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Thio QCBS, van Wulfften Palthe ODR, Bramer JAM, DeLaney TF, Bredella MA, Dempster DW, Zhou H, Hornicek FJ, Chen YLE, Schwab JH. Pilot Study: Short Term Impact of Radiation Therapy on Bone Mineral Density and Bone Metabolism. Calcif Tissue Int 2023; 113:640-650. [PMID: 37910222 PMCID: PMC10673955 DOI: 10.1007/s00223-023-01149-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 10/04/2023] [Indexed: 11/03/2023]
Abstract
Despite the risk of complications, high dose radiation therapy is increasingly utilized in the management of selected bone malignancies. In this study, we investigate the impact of moderate to high dose radiation (over 50 Gy) on bone metabolism and structure. Between 2015 and 2018, patients with a primary malignant bone tumor of the sacrum that were either treated with high dose definitive radiation only or a combination of moderate to high dose radiation and surgery were prospectively enrolled at a single institution. Quantitative CTs were performed before and after radiation to determine changes in volumetric bone mineral density (BMD) of the irradiated and non-irradiated spine. Bone histomorphometry was performed on biopsies of the irradiated sacrum and the non-irradiated iliac crest of surgical patients using a quadruple tetracycline labeling protocol. In total, 9 patients were enrolled. Two patients received radiation only (median dose 78.3 Gy) and 7 patients received a combination of preoperative radiation (median dose 50.4 Gy), followed by surgery. Volumetric BMD of the non-irradiated lumbar spine did not change significantly after radiation, while the BMD of the irradiated sacrum did (pre-radiation median: 108.0 mg/cm3 (IQR 91.8-167.1); post-radiation median: 75.3 mg/cm3 (IQR 57.1-110.2); p = 0.010). The cancellous bone of the non-irradiated iliac crest had a stable bone formation rate, while the irradiated sacrum showed a significant decrease in bone formation rate [pre-radiation median: 0.005 mm3/mm2/year (IQR 0.003-0.009), post-radiation median: 0.001 mm3/mm2/year (IQR 0.001-0.001); p = 0.043]. Similar effects were seen in the cancellous and endocortical envelopes. This pilot study shows a decrease of volumetric BMD and bone formation rate after high-dose radiation therapy. Further studies with larger cohorts and other endpoints are needed to get more insight into the effect of radiation on bone. Level of evidence: IV.
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Affiliation(s)
- Quirina C B S Thio
- Department of Orthopedic Surgery, Academic University Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Massachusetts General Hospital, Room 3.946, Yawkey Building, 55 Fruit Street, Boston, MA, 02114, USA.
| | - Olivier D R van Wulfften Palthe
- Department of Orthopedic Surgery, Academic University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jos A M Bramer
- Department of Orthopedic Surgery, Academic University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Thomas F DeLaney
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Miriam A Bredella
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - David W Dempster
- Department of Pathology and Cell Biology, Columbia University, New York, NY, USA
- Regional Bone Center, Helen Hayes Hospital, West Haverstraw, New York, USA
| | - Hua Zhou
- Regional Bone Center, Helen Hayes Hospital, West Haverstraw, New York, USA
| | | | - Yen-Lin E Chen
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Joseph H Schwab
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Dean DC, Feng W, Walker RL, Thanindratarn P, Temple HT, Trent JC, Rosenberg AE, Hornicek FJ, Duan Z. Discoidin Domain Receptor Tyrosine Kinase 1 (DDR1) Is a Novel Therapeutic Target in Liposarcoma: A Tissue Microarray Study. Clin Orthop Relat Res 2023; 481:2140-2153. [PMID: 37768856 PMCID: PMC10567009 DOI: 10.1097/corr.0000000000002865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 08/22/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND Liposarcoma is the most commonly diagnosed subtype of soft tissue sarcoma. As these tumors often arise near vital organs and neurovascular structures, complete resection can be challenging; consequently, recurrence rates are high. Additionally, available chemotherapeutic agents have shown limited benefit and substantial toxicities. There is, therefore, a clear and unmet need for novel therapeutics for liposarcoma. Discoidin domain receptor tyrosine kinase 1 (DDR1) is involved in adhesion, proliferation, differentiation, migration, and metastasis in several cancers. However, the expression and clinical importance of DDR1 in liposarcoma are unknown. QUESTIONS/PURPOSES The purposes of this study were to assess (1) the expression, (2) the association between DDR1 and survival, and (3) the functional roles of DDR1 in liposarcoma. METHODS The correlation between DDR1 expression in tumor tissues and clinicopathological features and survival was assessed via immunohistochemical staining of a liposarcoma tissue microarray. It contained 53 samples from 42 patients with liposarcoma and 11 patients with lipoma. The association between DDR1 and survival in liposarcoma was analyzed by Kaplan-Meier plots and log-rank tests. The DDR1 knockout liposarcoma cell lines were generated by CRISPR-Cas9 technology. The DDR1-specific and highly selective DDR1 inhibitor 7RH was applied to determine the impact of DDR1 expression on liposarcoma cell growth and proliferation. In addition, the effect of DDR1 inhibition on liposarcoma growth was further accessed in a three-dimensional cell culture model to mimic DDR1 effects in vivo. RESULTS The results demonstrate elevated expression of DDR1 in all liposarcoma subtypes relative to benign lipomas. Specifically, high DDR1 expression was seen in 55% (23 of 42) of liposarcomas and no benign lipomas. However, DDR1 expression was not found to be associated with poor survival in patients with liposarcoma. DDR1 knockout or treatment of 7RH showed decreased liposarcoma cell growth and proliferation. CONCLUSION DDR1 is aberrantly expressed in liposarcoma, and it contributes to several markers of oncogenesis in these tumors. CLINICAL RELEVANCE This work supports DDR1 as a promising therapeutic target in liposarcoma.
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Affiliation(s)
- Dylan C. Dean
- Sarcoma Biology Laboratory, Department of Orthopaedics, Sylvester Comprehensive Cancer Center and the University of Miami Miller School of Medicine, Miami, FL, USA
| | - Wenlong Feng
- Sarcoma Biology Laboratory, Department of Orthopaedics, Sylvester Comprehensive Cancer Center and the University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Robert L. Walker
- Sarcoma Biology Laboratory, Department of Orthopaedics, Sylvester Comprehensive Cancer Center and the University of Miami Miller School of Medicine, Miami, FL, USA
| | - Pichaya Thanindratarn
- Sarcoma Biology Laboratory, Department of Orthopaedics, Sylvester Comprehensive Cancer Center and the University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Orthopedic Surgery, Chulabhorn hospital, HRH Princess Chulabhorn College of Medical Science, Bangkok, Thailand
| | - H. Thomas Temple
- Sarcoma Biology Laboratory, Department of Orthopaedics, Sylvester Comprehensive Cancer Center and the University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jonathan C. Trent
- Department of Medicine, Division of Medical Oncology, Sylvester Comprehensive Cancer Center and the University of Miami Miller School of Medicine, Miami, FL, USA
| | - Andrew E. Rosenberg
- Departments of Pathology and Laboratory Medicine, Sylvester Comprehensive Cancer Center and the University of Miami Miller School of Medicine, Miami, FL, USA
| | - Francis J. Hornicek
- Sarcoma Biology Laboratory, Department of Orthopaedics, Sylvester Comprehensive Cancer Center and the University of Miami Miller School of Medicine, Miami, FL, USA
| | - Zhenfeng Duan
- Sarcoma Biology Laboratory, Department of Orthopaedics, Sylvester Comprehensive Cancer Center and the University of Miami Miller School of Medicine, Miami, FL, USA
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Cui J, Dean D, Hornicek FJ, Pollock RE, Hoffman RM, Duan Z. Erratum: ATR inhibition sensitizes liposarcoma to doxorubicin by increasing DNA damage. Am J Cancer Res 2023; 13:5021-5023. [PMID: 37970365 PMCID: PMC10636686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 02/08/2023] [Indexed: 11/17/2023] Open
Abstract
[This corrects the article on p. 1577 in vol. 12, PMID: 35530299.].
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Affiliation(s)
- Juncheng Cui
- Department of Orthopedic Surgery, The First Affiliated Hospital of University of South China69 Chuanshan Road, Hengyang 421001, Hunan, China
- Department of Orthopedic Surgery, Sarcoma Biology Laboratory, Sylvester Comprehensive Cancer Center, and The University of Miami Miller School of Medicine, Papanicolaou Cancer Research Building1550 NW. 10th Avenue, Miami, Florida 33136, USA
| | - Dylan Dean
- Department of Orthopedic Surgery, Sarcoma Biology Laboratory, Sylvester Comprehensive Cancer Center, and The University of Miami Miller School of Medicine, Papanicolaou Cancer Research Building1550 NW. 10th Avenue, Miami, Florida 33136, USA
- Department of Orthopaedic Surgery, Keck School of Medicine at University of Southern California (USC), USC Norris Comprehensive Cancer Center1441 Eastlake Ave, NTT 3449, Los Angeles, Califormia 90033, USA
| | - Francis J Hornicek
- Department of Orthopedic Surgery, Sarcoma Biology Laboratory, Sylvester Comprehensive Cancer Center, and The University of Miami Miller School of Medicine, Papanicolaou Cancer Research Building1550 NW. 10th Avenue, Miami, Florida 33136, USA
| | - Raphael E Pollock
- The James Comprehensive Cancer Center, The Ohio State UniversityColumbus, OH, USA
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical CenterColumbus, Ohio 43210, USA
| | - Robert M Hoffman
- AntiCancer Inc., San Diego, CA, USA Department of Surgery, University of CaliforniaSan Diego, Califormia 92111, USA
| | - Zhenfeng Duan
- Department of Orthopedic Surgery, Sarcoma Biology Laboratory, Sylvester Comprehensive Cancer Center, and The University of Miami Miller School of Medicine, Papanicolaou Cancer Research Building1550 NW. 10th Avenue, Miami, Florida 33136, USA
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Baron M, Drohat P, Crawford B, Hornicek FJ, Best TM, Kouroupis D. Mesenchymal Stem/Stromal Cells: Immunomodulatory and Bone Regeneration Potential after Tumor Excision in Osteosarcoma Patients. Bioengineering (Basel) 2023; 10:1187. [PMID: 37892917 PMCID: PMC10604230 DOI: 10.3390/bioengineering10101187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
Osteosarcoma (OS) is a type of bone cancer that is derived from primitive mesenchymal cells typically affecting children and young adults. The current standard of treatment is a combination of neoadjuvant chemotherapy and surgical resection of the cancerous bone. Post-resection challenges in bone regeneration arise. To determine the appropriate amount of bone to be removed, preoperative imaging techniques such as bone and CT scans are employed. To prevent local recurrence, the current standard of care suggests maintaining bony and soft tissue margins from 3 to 7 cm beyond the tumor. The amount of bone removed in an OS patient leaves too large of a deficit for bone to form on its own and requires reconstruction with metal implants or allografts. Both methods require the bone to heal, either to the implant or across the allograft junction, often in the setting of marrow-killing chemotherapy. Therefore, the issue of bone regeneration within the surgically resected margins remains an important challenge for the patient, family, and treating providers. Mesenchymal stem/stromal cells (MSCs) are potential agents for enhancing bone regeneration post tumor resection. MSCs, used with scaffolds and growth factors, show promise in fostering bone regeneration in OS cases. We spotlight two MSC types-bone marrow-derived (BM-MSCs) and adipose tissue-derived (ASCs)-highlighting their bone regrowth facilitation and immunomodulatory effects on immune cells like macrophages and T cells, enhancing therapeutic outcomes. The objective of this review is two-fold: review work demonstrating any ability of MSCs to target the deranged immune system in the OS microenvironment, and synthesize the available literature on the use of MSCs as a therapeutic option for stimulating bone regrowth in OS patients post bone resection. When it comes to repairing bone defects, both MB-MSCs and ASCs hold great potential for stimulating bone regeneration. Research has showcased their effectiveness in reconstructing bone defects while maintaining a non-tumorigenic role following wide resection of bone tumors, underscoring their capability to enhance bone healing and regeneration following tumor excisions.
