patients a local recurrence occurred, resulting in a 5-year local recurrence-free rate of 66.7% (95% CI: 19.5%-90.4%). Distant metastases were found in 4 patients resulting in a 5-year metastasis-free rate of 33.3% (95% CI: 4.6%-67.5%). Two patients underwent at least one revision surgery, including one patient in whom the allograft had to be removed. According to the ISOLS function score 24.7 points (range: 19-28 points) were achieved at the last follow-up. The mean active flexion of the knee joint was 82.5° (range: 25-120°) and a mean extension lag of 10° (range: 0-30°) was observed. CONCLUSIONS The replacement of the extensor mechanism by an allograft is a reasonable option, allowing wide margins and restoration of active extension in most patients. TRIAL REGISTRATION The presented study is listed on the ISRCTN registry with trial number ISRCTN63060594.
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Affiliation(s)
- Daniel A. Müller
- Department of Orthopedic Surgery, Balgrist University Hospital, Forchstrasse 340, 8008 Zürich, Switzerland
| | - Giovanni Beltrami
- Department of Orthopedic Oncology, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Firenze, Italy
| | - Guido Scoccianti
- Department of Orthopedic Oncology, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Firenze, Italy
| | - Pierluigi Cuomo
- Department of Orthopedic Oncology, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Firenze, Italy
| | - Francesca Totti
- Department of Orthopedic Oncology, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Firenze, Italy
| | - Rodolfo Capanna
- Department of Orthopedic Surgery, Azienda Ospedaliero-Universitaria Pisana, Via Paradisa 2, Cisanello, 56125 Pisa, Italy
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Salah S, Lewin J, Amir E, Abdul Razak A. Tumor necrosis and clinical outcomes following neoadjuvant therapy in soft tissue sarcoma: A systematic review and meta-analysis. Cancer Treat Rev 2018; 69:1-10. [PMID: 29843049 DOI: 10.1016/j.ctrv.2018.05.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 05/10/2018] [Accepted: 05/12/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND The prognostic role of tumor necrosis following neoadjuvant therapy is established in bone sarcomas but remains unclear in soft tissue sarcomas (STS). METHODS We searched MEDLINE, MEDLINE in progress, EMBASE and Cochrane to identify studies that investigated neoadjuvant therapy in STS. Studies were required to report survival data based on extent of necrosis, or provided individual patient data allowing estimation thereof. Hazard ratios (HR) for relapse-free (RFS) and overall survival (OS) and odds ratios (OR) for recurrence at 3 years and for death at 5 years were pooled in a random effect meta-analysis. Associations between patient characteristics and attainment of ≥90% necrosis were explored. RESULTS 21 studies comprising 1663 patients were included. Extremity tumors were most common (n = 1554; 93%). Induction regimens included chemotherapy with radiotherapy (n = 924; 56%), chemotherapy alone (n = 412; 25%), radiotherapy alone (n = 78; 5%), isolated limb perfusion (ILP) (n = 231; 14%), and targeted therapy/radiotherapy (n = 18; 1%). Patients with <90% necrosis had higher hazard of recurrence (hazard ratio [HR] 1.47; 95% CI: 1.06-2.04; p = 0.02) and death (HR 1.86; 95% CI: 1.41-2.46; p < 0.001). Risk of recurrence at 3 years (OR = 3.35; 95% CI: 2.27-4.92; p < 0.001) and of death at 5 years (OR 2.60; 95% CI: 1.59-4.26; p < 0.001) were similarly increased. Compared to other modalities, ILP was associated with higher odds of achieving ≥90% necrosis (OR 12.1; 95% CI: 3.69-39.88; p < 0.001). CONCLUSION Tumour necrosis <90% following neoadjuvant therapy is associated with increased recurrence risk and inferior OS in patients with STS.
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Affiliation(s)
- Samer Salah
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada; Department of Medical Oncology, King Hussein Cancer Centre, Queen Rania Al Abdullah St 202, Amman, Jordan.
| | - Jeremy Lewin
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada.
| | - Eitan Amir
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada.
| | - Albiruni Abdul Razak
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada.