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Affiliation(s)
- Max Baron
- Department of Orthopedics, UHealth Sports Medicine Institute, Miller School of Medicine, University of Miami, Miami, FL 33146, USA; (M.B.); (P.D.); (T.M.B.)
| | - Philip Drohat
- Department of Orthopedics, UHealth Sports Medicine Institute, Miller School of Medicine, University of Miami, Miami, FL 33146, USA; (M.B.); (P.D.); (T.M.B.)
| | - Brooke Crawford
- Sarcoma Biology Laboratory, Department of Orthopedics, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL 33136, USA; (B.C.); (F.J.H.)
| | - Francis J. Hornicek
- Sarcoma Biology Laboratory, Department of Orthopedics, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL 33136, USA; (B.C.); (F.J.H.)
| | - Thomas M. Best
- Department of Orthopedics, UHealth Sports Medicine Institute, Miller School of Medicine, University of Miami, Miami, FL 33146, USA; (M.B.); (P.D.); (T.M.B.)
| | - Dimitrios Kouroupis
- Department of Orthopedics, UHealth Sports Medicine Institute, Miller School of Medicine, University of Miami, Miami, FL 33146, USA; (M.B.); (P.D.); (T.M.B.)
- Diabetes Research Institute, Cell Transplant Center, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
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Halvorsen SC, Benita Y, Hopton M, Hoppe B, Gunnlaugsson HO, Korgaonkar P, Vanderburg CR, Nielsen GP, Trepanowski N, Cheah JH, Frosch MP, Schwab JH, Rosenberg AE, Hornicek FJ, Sassi S. Transcriptional Profiling Supports the Notochordal Origin of Chordoma and Its Dependence on a TGFΒ1-TBXT Network. Am J Pathol 2023; 193:532-547. [PMID: 36804377 DOI: 10.1016/j.ajpath.2023.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 12/23/2022] [Accepted: 01/26/2023] [Indexed: 02/19/2023]
Abstract
Chordoma is a rare malignant tumor demonstrating notochordal differentiation. It is dependent on brachyury (TBXT), a hallmark notochordal gene and transcription factor, and shares histologic features and the same anatomic location as the notochord. In this study, we perform a molecular comparison of chordoma and notochord to identify dysregulated cellular pathways. The lack of a molecular reference from appropriate control tissue limits our understanding of chordoma and its relationship to notochord. Accordingly, we conducted an unbiased comparison of chordoma, human notochord, and an atlas of normal and cancerous tissue using gene expression profiling to clarify the chordoma/notochord relationship and potentially identify novel drug targets. We found striking consistency in gene expression profiles between chordoma and notochord, supporting the hypothesis that chordoma develops from notochordal remnants. We identified a 12-gene diagnostic chordoma signature and found that the TBXT/transforming growth factor (TGF)-β/SOX6/SOX9 pathway is hyperactivated in the tumor, suggesting that pathways associated with chondrogenesis are a central driver of chordoma development. Experimental validation in chordoma cells confirms these findings and emphasizes the dependence of chordoma proliferation and survival on TGF-β. Our computational and experimental evidence provides the first molecular connection between notochord and chordoma and identifies core members of a chordoma regulatory pathway involving TBXT. This pathway provides new therapeutic targets for this unique malignant neoplasm and highlights TGF-β as a prime druggable candidate.
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Affiliation(s)
- Stefan C Halvorsen
- Center for Computational and Integrative Biology, Massachusetts General Hospital, Boston, Massachusetts
| | - Yair Benita
- Center for Computational and Integrative Biology, Massachusetts General Hospital, Boston, Massachusetts
| | - Megan Hopton
- Center for Computational and Integrative Biology, Massachusetts General Hospital, Boston, Massachusetts
| | - Brooke Hoppe
- Center for Computational and Integrative Biology, Massachusetts General Hospital, Boston, Massachusetts
| | - Hilmar Orn Gunnlaugsson
- Center for Computational and Integrative Biology, Massachusetts General Hospital, Boston, Massachusetts
| | - Parimal Korgaonkar
- Center for Computational and Integrative Biology, Massachusetts General Hospital, Boston, Massachusetts
| | - Charles R Vanderburg
- Harvard NeuroDiscovery Center, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts
| | - G Petur Nielsen
- Department of Pathology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Nicole Trepanowski
- Center for Computational and Integrative Biology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jaime H Cheah
- High Throughput Sciences Facility, Koch Institute of MIT, Cambridge, Massachusetts
| | - Matthew P Frosch
- C.S. Kubik Laboratory for Neuropathology, Massachusetts General Hospital, Charlestown, Massachusetts
| | - Joseph H Schwab
- Department of Orthopedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Andrew E Rosenberg
- Department of Pathology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Francis J Hornicek
- Department of Orthopedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts.
| | - Slim Sassi
- Center for Computational and Integrative Biology, Massachusetts General Hospital, Boston, Massachusetts; Department of Orthopedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts.
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Casadei L, Sarchet P, de Faria FCC, Calore F, Nigita G, Tahara S, Cascione L, Wabitsch M, Hornicek FJ, Grignol V, Croce CM, Pollock RE. In situ hybridization to detect DNA amplification in extracellular vesicles. J Extracell Vesicles 2022; 11:e12251. [PMID: 36043432 PMCID: PMC9428764 DOI: 10.1002/jev2.12251] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 07/20/2022] [Accepted: 07/20/2022] [Indexed: 11/07/2022] Open
Abstract
EVs have emerged as an important component in tumour initiation, progression and metastasis. Although notable progresses have been made, the detection of EV cargoes remain significantly challenging for researchers to practically use; faster and more convenient methods are required to validate the EV cargoes, especially as biomarkers. Here we show, the possibility of examining embedded EVs as substrates to be used for detecting DNA amplification through ultrasensitive in situ hybridization (ISH). This methodology allows the visualization of DNA targets in a more direct manner, without time consuming optimization steps or particular expertise. Additionally, formalin‐fixed paraffin‐embedded (FFPE) blocks of EVs allows long‐term preservation of samples, permitting future studies. We report here: (i) the successful isolation of EVs from liposarcoma tissues; (ii) the EV embedding in FFPE blocks (iii) the successful selective, specific ultrasensitive ISH examination of EVs derived from tissues, cell line, and sera; (iv) and the detection of MDM2 DNA amplification in EVs from liposarcoma tissues, cell lines and sera. Ultrasensitive ISH on EVs would enable cargo study while the application of ISH to serum EVs, could represent a possible novel methodology for diagnostic confirmation. Modification of probes may enable researchers to detect targets and specific DNA alterations directly in tumour EVs, thereby facilitating detection, diagnosis, and improved understanding of tumour biology relevant to many cancer types.
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Affiliation(s)
- Lucia Casadei
- The Ohio State University Comprehensive Cancer CenterColumbusOhioUSA
| | - Patricia Sarchet
- The Ohio State University Comprehensive Cancer CenterColumbusOhioUSA
| | | | - Federica Calore
- Department of Cancer Biology and GeneticsThe Ohio State UniversityColumbusOhioUSA
| | - Giovanni Nigita
- Department of Cancer Biology and GeneticsThe Ohio State UniversityColumbusOhioUSA
| | - Sayumi Tahara
- The Ohio State University Comprehensive Cancer CenterColumbusOhioUSA
| | - Luciano Cascione
- Institute of Oncology Research (IOR), Faculty of Biomedical SciencesUniversità della Svizzera italiana (USI), Bellinzona, Switzerland, Swiss Institute of Bioinformatics (SIB)LausanneSwitzerland
| | - Martin Wabitsch
- Department of Pediatrics and Adolescent Medicine Division of Paediatric Endocrinology and Diabetes Centre for Hormonal Disorders in Children and AdolescentsUlm University HospitalUlmGermany
| | - Francis J. Hornicek
- Sarcoma Biology Laboratory, Department of Orthopaedics, Sylvester Comprehensive Cancer Centerand the University of Miami Miller School of MedicineMiamiFloridaUSA
| | - Valerie Grignol
- The Ohio State University Comprehensive Cancer CenterColumbusOhioUSA
| | - Carlo M. Croce
- Department of Cancer Biology and GeneticsThe Ohio State UniversityColumbusOhioUSA
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Shah AA, Lozano-Calderon SA, Berner EA, Austen WG, Winograd JM, Park HY, Bernthal NM, Crawford BM, Hornicek FJ. Pedicled vastus lateralis myocutaneous flap for sacropelvic defects after wide oncologic resection: Wound complications and outcomes. J Surg Oncol 2022; 126:978-985. [PMID: 35809223 DOI: 10.1002/jso.27006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 06/25/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVES Adequate coverage of the soft tissue defects from wide resection of sacropelvic malignancies remains challenging. The vastus lateralis flap has been described for coverage in the setting of trauma and infection. This flap has not been described for coverage of sacropelvic tumor defects. METHODS This is a retrospective cohort study of adult patients who underwent wide resection of a primary sacropelvic malignancy with reconstruction employing a pedicled vastus lateralis flap at two tertiary care centers. Patient demographics, tumor staging, and rate of complications were assessed. RESULTS Twenty-eight patients were included, with a median age of 51 years. The most common primary tumor was chondrosarcoma followed by chondroblastic osteosarcoma. The median follow-up was 1.1 years. There were 10 cases of wound infection requiring re-operation and three cases of flap failure. CONCLUSIONS We describe a pedicled vastus lateralis flap for coverage of defects after wide resection of sacropelvic malignancies. A large proportion of our cohort had independent risk factors for wound complications. Even with a cohort with high baseline risk for wound complications, we show that the use of a pedicled vastus lateralis flap is a safe reconstructive option with a wound complication rate in line with the literature.
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Affiliation(s)
- Akash A Shah
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | | | - Emily A Berner
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - William G Austen
- Division of Plastic & Reconstructive Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jonathan M Winograd
- Division of Plastic & Reconstructive Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Howard Y Park
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Nicholas M Bernthal
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Brooke M Crawford
- Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Francis J Hornicek
- Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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Li X, Dean DC, Yuan J, Temple TH, Trent JC, Rosenberg AE, Yu S, Hornicek FJ, Duan Z. Inhibition of CDK7-dependent transcriptional addiction is a potential therapeutic target in synovial sarcoma. Biomed Pharmacother 2022; 149:112888. [PMID: 35367753 DOI: 10.1016/j.biopha.2022.112888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 11/02/2022] Open
Abstract
Synovial sarcoma is typical aggressive malignant without satisfactory treatment outcome in adult series. Cyclin-dependent kinases (CDKs) in transcription have been considered promising molecular targets in cancer. Among these, CDK7 has been shown to play important roles in the pathogenesis of malignancies. However, the modulation mechanism of CDK7-regulated transcription in synovial sarcoma is unknown. In the present study, we aim to determine the expression and function of CDK7 in the transcription cycle of RNA polymerase II (RNAP II), and evaluate its prognostic and therapeutic significance in synovial sarcoma. Results showed that overexpression of CDK7 correlates with higher clinical stage and grade, and worse outcomes in clinic. High CDK7 expression was confirmed in all tested human synovial sarcoma cell lines and CDK7 was largely localized to the cell nucleus. Downregulation through siRNA or inhibition with the CDK7-targeting agent BS-181 exhibited dose-dependent cytotoxicity and prevented cell colony formation. Western blots demonstrated that inhibition of CDK7 paused transcription by a reduction of RNAP II phosphorylation. Blocking CDK7-dependent transcriptional addiction was accompanied by promotion of apoptosis. Furthermore, the CDK7-specific inhibitor reduced 3D spheroid formation and migration of synovial sarcoma. Collectively, our findings highlight the role of CDK7-dependent transcriptional addiction in human synovial sarcoma. CDK7-specific cytotoxic agents are therefore promising novel treatment options for synovial sarcoma.
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Affiliation(s)
- Xiaoyang Li
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China; Sarcoma Biology Laboratory, Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, 90095, USA.
| | - Dylan C Dean
- Sarcoma Biology Laboratory, Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, 90095, USA; Department of Orthopaedic Surgery, Keck School of Medicine at University of Southern California (USC), USC Norris Comprehensive Cancer Center, 1441 Eastlake Ave, NTT 3449, Los Angeles, California, 90033, USA.
| | - Jin Yuan
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
| | - Thomas H Temple
- Sarcoma Biology Laboratory, Department of Orthopaedics, Sylvester Comprehensive Cancer Center, and the University of Miami Miller School of Medicine, Miami, Florida 33136, USA.
| | - Jonathan C Trent
- Department of Medicine, Hematology & Oncology, Sylvester Comprehensive Cancer Center, and the University of Miami Miller School of Medicine, Miami, Florida 33136, USA.
| | - Andrew E Rosenberg
- Departments of Pathology and Laboratory Medicine, Sylvester Comprehensive Cancer Center, and the University of Miami Miller School of Medicine, Miami, Florida 33136, USA.
| | - Shengji Yu
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
| | - Francis J Hornicek
- Sarcoma Biology Laboratory, Department of Orthopaedics, Sylvester Comprehensive Cancer Center, and the University of Miami Miller School of Medicine, Miami, Florida 33136, USA; Sarcoma Biology Laboratory, Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, 90095, USA.
| | - Zhenfeng Duan
- Sarcoma Biology Laboratory, Department of Orthopaedics, Sylvester Comprehensive Cancer Center, and the University of Miami Miller School of Medicine, Miami, Florida 33136, USA; Sarcoma Biology Laboratory, Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, 90095, USA.
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9
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Cui J, Dean D, Hornicek FJ, Pollock RE, Hoffman RM, Duan Z. ATR inhibition sensitizes liposarcoma to doxorubicin by increasing DNA damage. Am J Cancer Res 2022; 12:1577-1592. [PMID: 35530299 PMCID: PMC9077062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/04/2022] [Indexed: 06/14/2023] Open
Abstract
Liposarcomas account for approximately 20% of all adult sarcomas and have limited therapeutic options outside of surgery. Inhibition of ataxia-telangiectasia and Rad3 related protein kinase (ATR) has emerged as a promising chemotherapeutic strategy in various cancers. However, its activation, expression, and function in liposarcoma remain unkown. In this study, we investigated the expression, function, and potential of ATR as a therapeutic target in liposarcoma. Activation and expression of ATR in liposarcoma was analyzed by immunohistochemistry, which was further explored for correlation with patient clinical characteristics. ATR-specific siRNA and the ATR inhibitor VE-822 were applied to determine the effect of ATR inhibition on liposarcoma cell proliferation and anti-apoptotic activity. Migration activity and clonogenicity were examined using wound healing and clonogenic assays. ATR (p-ATR) was overexpressed in 88.1% of the liposarcoma specimens and correlated with shorter overall survival in patients. Knockdown of ATR via specific siRNA or inhibition with VE-822 suppressed liposarcoma cell growth, proliferation, migration, colony-forming ability, and spheroid growth. Importantly, ATR inhibition significantly and synergistically enhanced liposarcoma cell line chemosensitivity to doxorubicin. Our findings support ATR as critical to liposarcoma proliferation and doxorubicin resistance. Therefore, the addition of ATR inhibition to a standard doxorubicin regimen is a potential treatment strategy for liposarcoma.
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Affiliation(s)
- Juncheng Cui
- Department of Orthopedic Surgery, The First Affiliated Hospital of University of South China69 Chuanshan Road, Hengyang 421001, Hunan, China
- Department of Orthopedic Surgery, Sarcoma Biology Laboratory, Sylvester Comprehensive Cancer Center, and The University of Miami Miller School of Medicine, Papanicolaou Cancer Research Building1550 NW. 10th Avenue, Miami, Florida 33136, USA
| | - Dylan Dean
- Department of Orthopedic Surgery, Sarcoma Biology Laboratory, Sylvester Comprehensive Cancer Center, and The University of Miami Miller School of Medicine, Papanicolaou Cancer Research Building1550 NW. 10th Avenue, Miami, Florida 33136, USA
- Department of Orthopaedic Surgery, Keck School of Medicine at University of Southern California (USC), USC Norris Comprehensive Cancer Center1441 Eastlake Ave, NTT 3449, Los Angeles, Califormia 90033, USA
| | - Francis J Hornicek
- Department of Orthopedic Surgery, Sarcoma Biology Laboratory, Sylvester Comprehensive Cancer Center, and The University of Miami Miller School of Medicine, Papanicolaou Cancer Research Building1550 NW. 10th Avenue, Miami, Florida 33136, USA
| | - Raphael E Pollock
- The James Comprehensive Cancer Center, The Ohio State UniversityColumbus, OH, USA
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical CenterColumbus, Ohio 43210, USA
| | - Robert M Hoffman
- AntiCancer Inc., San Diego, CA, USA Department of Surgery, University of CaliforniaSan Diego, Califormia 92111, USA
| | - Zhenfeng Duan
- Department of Orthopedic Surgery, Sarcoma Biology Laboratory, Sylvester Comprehensive Cancer Center, and The University of Miami Miller School of Medicine, Papanicolaou Cancer Research Building1550 NW. 10th Avenue, Miami, Florida 33136, USA
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10
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Cui J, Dean D, Hornicek FJ, Yi G, Duan Z. Expression and Clinical Significance of High-Mobility Group AT-hook 2 (HMGA2) in Osteosarcoma. Orthop Surg 2022; 14:955-966. [PMID: 35388973 PMCID: PMC9087380 DOI: 10.1111/os.13167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 09/27/2021] [Accepted: 10/09/2021] [Indexed: 11/29/2022] Open
Abstract
Objective Although high‐mobility group AT‐hook 2 (HMGA2) has been shown to have crucial roles in the pathogenesis and metastasis of various malignancies, its expression and significance in osteosarcoma remain unknown. Here we evaluate the expression, clinical prognostic value, and overall function of HMGA2 in osteosarcoma. Methods Sixty‐nine osteosarcoma patient specimens within a tissue microarray (TMA) were analyzed by immunohistochemistry for HMGA2 expression. Demographics and clinicopathological information including age, gender, tumor location, metastasis, recurrence, chemotherapy response, follow‐up time, and disease status were also collected. After validation of expression, we determined whether there was a correlation between HMGA2 expression and patient clinicopathology. HMGA2 expression was also evaluated in osteosarcoma cell lines and patient tissues by Western blot, we analyzed the expression of HMGA2 in the human osteosarcoma cell lines MG63, 143B, U2OS, Saos‐2, MNNG/HOS, and KHOS. HMGA2‐specific siRNA and clonogenic assays were then used to determine the effect of HMGA2 inhibition on osteosarcoma cell proliferation, growth, and chemosensitivity. Results HMGA2 expression was elevated in the osteosarcoma patient specimens and human osteosarcoma cell lines. HMGA2 was differentially expressed in human osteosarcoma cell lines. Specifically, a relatively high expression of HMGA2 was present in KHOS, MNNG/HOS, 143B and a relatively low expression was in MG63, U2OS as well as Saos‐2. HMGA2 expression is correlated with metastasis and shorter overall survival. High HMGA2 expression is an independent predictor of poor osteosarcoma prognosis. There was no significant correlation between HMGA2 expression and the age, gender, or tumor site of the patient. HMGA2 expression is predominantly within the nucleus. The expression of HMGA2 also directly correlated to neoadjuvant chemoresistance. There was a significant reduction of HMGA2 expression in the siRNA transfection group. After the use of siRNA, the proliferation of osteosarcoma cells is decreased and the chemosensitivity of osteosarcoma cells is significantly increased. Conclusion Our study supports HMGA2 as a potential prognostic biomarker and therapeutic target in osteosarcoma.
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Affiliation(s)
- Juncheng Cui
- Department of Orthopedic Surgery, The First Affiliated Hospital of University of South China, Hengyang, China.,Department of Orthopedic Surgery, Sarcoma Biology Laboratory, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Dylan Dean
- Department of Orthopedic Surgery, Sarcoma Biology Laboratory, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Francis J Hornicek
- Department of Orthopedic Surgery, Sarcoma Biology Laboratory, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Guoliang Yi
- Department of Orthopedic Surgery, The First Affiliated Hospital of University of South China, Hengyang, China
| | - Zhenfeng Duan
- Department of Orthopedic Surgery, Sarcoma Biology Laboratory, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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11
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Li X, Dean DC, Ferreira A, Nelson SD, Hornicek FJ, Yu S, Duan Z. Establishment and Characterization of a Novel Dedifferentiated Chondrosarcoma Cell Line DDCS2. Cancer Control 2021; 28:10732748211045274. [PMID: 34767468 PMCID: PMC8645311 DOI: 10.1177/10732748211045274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background The dedifferentiated variant of chondrosarcoma is highly aggressive and carries an especially grim prognosis. While chemotherapeutics has failed to benefit patients with dedifferentiated chondrosarcoma significantly, preclinical chemosensitivity studies have been limited by a scarcity of available cell lines. There is, therefore, an urgent need to expand the pool of available cell lines. Methods We report the establishment of a novel dedifferentiated chondrosarcoma cell line DDCS2, which we isolated from the primary tumor specimen of a 60-year-old male patient. We characterized its short tandem repeat (STR) DNA profile, growth potential, antigenic markers, chemosensitivity, and oncogenic spheroid and colony-forming capacity. Results DDCS2 showed a spindle to polygonal shape and an approximate 60-hour doubling time. STR DNA profiling revealed a unique genomic identity not matching any existing cancer cell lines within the ATCC, JCRB, or DSMZ databases. There was no detectable contamination with another cell type. Western blot and immunofluorescence assays were consistent with a mesenchymal origin, and our MTT assay revealed relative resistance to conventional chemotherapeutics, which is typical of a dedifferentiated chondrosarcoma. Under ex vivo three-dimensional (3D) culture conditions, the DDCS2 cells produced spheroid patterns similar to the well-established CS-1 and SW1353 chondrosarcoma cell lines. Conclusion Our findings confirm DDCS2 is a novel model for dedifferentiated chondrosarcoma and therefore adds to the limited pool of current cell lines urgently needed to investigate the chemoresistance within this deadly cancer.