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Greto D, Loi M, Saieva C, Muntoni C, Delli Paoli C, Becherini C, Ciabatti C, Perna M, Campanacci D, Terziani F, Beltrami G, Scoccianti G, Bonomo P, Meattini I, Desideri I, Simontacchi G, Mangoni M, Livi L. Safety of concurrent adjuvant radiotherapy and chemotherapy for locally advanced soft tissue sarcoma. TUMORI JOURNAL 2018; 104:322-329. [PMID: 29714662 DOI: 10.1177/0300891618765565] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION: This retrospective study analyzes the safety and feasibility of concurrent chemoradiotherapy (CRT) in adjuvant treatment of soft tissue sarcoma (STS). METHODS: A total of 158 patients with STS were retrospectively analyzed. Anthracycline-based computed tomography was performed in high-risk patients. Acute radiotherapy toxicity and chemotherapy-related toxicity were assessed according to the Common Terminology Criteria for Adverse Events 4.0; late radiotherapy toxicity was recorded according to Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer criteria. RESULTS: Fifty-four (34.2%) patients received CRT. Mean follow up was 5.4 years (range .2-21.1 years). Local DFS-recurrence-free survival, distant DFS-relapse-free survival, and overall survival were 79.1%, 76.4%, and 64.6%, respectively, at last follow-up. Leukopenia occurred in 11.4% of patients. Skin acute toxicity developed in 60.1% of patients and determined interruption of radiotherapy treatment in 19 (12%) patients. Nineteen patients (12%) experienced moderate fibrosis (grade 2). Mild and moderate joint stiffness was recorded in 16 (10.1%) patients. Size ≥5 cm was the only predictor of local recurrence at multivariate analysis (hazard ratio [HR] 9.65, 95% confidence interval [CI] 1.28-72.83, p = .028). Age and stage resulted as independent distant relapse predictors (HR 4.77, 95% CI 1.81-12.58, p = .002 and HR 4.83, CI 1.41-16.57, p = .012, respectively). At Cox regression univariate analysis, Karnofsky Performance Status, size, and stage were significant survival predictors (HR 2.23, 95% CI 1.02-4.87, p = .045; HR 2.88, 95% CI 1.10-7.52, p = .031; HR 2.59, 95% CI 1.11-6.04, p = .028). CONCLUSIONS: Concurrent CRT is a well-tolerated treatment option with no additional toxicity compared to exclusive radiotherapy or sequential CRT.
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Affiliation(s)
- Daniela Greto
- 1 Department of Radiation-Oncology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Mauro Loi
- 1 Department of Radiation-Oncology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Calogero Saieva
- 2 Molecular and Nutritional Epidemiology Unit, ISPO (Cancer Research and Prevention Institute), Florence, Italy
| | - Cristina Muntoni
- 1 Department of Radiation-Oncology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Camilla Delli Paoli
- 1 Department of Radiation-Oncology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Carlotta Becherini
- 1 Department of Radiation-Oncology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Cinzia Ciabatti
- 1 Department of Radiation-Oncology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Marco Perna
- 1 Department of Radiation-Oncology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Domenico Campanacci
- 3 Department of Orthopaedic Oncology and Reconstructive Surgery, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Francesca Terziani
- 1 Department of Radiation-Oncology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Giovanni Beltrami
- 3 Department of Orthopaedic Oncology and Reconstructive Surgery, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Guido Scoccianti
- 3 Department of Orthopaedic Oncology and Reconstructive Surgery, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Pierluigi Bonomo
- 1 Department of Radiation-Oncology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Icro Meattini
- 1 Department of Radiation-Oncology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Isacco Desideri
- 1 Department of Radiation-Oncology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Gabriele Simontacchi
- 1 Department of Radiation-Oncology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Monica Mangoni
- 1 Department of Radiation-Oncology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Lorenzo Livi
- 1 Department of Radiation-Oncology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
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Harati K, Kolbenschlag J, Bohm J, Niggemann H, Joneidi-Jafari H, Stricker I, Lehnhardt M, Daigeler A. Long-term outcomes of patients with soft tissue sarcoma of the chest wall: Analysis of the prognostic significance of microscopic margins. Oncol Lett 2017; 15:2179-2187. [PMID: 29434923 PMCID: PMC5777128 DOI: 10.3892/ol.2017.7624] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 01/17/2017] [Indexed: 12/05/2022] Open
Abstract
Data on prognostic factors and treatment outcomes for chest wall soft tissue sarcomas (STS) are sparse. Wide resections with negative margins are the mainstay of therapy, but the prognostic impact of surgical margins remains controversial. The purpose of the present study was to determine the significance of microscopic margins through a long-term follow-up. The associations between local recurrence-free survival (LRFS), overall survival (OS) and potential prognostic factors were retrospectively assessed in a consecutive series of 110 patients who were suitable for surgical treatment with curative intent. Potential prognostic factors were assessed using univariate and multivariate analyses. The median follow-up time following primary diagnosis was 9.6 years [95% confidence interval (CI), 7.2–10.5]. In the entire cohort, the 5-year estimates of the OS and LRFS rates were 66.0% (95% CI, 55.9–74.3) and 60.6% (95% CI, 50.3–69.4), respectively. A total of 27 patients (24.5%) developed distant metastases with a median survival time of 0.9 years following the diagnosis of metastasis. Surgical margins attained at the initial resection and eventual re-excisions significantly influenced OS in univariate analysis (5-year OS, R0 69.9% vs. R1/R2 38.5%; P=0.046), but this failed to reach statistical significance in the multivariate analysis. In the multivariate analysis, significant adverse prognostic features of LRFS included angiosarcoma subtype, G2 and G3 histology. For OS, the only independent significant predictors were age >50 years, tumor size >5 cm, angiosarcoma subtype and G3 histology. The results of the present study suggest that tumor biology, as reflected by the histological grade, influences the final outcome in patients with chest wall STS. Surgical margins failed to reach statistical significance in multivariate analysis as they demonstrated a dependency towards the independent predictors of OS. Subsequently, a positive margin status may be a result rather than a cause of biological aggressiveness, and it may not influence the outcome directly.