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Affiliation(s)
- Xiaoyang Li
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, 71041Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.,Sarcoma Biology Laboratory, Department of Orthopaedics, Sylvester Comprehensive Cancer Center, and the University of Miami Miller School of Medicine, Miami, FL 33136
| | - Dylan C Dean
- Sarcoma Biology Laboratory, Department of Orthopaedics, Sylvester Comprehensive Cancer Center, and the University of Miami Miller School of Medicine, Miami, FL 33136
| | - Al Ferreira
- Sarcoma Biology Laboratory, Department of Orthopaedics, Sylvester Comprehensive Cancer Center, and the University of Miami Miller School of Medicine, Miami, FL 33136
| | - Scott D Nelson
- Sarcoma Biology Laboratory, Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA 90095
| | - Francis J Hornicek
- Sarcoma Biology Laboratory, Department of Orthopaedics, Sylvester Comprehensive Cancer Center, and the University of Miami Miller School of Medicine, Miami, FL 33136
| | - Shengji Yu
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, 71041Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Zhenfeng Duan
- Sarcoma Biology Laboratory, Department of Orthopaedics, Sylvester Comprehensive Cancer Center, and the University of Miami Miller School of Medicine, Miami, FL 33136
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12
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Shah AA, Karhade AV, Park HY, Sheppard WL, Macyszyn LJ, Everson RG, Shamie AN, Park DY, Schwab JH, Hornicek FJ. Updated external validation of the SORG machine learning algorithms for prediction of ninety-day and one-year mortality after surgery for spinal metastasis. Spine J 2021; 21:1679-1686. [PMID: 33798728 DOI: 10.1016/j.spinee.2021.03.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/23/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Surgical decompression and stabilization in the setting of spinal metastasis is performed to relieve pain and preserve functional status. These potential benefits must be weighed against the risks of perioperative morbidity and mortality. Accurate prediction of a patient's postoperative survival is a crucial component of patient counseling. PURPOSE To externally validate the SORG machine learning algorithms for prediction of 90-day and 1-year mortality after surgery for spinal metastasis. STUDY DESIGN/SETTING Retrospective, cohort study PATIENT SAMPLE: Patients 18 years or older at a tertiary care medical center treated surgically for spinal metastasis OUTCOME MEASURES: Mortality within 90 days of surgery, mortality within 1 year of surgery METHODS: This is a retrospective cohort study of 298 adult patients at a tertiary care medical center treated surgically for spinal metastasis between 2004 and 2020. Baseline characteristics of the validation cohort were compared to the derivation cohort for the SORG algorithms. The following metrics were used to assess the performance of the algorithms: discrimination, calibration, overall model performance, and decision curve analysis. RESULTS Sixty-one patients died within 90 days of surgery and 133 died within 1 year of surgery. The validation cohort differed significantly from the derivation cohort. The SORG algorithms for 90-day mortality and 1-year mortality performed excellently with respect to discrimination; the algorithm for 1-year mortality was well-calibrated. At both postoperative time points, the SORG algorithms showed greater net benefit than the default strategies of changing management for no patients or for all patients. CONCLUSIONS With an independent, contemporary, and geographically distinct population, we report successful external validation of SORG algorithms for preoperative risk prediction of 90-day and 1-year mortality after surgery for spinal metastasis. By providing accurate prediction of intermediate and long-term mortality risk, these externally validated algorithms may inform shared decision-making with patients in determining management of spinal metastatic disease.
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Affiliation(s)
- Akash A Shah
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | - Aditya V Karhade
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Howard Y Park
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - William L Sheppard
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Luke J Macyszyn
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Richard G Everson
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Arya N Shamie
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Don Y Park
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Joseph H Schwab
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Francis J Hornicek
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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13
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Wong K, Chantharasamee J, Nelson S, Eckardt MA, Motamedi K, Hornicek FJ, Singh AS. Aggressive osteoblastoma with a secondary aneurysmal bone cyst treated with denosumab. Rare Tumors 2021; 13:20363613211034710. [PMID: 34484648 PMCID: PMC8408893 DOI: 10.1177/20363613211034710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/06/2021] [Indexed: 11/16/2022] Open
Abstract
Osteoblastomas and aneurysmal bone cysts (ABC) are rare benign bone tumors that make up about 1%-2% of primary bone malignancies, typically occurring in young patients with a median age of 20 years, most commonly effecting the axial skeleton. ABCs may develop independently as primary lesions, or secondary to other bony lesions including osteoblastomas, chondroblastomas, and giant cell tumors. Treatment of unresectable or extensive osteoblastomas can be challenging. In 2013, the Food and Drug Administration (FDA) approved denosumab for the treatment of giant cell tumors of the bone due to its efficacy in these morbid bony lesions. Various case reports have shown that osteoblastomas can respond to denosumab. Furthermore, numerous ABC case reports have described the efficacy of denosumab in these situations. We herein describe a unique case of a young patient with an aggressive osteoblastoma and secondary ABCs who was successfully treated with denosumab.
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Affiliation(s)
- Karlton Wong
- Division of Hematology/Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | - Jomjit Chantharasamee
- Division of Hematology/Oncology, University of California Los Angeles, Los Angeles, CA, USA.,Division of Medical Oncology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Scott Nelson
- Department of Pathology, University of California Los Angeles, Los Angeles, CA, USA
| | - Mark A Eckardt
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA.,Division of Surgical Oncology, University of California Los Angeles, Los Angeles, CA, USA.,Department of Surgery, Greater Los Angeles Veterans Health Administration, Los Angeles, CA, USA
| | - Kambiz Motamedi
- Department of Radiology, University of California Los Angeles Medical Center, Los Angeles, CA, USA
| | - Francis J Hornicek
- Department of Orthopedic Surgery, University of California Los Angeles, Los Angeles, CA, USA
| | - Arun S Singh
- Division of Hematology/Oncology, University of California Los Angeles, Los Angeles, CA, USA
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14
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Power JD, Glennie A, Rogers S, Aziz M, Singh S, Dandurand C, Tauh S, Richard-Denis A, Morris S, Richard-Denis A, Lim V, Mputu PM, Soroceanu A, Sadiq I, Daly C, Dandurand C, Larouche J, Correale M, Sharma A, Charest-Morin R, Lee J, Ajoku U, Moskven E, Asif H, Al-attar ENM, Mishreky A, Rocos B, Rocos B, Rocos B, Srivastava SK, Patgaonkar P, Cummins D, Bednar D, Chan V, Bowker R, Evaniew N, Hathi K, Hall H, Ludwig T, Ludwig T, Truong VT, Passalent L, Wang S, Shaikh N, Pelletier-Roy R, Shen J, Wang Z, Singh S, Machida M, Machida M, Fernandes R, Fernandes R, Marathe N, Kerr J, Magnan MC, Visva S, Jarvis J, Jarvis J, Jentzsch T, Cherry A, Cherry A, Cherry A, Dandurand C, Rampersaud R, Sundararajan K, Levasseur A, Fernandes R, Fernandes R, Fullerton K, Malone H, Daly C, Peloza J, Peloza J, Walden K, Elsemin O, MacLean MA, Rose J, Oppermann M, Ferguson D, Hindi M, Dermott JA, DeVries Z, Lebel D, Ayling O, Singh V, Craig M, Lasswell T, Perruccio AV, Canizares M, McIntosh G, Rampersaud YR, Urquhart J, Koto P, Rasoulinejad P, Sequeira K, Miller T, Watson J, Rosedale R, Gurr K, Siddiqi F, Bailey C, Manson N, Bigney E, Vandewint A, Richardson E, El-Mughayyar D, McPhee R, Abraham E, Weber M, McIntosh G, Kelly A, Santaguida C, Ouellet J, Reindl R, Jarzem P, Lasry O, Dea N, Fisher C, Street J, Boyd M, Charest-Morin R, Rhines L, Boriani S, Charest-Morin R, Gokaslan Z, Gasbarrini A, Saghal A, Laufer II, Lazary A, Bettegowda C, Kawahara N, Clarke M, Rampersaud YR, Reynolds J, Disch A, Chou D, Shin JH, Wei F, Hornicek FJ, Barzilai O, Fisher C, Dea N, Nickel D, Thorpe L, Brown J, Weiler R, Linassi G, Fourney D, Dionne A, Bégin J, Mac-Thiong JM, Yung A, George S, Prevost V, Bauman A, Kozlowski P, Samadi F, Fournier C, Parker L, Dong K, Streijger F, Moore GW, Laule C, Kwon B, Gravel LF, Dionne A, Bourassa-Moreau E, Maurais G, Khoueir P, Mac-Thiong JM, Richard-Denis A, Dionne A, Bourassa-Moreau É, Bégin J, Mac-Thiong JM, Beausejour M, Richard-Denis A, Begin J, Dionne A, Mac-Thiong JM, Scheer J, Protopsaltis T, Gupta M, Passias P, Gum J, Smith J, Bess S, Lafage V, Ames C, Klineberg E, Frederick A, Nicholls F, Lewkonia P, Thomas K, Jacobs B, Swamy G, Miller N, Tanguay R, Soroceanu A, Nevin J, Bourassa-Moreau E, Dvorak M, Fisher C, Paquette S, Kwon B, Dea N, Ailon T, Charest-Morin R, Street J, Hindi M, Kwon B, Dvorak M, Ailon T, Paquette S, Fisher C, Charest-Morin R, Dea N, Street J, Finkelstein J, Bowes J, Ford M, Yee A, Soever L, Rachevitz M, Bigness A, Robertson S, Wilson R, Wong W, Nugent J, Frantzeskos S, Duffy M, Rampersaud R, Marathe N, Agarwal R, Bailey CS, Paquet J, Dea N, Goytan M, McIntosh G, Street J, Fisher C, Jacobs B, Johnson M, Paquet J, Hall H, Bailey C, Christie S, Nataraj A, Manson N, Phan P, Rampersaud R, Thomas K, McIntosh G, Abraham E, Glennie A, Jarzem P, Ahn H, Blanchard J, Hogan G, Kelly A, Charest-Morin R, Tohidi M, Hopman W, Yen D, Parent S, Miyanji F, Murphy J, El-Hawary R, Lebel D, Zeller R, Reda L, Dodds M, Lebel D, Zeller R, Zeller R, Marathe N, Bhosale S, Raj A, Marathe N, Goyal V, Theologis A, Witiw C, Fehlings M, Morash K, Yaszay B, Andras L, Sturm P, Sponseller P, El-Hawary R, Swamy G, Jacobs WB, Bouchard J, Cho R, Manson NA, Rampersaud YR, Paquet J, Bailey CS, Johnson M, Attabib N, Fisher CG, McIntosh G, Thomas KC, Bigney E, Richardson E, Alugo T, El-Mughayyar D, Vandewint A, Manson N, Abraham E, Attabib N, Prostko R, Cheng B, Haring K, Fischer M, Bourget-Murray J, Sridharan S, Frederick A, Johnston K, Edwards B, Nicholls F, Soroceanu A, Bouchard J, Shedid D, Al-Shakfa F, Shen J, Boubez G, Yuh SJ, Wang Z, Sundararajan K, Perruccio A, Coyte P, Bombardier C, Bloom J, Hawke C, Haroon N, Inman R, Rampersaud YR, Hebert J, Abraham E, Vandewint A, Bigney E, Richardson E, El-Mughayyar D, Attabib N, Small C, Manson N, Zhang H, Beresford-Cleary N, Street J, Wilson D, Oxland T, Richard-Denis A, Jean S, Bourassa-Moreau É, Fleury J, Beauchamp-Vien G, Bégin J, Mac-Thiong JM, Boudier-Revéret M, Majdalani C, Truong VT, Wang Z, Shedid D, Najjar A, Yuh SJ, Boubez G, Sebaaly A, McIntosh G, Ailon T, Dea N, Fisher C, Charest-Morin R, Lebel D, Rocos B, Zabjek K, Zeller R, Zabjek K, Rocos B, Lebel D, Zeller R, Gee A, Schneider N, Kanawati A, Schemitsch E, Bailey C, Rasoulinejad P, Zdero R, Schneider N, Gee A, Kanawati A, Zdero R, Bailey C, Rasoulinejad P, Lohkamp LN, Fehlings M, Abraham E, Vandewint A, Bigney E, Hebert J, Richardson E, El-Mughayyar D, Chorney J, El-Hawary R, Manson N, Wai E, Phan P, Kingwell S, Tierney S, Stratton A, AlDuwaisan A, Moravek D, Wai E, Kingwell S, Stratton A, Phan P, Devries Z, Barrowman N, Smit K, Tice A, Devries Z, Barrowman N, Smit K, Tice A, Sundararajan K, Rampersaud YR, Oitment C, Wunder J, Ferguson P, Rampersaud R, Rampersaud R, Rampersaud R, Ailon T, Dvorak M, Kwon B, Paquette S, Charest-Morin R, Dea N, Fisher C, Street J, Bailey C, Casha S, Glennie A, Fox R, McIntosh G, Yee A, Fisher C, Perruccio A, Perruccio A, Rampersaud YR, Mac-Thiong JM, Richard-Denis A, Gee A, Kanawati A, Rasoulinejad P, Zdero R, Bailey C, Gee A, Kanawati A, Rasoulinejad P, Zdero R, Bailey C, Klein G, Emmenegger U, Finkelstein J, Lyons F, Whyne C, Hardisty M, Millgram M, Guyer R, Harel R, Ashkenazi E, Dvorak M, Fisher C, Paquette S, Street J, Dea N, Ailon T, Charest-Morin R, Kwon B, Millgram M, Guyer R, Le Huec JC, Ashkenazi E, Millgram M, Guyer R, Harel R, Kutz S, Ashkenazi E, Parsons J, Bailey CS, Dhaliwal P, Fourney DR, Noonan V, Mac-Thiong JM, Beausejour M, Sassine S, Joncas J, Barchi S, Le May S, Cobetto N, Fortin C, Carl-Éric A, Parent S, Labelle H, Bailey C, Fisher C, Rampersaud R, Glennie A, Manson N, Bigney E, Vandewint A, Hebert J, El-Mughayyar D, Richardson E, Ghallab N, Flood M, Attabib N, Abraham E, Swamy G, Nicholls F, Thomas K, Jacobs WB, Soroceanu A, Evaniew N, Stevens M, Dunning C, Oxner W, Glennie A, Dandurand C, Paquette S, Kwon B, Ailon T, Dvorak M, Dea N, Charest-Morin R, Fisher C, Street J, Kim D, Lebel DE, Jarvis J, Tice A, Smit K, Campbell F, Mashida M, Isaac L, Bath N, Stocki D, Levin D, Koyle M, Ruskin D, Stinson J, Ailon T, Dea N, Fisher C, Evaniew N, Soroceanu A, Nicholls F, Jacobs WB, Thomas K, Cho R, Lewkonia P, Swamy G, Lasry O, Ailon T, Zamani N, Rampersaud R, Rasoulinejad P. 2021 Canadian Spine Society Abstracts. Can J Surg 2021; 64:S1-S36. [PMID: 34296831 PMCID: PMC8410468 DOI: 10.1503/cjs.012621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Higuchi T, Igarashi K, Oshiro H, Miyake K, Sugisawa N, Yamamoto N, Hayashi K, Kimura H, Miwa S, Duan Z, Hornicek FJ, Tsuchiya H, Hoffman RM. Patient-derived orthotopic xenograft models for osteosarcoma individualized precision treatment and effective drug discovery. Ann Joint 2021. [DOI: 10.21037/aoj.2020.02.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Thanindratarn P, Wei R, Dean DC, Singh A, Federman N, Nelson SD, Hornicek FJ, Duan Z. T-LAK cell-originated protein kinase (TOPK): an emerging prognostic biomarker and therapeutic target in osteosarcoma. Mol Oncol 2021; 15:3721-3737. [PMID: 34115928 PMCID: PMC8637563 DOI: 10.1002/1878-0261.13039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 05/12/2021] [Accepted: 06/11/2021] [Indexed: 12/29/2022] Open
Abstract
T-lymphokine-activated killer (T-LAK) cell-originated protein kinase (TOPK) is an emerging target with critical roles in various cancers; however, its expression and function in osteosarcoma remain unexplored. We evaluated TOPK expression using RNA sequencing and gene expression data from public databases (TARGET-OS, CCLE, GTEx, and GENT2) and immunohistochemistry in an osteosarcoma tissue microarray (TMA). TOPK gene expression was significantly higher in osteosarcoma than normal tissues and directly correlated with shorter overall survival. TOPK was overexpressed in 83.3% of the osteosarcoma specimens within our TMA and all osteosarcoma cell lines, whereas normal osteoblast cells had no aberrant expression. High expression of TOPK associated with metastasis, disease status, and shorter overall survival. Silencing of TOPK with small interfering RNA (siRNA) decreased cell viability, and inhibition with the selective inhibitor OTS514 suppressed osteosarcoma cell proliferation, migration, colony-forming ability, and spheroid growth. Enhanced chemotherapeutic sensitivity and a synergistic effect were also observed with the combination of OTS514 and either doxorubicin or cisplatin in osteosarcoma cell lines. Taken together, our study demonstrated that TOPK is a potential prognostic biomarker and therapeutic target for osteosarcoma treatment.
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Affiliation(s)
- Pichaya Thanindratarn
- Department of Orthopaedic Surgery, Sarcoma Biology Laboratory, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.,Department of Orthopedic Surgery, Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Ran Wei
- Department of Orthopaedic Surgery, Sarcoma Biology Laboratory, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.,Musculoskeletal Tumor Center, Beijing Key Laboratory of Musculoskeletal Tumor, Peking University People's Hospital, Beijing, China
| | - Dylan C Dean
- Department of Orthopaedic Surgery, Sarcoma Biology Laboratory, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Arun Singh
- Sarcoma Service, Division of Hematology-Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Noah Federman
- Department of Pediatrics, Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,UCLA's Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Scott D Nelson
- Department of Pathology, University of California, Los Angeles, CA, USA
| | - Francis J Hornicek
- Department of Orthopaedic Surgery, Sarcoma Biology Laboratory, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Zhenfeng Duan
- Department of Orthopaedic Surgery, Sarcoma Biology Laboratory, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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Christ AB, Hornicek FJ, Fabbri N. Distal femoral replacement - Cemented or cementless? Current concepts and review of the literature. J Clin Orthop Trauma 2021; 19:11-16. [PMID: 34040980 PMCID: PMC8138588 DOI: 10.1016/j.jcot.2021.04.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/22/2021] [Accepted: 04/30/2021] [Indexed: 11/19/2022] Open
Abstract
Distal femoral endoprosthetic replacement has been successfully used to reconstruct distal femoral defects after tumor resection for over four decades. Despite continued advances, aseptic loosening continues to be the most common failure mode after infection. Debate still exists about a variety of design features and the optimal fixation method remains controversial. To date, no large-scale study or meta-analysis has demonstrated the superiority of one fixation technique over another. While the classic dichotomy of cemented versus cementless stems is well-known, the contemporary surgeon needs to fully understand the optimal clinical setting for each type of fixation technique and additional strategies to maximize implant stability. In clinical practice, the choice of fixation must be tailored to the individual patient. The surgeon must consider whether the operation is being performed for primary sarcoma or metastatic carcinoma, the presence of distant metastases, age, comorbidities, and whether radiotherapy has been previously given or will be required at the site of fixation. The best strategy for each patient optimizes tumor control and appropriately weighs risks of fixation failure versus the expected patient survival. This review will explore cemented and uncemented distal femoral replacement and highlight modern concepts to optimize each technique.
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Affiliation(s)
- Alexander B. Christ
- Keck Hospital of the University of Southern California, Department of Orthopaedic Surgery, Los Angeles, CA, USA
- Corresponding author. Keck Hospital of the University of Southern California, Department of Orthopaedic Surgery 1520 San Pablo Street, Suite 2000 Los Angeles, CA, 90033, USA.
| | - Francis J. Hornicek
- University of California, Los Angeles, Department of Orthopaedic Surgery, Los Angeles, CA, USA
| | - Nicola Fabbri
- Memorial Sloan Kettering Cancer Center, Department of Surgery, Orthopaedic Service, New York, NY, USA
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18
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Dandurand C, Fisher CG, Rhines LD, Boriani S, Charest-Morin R, Gasbarrini A, Luzzati A, Reynolds JJ, Wei F, Gokaslan ZL, Bettegowda C, Sciubba DM, Lazary A, Kawahara N, Clarke MJ, Rampersaud YR, Disch AC, Chou D, Shin JH, Hornicek FJ, Laufer II, Sahgal A, Dea N. Feasibility of achieving planned surgical margins in primary spine tumor: a PTRON study. Neurosurg Focus 2021; 50:E16. [PMID: 33932923 DOI: 10.3171/2021.2.focus201091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 02/22/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Oncological resection of primary spine tumors is associated with lower recurrence rates. However, even in the most experienced hands, the execution of a meticulously drafted plan sometimes fails. The objectives of this study were to determine how successful surgical teams are at achieving planned surgical margins and how successful surgeons are in intraoperatively assessing tumor margins. The secondary objective was to identify factors associated with successful execution of planned resection. METHODS The Primary Tumor Research and Outcomes Network (PTRON) is a multicenter international prospective registry for the management of primary tumors of the spine. Using this registry, the authors compared 1) the planned surgical margin and 2) the intraoperative assessment of the margin by the surgeon with the postoperative assessment of the margin by the pathologist. Univariate analysis was used to assess whether factors such as histology, size, location, previous radiotherapy, and revision surgery were associated with successful execution of the planned margins. RESULTS Three hundred patients were included. The surgical plan was successfully achieved in 224 (74.7%) patients. The surgeon correctly assessed the intraoperative margins, as reported in the final assessment by the pathologist, in 239 (79.7%) patients. On univariate analysis, no factor had a statistically significant influence on successful achievement of planned margins. CONCLUSIONS In high-volume cancer centers around the world, planned surgical margins can be achieved in approximately 75% of cases. The morbidity of the proposed intervention must be balanced with the expected success rate in order to optimize patient management and surgical decision-making.