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Affiliation(s)
- Kamran Harati
- Department of Plastic Surgery, BG-University Hospital Bergmannsheil, D-44789 Bochum, Germany
| | - Jonas Kolbenschlag
- Department of Plastic Surgery, BG-University Hospital Bergmannsheil, D-44789 Bochum, Germany
| | - Jens Bohm
- Department of Plastic Surgery, BG-University Hospital Bergmannsheil, D-44789 Bochum, Germany
| | | | - Hamid Joneidi-Jafari
- Department of Plastic Surgery, BG-University Hospital Bergmannsheil, D-44789 Bochum, Germany
| | - Ingo Stricker
- Institute of Pathology, Ruhr-University Bochum, D-44789 Bochum, Germany
| | - Marcus Lehnhardt
- Department of Plastic Surgery, BG-University Hospital Bergmannsheil, D-44789 Bochum, Germany
| | - Adrien Daigeler
- Department of Plastic Surgery, BG-University Hospital Bergmannsheil, D-44789 Bochum, Germany
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Boxberg M, Steiger K, Lenze U, Rechl H, von Eisenhart-Rothe R, Wörtler K, Weichert W, Langer R, Specht K. PD-L1 and PD-1 and characterization of tumor-infiltrating lymphocytes in high grade sarcomas of soft tissue - prognostic implications and rationale for immunotherapy. Oncoimmunology 2017; 7:e1389366. [PMID: 29399389 DOI: 10.1080/2162402x.2017.1389366] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 10/01/2017] [Accepted: 10/02/2017] [Indexed: 10/18/2022] Open
Abstract
Therapies targeting programmed death 1-(PD-1) or its ligand (PD-L1), promoting antitumor T-cell activity have been successfully introduced into clinical practice. Clinical response correlates with PD-L1 expression by tumor cells or immune cells within the tumor microenvironment. The PD-L1/PD-1 axis and tumor microenvironment has been rarely studied in high-grade sarcomas of soft tissue (hSTS), a group of rare, genetically heterogenous and clinically aggressive tumors. We examined PD-L1 protein and CD274/PD-L1 gene copy number variations in 128 primary resected, therapy-naive hSTS using immunohistochemistry and fluorescence-in-situ hybridization. Frequency of tumoral PD-L1 expression varied widely in different disease subentities, with highest rates of positivity (40%) seen in undifferentiated pleomorphic sarcomas (UPS) and rare positivity detected in synovial sarcomas (6%). Amplification of the CD274/PD-L1 gene occurred in 14% of UPS and was rare in other subtypes. PD-L1 protein expression was significantly more frequent in CD274/PD-L1 amplified cases (p = 0.015). The subgroup of UPS was further characterized regarding the interaction between PD-L1 and the immunologic tumor microenvironment. High density of CD3+ and CD8+ tumor infiltrating lymphocytes (TILs) was significantly correlated with the presence of PD-L1 expression and seen more frequently in tumors with lower TNM stage (p = 0.024). Both, PD-L1 expression and high density lymphocytic infiltration were independent prognostic factors for a favorable overall (p = 0.001, HR 6.105 (2.041-8.258)), disease-specific (p = 0.003, HR 10.536 (2.186-50.774)) and disease-free survival (p = 0.020, HR 3.317 (1.209-9.106); values for CD8) in this particular subgroup of hSTS, whereas PD-L1 expression in TILs or CD274/PD-L1 gene amplification were not associated with outcome. These findings represent novel insights into the immune landscape of soft tissue sarcomas, in particular UPS and strengthen the rationale for immunotherapy, including targeting the PD-1/PD-L1 axis in these tumors.