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Affiliation(s)
- Charlotte Dandurand
- 1Combined Neurosurgical and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charles G Fisher
- 1Combined Neurosurgical and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Raphaële Charest-Morin
- 1Combined Neurosurgical and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | - Feng Wei
- 6Peking University Third Hospital, Beijing, China
| | | | | | - Daniel M Sciubba
- 8Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Aron Lazary
- 9National Center for Spinal Disorders, Budapest, Hungary
| | | | | | | | | | - Dean Chou
- 14University of California, San Francisco, California
| | - John H Shin
- 15Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - IIya Laufer
- 17Memorial Sloan Kettering Cancer Center, New York, New York; and
| | - Arjun Sahgal
- 18Sunnybrook Hospital, University of Toronto, Ontario, Canada
| | - Nicolas Dea
- 1Combined Neurosurgical and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia, Canada
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19
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Ma H, Dean DC, Wei R, Hornicek FJ, Duan Z. Cyclin-dependent kinase 7 (CDK7) is an emerging prognostic biomarker and therapeutic target in osteosarcoma. Ther Adv Musculoskelet Dis 2021; 13:1759720X21995069. [PMID: 34104229 PMCID: PMC8164556 DOI: 10.1177/1759720x21995069] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/10/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Overexpression of cyclin-dependent kinase 7 (CDK7) is a well-known pathogenic feature of various malignancies and a sign of a more dismal prognosis. As relatively little is known about CDK7 in osteosarcoma, we elected to evaluate its expression, prognostic value, and function. Methods: We began by analyzing the publicly available data sets on CDK7 expression, including RNA sequencing data from the Therapeutically Applicable Research to Generate Effective Treatments on Osteosarcoma (TARGET-OS) and the Gene Expression database of Normal and Tumor tissues 2 (GENT2). The correlation between patient tissue CDK7 expression and their clinicopathological features and prognosis was assessed via immunohistochemical staining of a unique tissue microarray constructed from osteosarcoma specimens. Furthermore, we analyzed CDK7 expression in osteosarcoma cell lines and tissues by Western blot. CDK7-specific siRNA and a highly-selective CDK7 inhibitor, BS-181, were applied to determine the function of CDK7 on osteosarcoma cell growth and proliferation. In addition, the effect of CDK7 inhibition on clonogenicity was evaluated using a clonogenic assay, and a 3D cell culture model was used to mimic CDK7 effects in an in vivo environment. Results: Our results demonstrate that higher CDK7 expression significantly correlates with recurrence, metastasis, and shorter overall survival in osteosarcoma patients. Therapeutically, we show that CDK7 knockdown with siRNA or selective inhibition with BS-181 decreases proliferation and induces apoptosis of osteosarcoma cells. Conclusion: This study supports CDK7 overexpression as an independent predictor of poor prognosis and promising therapeutic target for osteosarcoma.
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Affiliation(s)
- Hangzhan Ma
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Dylan C Dean
- Department of Orthopedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Ran Wei
- Department of Orthopedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Francis J Hornicek
- Department of Orthopedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Zhenfeng Duan
- Department of Orthopedic Surgery, David Geffen School of Medicine at UCLA, 615 Charles E. Young Dr. South, Los Angeles, CA 90095, USA
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Wang K, Michelakos T, Wang B, Shang Z, DeLeo AB, Duan Z, Hornicek FJ, Schwab JH, Wang X. Targeting cancer stem cells by disulfiram and copper sensitizes radioresistant chondrosarcoma to radiation. Cancer Lett 2021; 505:37-48. [PMID: 33582212 PMCID: PMC8969896 DOI: 10.1016/j.canlet.2021.02.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 12/14/2022]
Abstract
Overcoming the radiosensitivity of chondrosarcoma (CS), the second most common primary bone tumor, is needed. Radioresistance is attributed to cancer stem cells (CSCs) in many malignancies. Disulfiram (DSF), an FDA-approved anti-alcoholism drug, complexed with Cu (DSF/Cu) can radiosensitize epithelial CSCs. This prompted us to investigate the radiosensitizing effect of DSF/Cu on CS CSCs (CCSCs). The radiosensitizing effects of DSF/Cu on CCSCs were investigated in vitro using cell lines SW1353 and CS-1. Stemness was identified independently by flow cytometry for CCSCs (ALDH+CD133+), sphere-forming ability, and Western blot analysis of stemness gene protein expression. The radiosensitizing effect of DSF/Cu was studied in an orthotopic CS xenograft mouse model by analyzing xenograft growth and residual xenografts for stemness. CCSCs were found to be resistant to single-dose (IR) and fractionated irradiation (FIR). IR and FIR increased CS stemness. Combined with DSF/Cu in vitro and in vivo, IR and FIR eliminated CS stemness. RT + DSF/Cu was safer and more effective than either RT ± DSF in inhibiting growth of orthotopic CS xenografts. In conclusion, DSF/Cu radiosensitizes CCSCs. These results can be translated into clinical trials for CS patients requiring RT for improved outcomes.
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Affiliation(s)
- Kun Wang
- Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA; Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Theodoros Michelakos
- Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Bing Wang
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Zikun Shang
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Albert B DeLeo
- Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Zhenfeng Duan
- The Sarcoma and Chordoma Molecular Biology Laboratory, Orthopaedic Surgery, The University of California, Los Angeles, CA, 90095, USA
| | - Francis J Hornicek
- The Sarcoma and Chordoma Molecular Biology Laboratory, Orthopaedic Surgery, The University of California, Los Angeles, CA, 90095, USA
| | - Joseph H Schwab
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA.
| | - Xinhui Wang
- Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA.
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Feng W, Dean DC, Hornicek FJ, Wang J, Jia Y, Duan Z, Shi H. ATR and p-ATR are emerging prognostic biomarkers and DNA damage response targets in ovarian cancer. Ther Adv Med Oncol 2020; 12:1758835920982853. [PMID: 33854565 PMCID: PMC8013598 DOI: 10.1177/1758835920982853] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 11/30/2020] [Indexed: 12/16/2022] Open
Abstract
Background: Although ataxia-telangiectasia and Rad3 related (ATR) has an established role in the DNA damage response of various cancers, its clinical and prognostic significance in ovarian cancer remains largely unknown. The aims of this study were to assess the expression, function, and clinical prognostic relationship of ATR and phospho-ATR ser428 (p-ATR) in ovarian cancer. Methods: We confirmed ATR and p-ATR expression by immunohistochemistry (IHC) in a unique ovarian cancer tissue microarray constructed of paired primary, recurrent, and metastatic tumor tissues from 26 individual patients. ATR-specific small interfering RNA (siRNA) and ATR inhibitor VE-822 were applied to determine the effects of ATR inhibition on ovarian cancer cell proliferation, apoptosis, and DNA damage. ATR expression and the associated proteins of the ATR/Chk1 pathway in ovarian cancer cell lines were evaluated by Western blotting. The clonogenicity was also examined using clonogenic assays. A three dimensional (3D) cell culture model was performed to mimic the in vivo ovarian cancer environment to further validate the effects of ATR inhibition on ovarian cancer cells. Results: We show recurrent ovarian cancer tissues express higher levels of ATR and p-ATR than their patient-matched primary tumor counterparts. Additionally, higher expression of p-ATR correlates with decreased survival in ovarian cancer patients. Treatment of ovarian cancer cells with ATR specific siRNA or ATR inhibitor VE-822 led to significant apoptosis and inhibition of cellular proliferation, with reduced phosphorylation of Chk1 (p-Chk1), Cdc25c (p-Cdc25c), Cdc2 (p-Cdc2), and increased expression of cleaved PARP and γH2AX. Inhibition of ATR also suppressed clonogenicity and spheroid growth of ovarian cancer cells. Conclusion: Our results support the ATR and p-ATR pathway as a prognostic biomarker, and targeting the ATR machinery is an emerging therapeutic approach in the treatment of ovarian cancer.
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Affiliation(s)
- Wenlong Feng
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Dylan C Dean
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Francis J Hornicek
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jinglu Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yanyan Jia
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Zhenfeng Duan
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, 615 Charles E. Young. Dr. South, Los Angeles, CA 90095, USA
| | - Huirong Shi
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, Henan 450052, China
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Wei R, Dean DC, Thanindratarn P, Hornicek FJ, Guo W, Duan Z. Prognostic Significance of Cyclin E1 Expression in Patients With Chordoma: A Clinicopathological and Immunohistochemical Study. Front Oncol 2020; 10:596330. [PMID: 33282745 PMCID: PMC7705258 DOI: 10.3389/fonc.2020.596330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/19/2020] [Indexed: 01/03/2023] Open
Abstract
PURPOSE Chordomas are rare, slow-growing sarcomas without any accepted prognostic biomarkers. Owing to their proximity to critical neurovascular structures, discovering predictive biomarkers in chordoma has been a significant research effort because it may potentially reduce risky therapies in patients with less aggressive tumors. In response, because cyclin E1 overexpression correlates with patient prognosis in several malignancies, we investigated its expression in chordoma and whether it informs patient prognosis. METHODS Seventy-five chordoma patient specimens were enrolled in a tissue microarray (TMA) to evaluate cyclin E1 expression via immunohistochemical staining. Western blot was used to assess cyclin E1 expression in chordoma cell lines and fresh tissues. We then correlated cyclin E1 staining intensity in the TMA to clinicopathological features and chordoma patient outcomes. RESULTS Sixty-three percent of the chordoma patient specimens in the TMA, fifty-six percent of the fresh chordoma tissues, and all chordoma cell lines showed high cyclin E1 expression. In TMA analysis, cyclin E1 expression positively correlated to chordoma patient disease status. By survival analysis, high cyclin E1 expression was an independent prognostic risk factor for chordoma patients along with advanced disease status and positive surgical margin. CONCLUSION Cyclin E1 is a promising biomarker predicting chordoma patient prognosis.
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Affiliation(s)
- Ran Wei
- Musculoskeletal Tumor Center, Beijing Key Laboratory of Musculoskeletal Tumor, Peking University People’s Hospital, Beijing, China
- Sarcoma Biology Laboratory, Department of Orthopedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Dylan C. Dean
- Sarcoma Biology Laboratory, Department of Orthopedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Pichaya Thanindratarn
- Sarcoma Biology Laboratory, Department of Orthopedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
- Department of Orthopedic Surgery, Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Bangkok, Thailand
| | - Francis J. Hornicek
- Sarcoma Biology Laboratory, Department of Orthopedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Wei Guo
- Musculoskeletal Tumor Center, Beijing Key Laboratory of Musculoskeletal Tumor, Peking University People’s Hospital, Beijing, China
| | - Zhenfeng Duan
- Sarcoma Biology Laboratory, Department of Orthopedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
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23
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Bongers MER, Ogink PT, Chu KF, Patel A, Rosenthal B, Shin JH, Lee SG, Hornicek FJ, Schwab JH. The use of autologous free vascularized fibula grafts in reconstruction of the mobile spine following tumor resection: surgical technique and outcomes. J Neurosurg Spine 2020; 34:283-292. [PMID: 33157532 DOI: 10.3171/2020.6.spine20521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/29/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Reconstruction of the mobile spine following total en bloc spondylectomy (TES) of one or multiple vertebral bodies in patients with malignant spinal tumors is a challenging procedure with high failure rates. A common reason for reconstructive failure is nonunion, which becomes more problematic when using local radiation therapy. Radiotherapy is an integral part of the management of primary malignant osseous tumors in the spine. Vascularized grafts may help prevent nonunion in the radiotherapy setting. The authors have utilized free vascularized fibular grafts (FVFGs) for reconstruction of the spine following TES. The purpose of this article is to describe the surgical technique for vascularized reconstruction of defects after TES. Additionally, the outcomes of consecutive cases treated with this technique are reported. METHODS Thirty-nine patients were treated at the authors' tertiary care institution for malignant tumors in the mobile spine using FVFG following TES between 2010 and 2018. Postoperative union, reoperations, complications, neurological outcome, and survival were reported. The median follow-up duration was 50 months (range 14-109 months). RESULTS The cohort consisted of 26 males (67%), and the median age was 58 years. Chordoma was the most prevalent tumor (67%), and the lumbar spine was most affected (46%). Complete union was seen in 26 patients (76%), the overall complication rate was 54%, and implant failure was the most common complication, with 13 patients (33%) affected. In 18 patients (46%), one or more reoperations were needed, and the fixation was surgically revised 15 times (42% of reoperations) in 10 patients (26%). A reconstruction below the L1 vertebra had a higher proportion of implant failure (67%; 8 of 12 patients) compared with higher resections (21%; 5 of 24 patients) (p = 0.011). Graft length, number of resected vertebrae, and docking the FVFG on the endplate or cancellous bone was not associated with union or implant failure on univariate analysis. CONCLUSIONS The FVFG is an effective reconstruction technique, particularly in the cervicothoracic spine. However, high implant failure rates in the lumbar spine have been seen, which occurred even in cases in which the graft completely healed. Methods to increase the weight-bearing capacity of the graft in the lumbar spine should be considered in these reconstructions. Overall, the rates of failure and revision surgery for FVFG compare with previous reports on reconstruction after TES.
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Affiliation(s)
| | - Paul T Ogink
- Departments of1Orthopedic Surgery, Orthopedic Oncology Service
| | | | - Anuj Patel
- Departments of1Orthopedic Surgery, Orthopedic Oncology Service
| | - Brett Rosenthal
- Departments of1Orthopedic Surgery, Orthopedic Oncology Service
| | | | - Sang-Gil Lee
- 4Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; and
| | - Francis J Hornicek
- 5Department of Orthopedic Surgery, Orthopedic Oncology Service, University of California, Los Angeles Medical Center, Los Angeles, California
| | - Joseph H Schwab
- Departments of1Orthopedic Surgery, Orthopedic Oncology Service
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24
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Cui J, Dean D, Wei R, Hornicek FJ, Ulmert D, Duan Z. Expression and clinical implications of leucine-rich repeat containing 15 (LRRC15) in osteosarcoma. J Orthop Res 2020; 38:2362-2372. [PMID: 32902907 DOI: 10.1002/jor.24848] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/31/2020] [Accepted: 09/02/2020] [Indexed: 02/04/2023]
Abstract
Leucine-rich repeat containing 15 (LRRC15) is a member of the leucine-rich repeat superfamily that is overexpressed in various cancers and associated with higher tumor grade and aggression. Despite its known tumorigenicity, its roles within osteosarcoma are unknown, prompting us to evaluate its expression and clinical significance within this rare yet aggressive cancer. Western blots showed differential expression of LRRC15 in the osteosarcoma cell lines MNNG/HOS, KHOS, 143B, MG63, Saos-2, and U2OS. We additionally validated this positive expression, as well as sublocalization to the cell membrane, with immunofluorescence. A tissue microarray constructed from 69 osteosarcoma patient tissues was immunohistochemically stained for LRRC15 expression, stratified, and used for clinicopathological analysis. Publicly available databases on LRRC15 expression, including RNA sequencing data from the Therapeutically Applicable Research to Generate Effective Treatments on Osteosarcoma (TARGET-OS) and the Gene Expression database of Normal and Tumor tissues 2 (GENT2) were also analyzed. We found 63 of the 69 (91.3%) patient tissues exhibited some degree of LRRC15 immunostaining, including no staining (6 of 69, 8.7%), 1+ staining (12 of 69, 17.4%), 2+ staining (25 of 69, 36.2%), and 3+ staining (26 of 69, 37.7%). The patients with osteosarcomas having elevated LRRC15 expression demonstrated comparatively increased metastasis, chemoresistance, and shorter 5-year survival rates. Our analysis of the TARGET-OS and GENT2 databases also showed increased LRRC15 gene expression in osteosarcoma. Taken together, our study supports LRRC15 as a prognostic biomarker and emerging therapeutic target in osteosarcoma.
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Affiliation(s)
- Juncheng Cui
- Department of Orthopedic Surgery, The First Affiliated Hospital of University of South China, Hengyang, Hunan, China.,Department of Orthopedic Surgery, Sarcoma Biology Laboratory, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Dylan Dean
- Department of Orthopedic Surgery, Sarcoma Biology Laboratory, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Ran Wei
- Department of Orthopedic Surgery, Sarcoma Biology Laboratory, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Francis J Hornicek
- Department of Orthopedic Surgery, Sarcoma Biology Laboratory, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - David Ulmert
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Zhenfeng Duan
- Department of Orthopedic Surgery, Sarcoma Biology Laboratory, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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25
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Thanindratarn P, Dean DC, Nelson SD, Hornicek FJ, Duan Z. T-LAK cell-originated protein kinase (TOPK) is a Novel Prognostic and Therapeutic Target in Chordoma. Cell Prolif 2020; 53:e12901. [PMID: 32960500 PMCID: PMC7574876 DOI: 10.1111/cpr.12901] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/15/2020] [Accepted: 08/24/2020] [Indexed: 12/15/2022] Open
Abstract
Objectives To assess the expression, prognostic value, and functionality of T‐lymphokine‐activated killer (T‐LAK) cell‐originated protein kinase (TOPK) in chordoma pathogenesis. Materials and Methods TOPK expression in chordoma was assessed via immunohistochemical staining of a tissue microarray (TMA) and correlated with patient clinicopathology. TOPK expression in chordoma cell lines and fresh patient tissues was then evaluated by Western blot. TOPK small interfering RNA (siRNA) and the specific inhibitor OTS514 were applied to determine the roles of TOPK in chordoma pathogenicity. The effect of TOPK expression on chordoma cell clonogenicity was also investigated using clonogenic assays. A 3D cell culture model was utilized to mimic in vivo environment to validate the effect of TOPK inhibition on chordoma cells. Results TOPK was highly expressed in 78.2% of the chordoma specimens in the TMA and all chordoma cell lines. High TOPK expression significantly correlated with metastasis, recurrence, disease status and shorter overall survival. Knockdown of TOPK with specific siRNA resulted in significantly decrease chordoma cell viability. Inhibition of TOPK with OTS514 significantly inhibited chordoma cell growth and proliferation, colony‐forming capacity and ex vivo spheroid growth. Conclusions High expression of TOPK is an important predictor of poor prognosis in chordoma. Inhibition of TOPK resulted in significantly decrease chordoma cell proliferation and increase apoptosis. Our results indicate TOPK as a novel prognostic biomarker and therapeutic target for chordoma.
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Affiliation(s)
- Pichaya Thanindratarn
- Department of Orthopedic Surgery, Sarcoma Biology Laboratory, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.,Department of Orthopedic Surgery, Chulabhorn hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Dylan C Dean
- Department of Orthopedic Surgery, Sarcoma Biology Laboratory, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Scott D Nelson
- Department of Pathology, University of California, Los Angeles, CA, USA
| | - Francis J Hornicek
- Department of Orthopedic Surgery, Sarcoma Biology Laboratory, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Zhenfeng Duan
- Department of Orthopedic Surgery, Sarcoma Biology Laboratory, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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Li X, Dean DC, Cote GM, Zou L, Hornicek FJ, Yu S, Duan Z. Inhibition of ATR-Chk1 signaling blocks DNA double-strand-break repair and induces cytoplasmic vacuolization in metastatic osteosarcoma. Ther Adv Med Oncol 2020; 12:1758835920956900. [PMID: 32973933 PMCID: PMC7493280 DOI: 10.1177/1758835920956900] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/12/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Ataxia-telangiectasia and Rad3 related protein kinase (ATR) is an essential regulator of the DNA damage response in various cancers; however, its expression and roles in osteosarcoma are unclear. We therefore chose to evaluate the significance and mechanism of ATR in metastatic osteosarcoma, as well as its potential to be a therapeutic target. METHODS The osteosarcoma tissue microarrays constructed from 70 patient specimens underwent immunohistochemistry to quantify ATR and activated phospho-ATR (pATR) expression and their correlation with clinical outcomes. ATR sublocalization within the metastatic osteosarcoma cells was confirmed by immunofluorescence assay. Cell proliferation, apoptosis, and migration were evaluated following treatment with ATR siRNA or the selective inhibitor Berzosertib. Antitumor effects were determined with ex vivo three-dimensional (3D) culture models, and the impacts on the DNA damage repair pathways were measured with Western blotting. RESULTS Elevated ATR and activated pATR expression correlated with shorter patient survival and less necrosis following neoadjuvant chemotherapy. Intranuclear sublocalization of ATR and pATR suggested a mechanism related to DNA replication. ATR knockdown with siRNA or inhibition with Berzosertib suppressed cell proliferation in a time- and dose-dependent manner and induced apoptosis. In addition, ATR inhibition decreased Chk1 phosphorylation while increasing γH2AX expression and PARP cleavage, consistent with the interference of DNA damage repair. The ATR inhibitor Berzosertib also produced the characteristic cytoplasmic vacuolization preceding cell death, and suppressed ex vivo 3D spheroid formation and cell motility. CONCLUSION The faithful dependence of cells on ATR signaling for survival and progression makes it an emerging therapeutic target in metastatic osteosarcoma.
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Affiliation(s)
- Xiaoyang Li
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, CHINA
- Sarcoma Biology Laboratory, Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Dylan C. Dean
- Sarcoma Biology Laboratory, Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Gregory M. Cote
- Department of Hematology/Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lee Zou
- Department of Hematology/Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Charlestown, MA, USA
| | - Francis J. Hornicek
- Sarcoma Biology Laboratory, Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Shengji Yu
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People’s Republic of China
| | - Zhenfeng Duan
- Sarcoma Biology Laboratory, Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, 615 Charles E. Young Dr. S., Los Angeles, CA 90095, USA
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Cui J, Dean D, Hornicek FJ, Chen Z, Duan Z. The role of extracelluar matrix in osteosarcoma progression and metastasis. J Exp Clin Cancer Res 2020; 39:178. [PMID: 32887645 PMCID: PMC7650219 DOI: 10.1186/s13046-020-01685-w] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 08/20/2020] [Indexed: 02/07/2023]
Abstract
Osteosarcoma (OS) is the most common primary bone malignancy and responsible for considerable morbidity and mortality due to its high rates of pulmonary metastasis. Although neoadjuvant chemotherapy has improved 5-year survival rates for patients with localized OS from 20% to over 65%, outcomes for those with metastasis remain dismal. In addition, therapeutic regimens have not significantly improved patient outcomes over the past four decades, and metastases remains a primary cause of death and obstacle in curative therapy. These limitations in care have given rise to numerous works focused on mechanisms and novel targets of OS pathogenesis, including tumor niche factors. OS is notable for its hallmark production of rich extracellular matrix (ECM) of osteoid that goes beyond simple physiological growth support. The aberrant signaling and structural components of the ECM are rich promoters of OS development, and very recent works have shown the specific pathogenic phenotypes induced by these macromolecules. Here we summarize the current developments outlining how the ECM contributes to OS progression and metastasis with supporting mechanisms. We also illustrate the potential of tumorigenic ECM elements as prognostic biomarkers and therapeutic targets in the evolving clinical management of OS.