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Affiliation(s)
- Melanie Boxberg
- Institute of Pathology, Technical University of Munich, Munich, Germany
| | - Katja Steiger
- Institute of Pathology, Technical University of Munich, Munich, Germany
| | - Ulrich Lenze
- Department of Orthopedics, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Hans Rechl
- Department of Orthopedics, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | | | - Klaus Wörtler
- Department of Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Wilko Weichert
- Institute of Pathology, Technical University of Munich, Munich, Germany.,National Center of Tumor Diseases (NCT), Heidelberg, University of Heidelberg, Germany.,Department of Pathology, German Cancer Consortium (DKTK), Partner Site Munich, Technical University of Munich, Munich, Germany
| | - Rupert Langer
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Katja Specht
- Institute of Pathology, Technical University of Munich, Munich, Germany
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Zhao R, Yu X, Feng Y, Yang Z, Chen X, Wand J, Ma S, Zhang Z, Guo X. Local recurrence is correlated with decreased overall survival in patients with intermediate high-grade localized primary soft tissue sarcoma of extremity and abdominothoracic wall. Asia Pac J Clin Oncol 2017; 14:e109-e115. [PMID: 29071781 DOI: 10.1111/ajco.12807] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 08/30/2017] [Indexed: 11/27/2022]
Abstract
AIM The aim of this study was to determine the effect of local recurrence on overall survival in patients with intermediate high-grade localized primary soft tissue sarcoma (STS) of extremity and abdominothoracic wall. METHODS This retrospective study identified 133 consecutive patients with intermediate high-grade localized primary STS of extremity and abdominothoracic wall from January 2000 to July 2010. Survival curves were constructed by the Kaplan-Meier method and log-rank test was used to assess statistical significance. Hazard ratios (HRs) were calculated based on multivariable Cox logistic regression method. RESULTS The 5-year cumulative incidence of local recurrence was 26.0% with a median follow-up of 68 months (range, 5-127 months). The univariate analysis showed that local recurrence was associated with decreased overall survival, with 5-year overall survival of 80.5% and 53.6% in the no local recurrence patients and local recurrence patients, respectively (P = 0.001). The multivariate analysis demonstrated that local recurrence was a negative prognostic factor for overall survival (HR = 2.115, 95% confidence interval [CI] 1.036-4.319, P = 0.040). Radiotherapy significantly reduced local recurrence compared with surgery alone (HR = 0.387, 95% CI 0.180-0.877, P = 0.019), while larger tumor size (HR = 3.184, 95% CI 1.351-7.506 P = 0.008) was correlated with higher rate of local recurrence. CONCLUSION Local recurrence in patients with intermediate high-grade localized primary STS is associated with decreased overall survival.
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Affiliation(s)
- Ruping Zhao
- Department of Radiation Oncology, Hangzhou Cancer Hospital, Nanjing Medical University, Hangzhou, Zhejiang, China
| | - Xiaoli Yu
- Department of Radiation Oncology, Cancer Hospital of Fudan University, Xuhui, Shanghai, China.,Department of Oncology, Shanghai Medical College of Fudan University, Xuhui, Shanghai, China
| | - Yan Feng
- Department of Radiation Oncology, Cancer Hospital of Fudan University, Xuhui, Shanghai, China.,Department of Oncology, Shanghai Medical College of Fudan University, Xuhui, Shanghai, China
| | - Zhaozhi Yang
- Department of Radiation Oncology, Cancer Hospital of Fudan University, Xuhui, Shanghai, China.,Department of Oncology, Shanghai Medical College of Fudan University, Xuhui, Shanghai, China
| | - Xingxing Chen
- Department of Radiation Oncology, Cancer Hospital of Fudan University, Xuhui, Shanghai, China.,Department of Oncology, Shanghai Medical College of Fudan University, Xuhui, Shanghai, China
| | - Jian Wand
- Department of Oncology, Shanghai Medical College of Fudan University, Xuhui, Shanghai, China.,Department of Pathology, Cancer Hospital of Fudan University, Xuhui, Shanghai, China
| | - Shenglin Ma
- Department of Radiation Oncology, Hangzhou First People's Hospital, Nanjing Medical University, Hangzhou, Zhejiang, China
| | - Zhen Zhang
- Department of Radiation Oncology, Cancer Hospital of Fudan University, Xuhui, Shanghai, China.,Department of Oncology, Shanghai Medical College of Fudan University, Xuhui, Shanghai, China
| | - Xiaomao Guo
- Department of Radiation Oncology, Cancer Hospital of Fudan University, Xuhui, Shanghai, China.,Department of Oncology, Shanghai Medical College of Fudan University, Xuhui, Shanghai, China
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Weichteilsarkome: Wie lassen sich posttherapeutische Veränderungen von Rezidiven unterscheiden? Radiologe 2017; 57:923-937. [DOI: 10.1007/s00117-017-0310-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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47
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Voss RK, Chiang YJ, Torres KE, Guadagnolo BA, Mann GN, Feig BW, Cormier JN, Roland CL. Adherence to National Comprehensive Cancer Network Guidelines is Associated with Improved Survival for Patients with Stage 2A and Stages 2B and 3 Extremity and Superficial Trunk Soft Tissue Sarcoma. Ann Surg Oncol 2017; 24:3271-3278. [PMID: 28741122 PMCID: PMC5693748 DOI: 10.1245/s10434-017-6015-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND The National Comprehensive Cancer Network (NCCN) has instituted treatment guidelines for stage 2A and stages 2B and 3 extremity and superficial trunk soft tissue sarcomas (ETSTS). This study examined adherence to the NCCN guidelines and factors associated with nonadherent treatment and survival outcomes. METHODS Patients with stage 2A and stages 2B and 3 ETSTS (n = 15,957) were categorized as undergoing adherent or nonadherent treatment based on the 2014 NCCN guidelines. Multivariate logistic regression models were used to determine factors associated with nonadherent treatment. Overall survival (OS) and disease-specific survival (DSS) were calculated, and Cox models were used to generate adjusted survival curves and hazard ratios (HRs). RESULTS The findings showed that 87.2% of the patients with stage 2A disease and 58.3% of the patients with stage 2B or 3 disease received adherent treatment. Community treatment facilities and uninsured or unknown insurance status were associated with nonadherent treatment for both stage groups. Adherent treatment was associated with higher 5-year adjusted OS and DSS for stage 2A and stage 2B or 3 patients. In Cox models, nonadherent treatment was associated with worse survival for both stage 2A disease (HR, 2.31; 95% confidence interval [CI], 2.02-2.63) and stages 2B and 3 disease (HR, 1.63; 95% CI, 1.53-1.73). Increasing age and non-private insurance were associated with poorer outcomes. For stages 2B and 3 disease, treatment at a community center and African American race were associated with worse survival. CONCLUSIONS Adherence to NCCN guidelines is excellent for stage 2A and poor for stages 2B and 3 ETSTS. Adherent treatment was associated with improved survival outcomes, highlighting the importance of adherence to NCCN guidelines.
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Affiliation(s)
- Rachel K Voss
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yi-Ju Chiang
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Keila E Torres
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - B Ashleigh Guadagnolo
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gary N Mann
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Barry W Feig
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Janice N Cormier
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Christina L Roland
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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van Praag VM, Rueten-Budde AJ, Jeys LM, Laitinen MK, Pollock R, Aston W, van der Hage JA, Dijkstra PS, Ferguson PC, Griffin AM, Willeumier JJ, Wunder JS, van de Sande MA, Fiocco M. A prediction model for treatment decisions in high-grade extremity soft-tissue sarcomas: Personalised sarcoma care (PERSARC). Eur J Cancer 2017; 83:313-323. [DOI: 10.1016/j.ejca.2017.06.032] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 06/19/2017] [Accepted: 06/24/2017] [Indexed: 11/28/2022]
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49
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Mahmoud O, Tunceroglu A, Chokshi R, Benevenia J, Beebe K, Patterson F, DeLaney TF. Overall survival advantage of chemotherapy and radiotherapy in the perioperative management of large extremity and trunk soft tissue sarcoma; a large database analysis. Radiother Oncol 2017; 124:277-284. [DOI: 10.1016/j.radonc.2017.07.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 07/10/2017] [Accepted: 07/16/2017] [Indexed: 11/16/2022]
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50
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Clinical overview of the current state and future applications of positron emission tomography in bone and soft tissue sarcoma. Clin Transl Imaging 2017. [DOI: 10.1007/s40336-017-0236-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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