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Affiliation(s)
- Juncheng Cui
- Department of Orthopedic Surgery, The First Affiliated Hospital of University of South China, 69 Chuanshan Road, Hengyang, 421001, Hunan, China.,Department of Orthopedic Surgery, Sarcoma Biology Laboratory, David Geffen School of Medicine at UCLA, 615 Charles E. Young Dr. South, Los Angeles, CA, 90095, USA
| | - Dylan Dean
- Department of Orthopedic Surgery, Sarcoma Biology Laboratory, David Geffen School of Medicine at UCLA, 615 Charles E. Young Dr. South, Los Angeles, CA, 90095, USA
| | - Francis J Hornicek
- Department of Orthopedic Surgery, Sarcoma Biology Laboratory, David Geffen School of Medicine at UCLA, 615 Charles E. Young Dr. South, Los Angeles, CA, 90095, USA
| | - Zhiwei Chen
- Department of Orthopedic Surgery, The First Affiliated Hospital of University of South China, 69 Chuanshan Road, Hengyang, 421001, Hunan, China.
| | - Zhenfeng Duan
- Department of Orthopedic Surgery, Sarcoma Biology Laboratory, David Geffen School of Medicine at UCLA, 615 Charles E. Young Dr. South, Los Angeles, CA, 90095, USA.
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Henderson ER, Keeney BJ, Husson EG, Bernthal NM, Ji T, Pala E, Funovics PT, Groundland JS, Lozano-Calderon S, Puchner S, Zoller SD, Ruggieri P, Windhager R, Guo W, Hornicek FJ, Letson GD, Temple HT. Nonmechanical Revision Indications Portend Repeat Limb-Salvage Failure Following Total Femoral Replacement. J Bone Joint Surg Am 2020; 102:1511-1520. [PMID: 32453111 DOI: 10.2106/jbjs.19.01022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is scant evidence to guide decision-making for patients considering total femoral replacement (TFR). We aimed to identify the indication, patient, disease, and surgical technique-related factors associated with failure. We hypothesized that failure occurs more frequently in the setting of revision surgical procedures, with infection as the predominant failure mode. METHODS We performed a retrospective cohort study of patients receiving total femoral endoprostheses for oncological and revision arthroplasty indications; 166 patients met these criteria. Our primary independent variable of interest was TFR for a revision indication (arthroplasty or limb salvage); the primary outcome was failure. Analyses were performed for patient variables (age, sex, diagnosis group, indication), implant variables (model, decade, length, materials), and treatment variables. We analyzed TFR failures with respect to patient factors, operative technique, and time to failure. We conducted bivariate logistic regressions predicting failure and used a multivariate model containing variables showing bivariate associations with failure. RESULTS Forty-four patients (27%) had treatment failure. Failure occurred in 24 (23%) of 105 primary TFRs and in 20 (33%) of 61 revision TFRs; the difference was not significant (p = 0.134) in bivariate analysis but was significant (p = 0.044) in multivariate analysis. The mean age at the time of TFR was 37 years in the primary group and 51 years in the revision group (p = 0.0006). Of the patients who had mechanical failure, none had reoccurrence of their original failure mode, whereas all 8 patients from the nonmechanical cohort had reoccurrence of the original failure mode; this difference was significant (p = 0.0001). CONCLUSIONS TFR has a high failure rate and a propensity for deep infection, especially in the setting of revision indications and prior infection. All failed TFRs performed for revision indications for infection or local recurrence failed by reoccurrence of the original failure mode and resulted in amputation. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Eric R Henderson
- Department of Orthopaedics and the Sarcoma & Connective Tissue Oncology Program, Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire
| | - Benjamin J Keeney
- Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire.,Berkley Medical Management Solutions, Overland Park, Kansas
| | - Emily G Husson
- Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire
| | - Nicholas M Bernthal
- University of California at Los Angeles Sarcoma Program, Los Angeles, California
| | - Tao Ji
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, People's Republic of China
| | - Elisa Pala
- Orthopaedic Oncology Unit, University of Padua, Padua, Italy
| | - Philipp T Funovics
- Department of Orthopaedic Surgery, Medical University of Vienna, Vienna, Austria
| | | | | | - Stephan Puchner
- Department of Orthopaedic Surgery, Medical University of Vienna, Vienna, Austria
| | - Stephen D Zoller
- University of California at Los Angeles Sarcoma Program, Los Angeles, California
| | - Pietro Ruggieri
- Orthopaedic Oncology Unit, University of Padua, Padua, Italy
| | - Reinhard Windhager
- Department of Orthopaedic Surgery, Medical University of Vienna, Vienna, Austria
| | - Wei Guo
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, People's Republic of China
| | - Francis J Hornicek
- University of California at Los Angeles Sarcoma Program, Los Angeles, California
| | - G Douglas Letson
- Sarcoma Program, H. Lee Moffitt Cancer and Research Institute, Tampa, Florida
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Wei R, Thanindratarn P, Dean DC, Hornicek FJ, Guo W, Duan Z. Cyclin E1 is a prognostic biomarker and potential therapeutic target in osteosarcoma. J Orthop Res 2020; 38:1952-1964. [PMID: 32162720 DOI: 10.1002/jor.24659] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/26/2020] [Accepted: 03/06/2020] [Indexed: 02/04/2023]
Abstract
While amplified expressed cyclin E1 is a well-known tumorigenic factor and prognostic biomarker in several malignancies, its prognostic predictive potential and function in osteosarcoma is poorly understood. Here we reveal discrete expression pattern, correlation to clinicopathological characteristics and prognosis and overall function of cyclin E1 in osteosarcoma. Sixty-nine osteosarcoma patient tumor specimens were enrolled to construct a tissue microarray to evaluate cyclin E1 expression through immunohistochemical staining. Cyclin E1 expression in osteosarcoma cell lines and fresh tissues was assessed by Western blot. Cyclin E1 gene expression was evaluated using RNA sequencing data acquired from the public database. We correlated staining intensity to clinical characteristics. Cyclin E1 small interfering RNA was used to determine the effect of cyclin E1 silencing on osteosarcoma cell proliferation and chemotherapeutic sensitivity. Sixty-one percent of the osteosarcoma patient specimens in the tissue microarray had high cyclin E1 expression. Cyclin E1 gene was significantly highly expressed in osteosarcoma tissues and cell lines compared to normal tissues. The expression of cyclin E1 positively correlated with disease status, and inversely correlated to prognosis and response to neoadjuvant chemotherapy. The expression of cyclin E1 was an independent prognostic factor for osteosarcoma patients. In addition, silencing cyclin E1 expression in osteosarcoma cells significantly inhibited cell proliferation and increased sensitivity to chemotherapeutics. We conclude that cyclin E1 is overexpressed in osteosarcoma and is a promising biomarker for prognosis and chemotherapeutic response. We confirm aberrant cyclin E1 expression is a potent therapeutic target in osteosarcoma, and its selective inhibition is a rational treatment strategy for osteosarcoma.
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Affiliation(s)
- Ran Wei
- Musculoskeletal Tumor Center, Beijing Key Laboratory of Musculoskeletal Tumor, Peking University People's Hospital, Beijing, China.,Department of Orthopedic Surgery, Sarcoma Biology Laboratory, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Pichaya Thanindratarn
- Department of Orthopedic Surgery, Sarcoma Biology Laboratory, David Geffen School of Medicine at UCLA, Los Angeles, California.,Department of Orthopedic Surgery, Chulabhorn hospital, HRH Princess Chulabhorn College of Medical Science, Bangkok, Thailand
| | - Dylan C Dean
- Department of Orthopedic Surgery, Sarcoma Biology Laboratory, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Francis J Hornicek
- Department of Orthopedic Surgery, Sarcoma Biology Laboratory, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Wei Guo
- Musculoskeletal Tumor Center, Beijing Key Laboratory of Musculoskeletal Tumor, Peking University People's Hospital, Beijing, China
| | - Zhenfeng Duan
- Department of Orthopedic Surgery, Sarcoma Biology Laboratory, David Geffen School of Medicine at UCLA, Los Angeles, California
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30
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Thanindratarn P, Dean DC, Feng W, Wei R, Nelson SD, Hornicek FJ, Duan Z. Cyclin-dependent kinase 12 (CDK12) in chordoma: prognostic and therapeutic value. Eur Spine J 2020; 29:3214-3228. [PMID: 32691223 DOI: 10.1007/s00586-020-06543-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 07/14/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE To determine the cyclin-dependent kinase 12 (CDK12) expression in chordoma patient tissues and cell lines, its correlation with oncologic outcomes, and its function in chordoma cell proliferation. METHODS A chordoma tissue microarray was constructed from fifty-six patient specimens and examined by immunohistochemistry to measure CDK12 expression and its correlation to patient clinical characteristics and survival. CDK12 expression in chordoma cell lines and patient tissues was evaluated via western blot. CDK12 specific small interfering RNA (siRNA) was applied to determine whether its inhibition attenuated chordoma cell growth and proliferation. RESULTS CDK12 was expressed in the majority of chordoma specimens, with notably higher expression in patients with recurrent or metastatic disease. High CDK12 expression was an independent prognostic predictor for shorter overall and progression-free survival in chordoma by univariate and multivariate analysis. Western blot analysis revealed that CDK12 was also highly expressed in chordoma cell lines, with CDK12 specific small interfering RNA (siRNA) mediated knockdown decreasing proliferation and inducing apoptosis. Mechanistically, inhibition of CDK12 decreased phosphorylation of RNA polymerase II (RNAP II) and the anti-apoptotic proteins Survivin and Mcl-1. CONCLUSION High expression of CDK12 is an independent predictor of poor prognosis in chordoma. Inhibition of CDK12 significantly decreased chordoma cell proliferation and induced apoptosis. Our results support CDK12 as a novel prognostic biomarker and therapeutic target in chordoma.
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Affiliation(s)
- Pichaya Thanindratarn
- Department of Orthopaedic Surgery, Sarcoma Biology Laboratory, David Geffen School of Medicine, University of California, Los Angeles, 615 Charles E. Young. Dr. South, Los Angeles, CA, 90095, USA.,Department of Orthopedic Surgery, Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Dylan C Dean
- Department of Orthopaedic Surgery, Sarcoma Biology Laboratory, David Geffen School of Medicine, University of California, Los Angeles, 615 Charles E. Young. Dr. South, Los Angeles, CA, 90095, USA
| | - Wenlong Feng
- Department of Orthopaedic Surgery, Sarcoma Biology Laboratory, David Geffen School of Medicine, University of California, Los Angeles, 615 Charles E. Young. Dr. South, Los Angeles, CA, 90095, USA.,Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Ran Wei
- Department of Orthopaedic Surgery, Sarcoma Biology Laboratory, David Geffen School of Medicine, University of California, Los Angeles, 615 Charles E. Young. Dr. South, Los Angeles, CA, 90095, USA.,Musculoskeletal Tumor Center, Beijing Key Laboratory of Musculoskeletal Tumor, Peking University People's Hospital, Beijing, China
| | - Scott D Nelson
- Department of Pathology, University of California, Los Angeles, CA, USA
| | - Francis J Hornicek
- Department of Orthopaedic Surgery, Sarcoma Biology Laboratory, David Geffen School of Medicine, University of California, Los Angeles, 615 Charles E. Young. Dr. South, Los Angeles, CA, 90095, USA
| | - Zhenfeng Duan
- Department of Orthopaedic Surgery, Sarcoma Biology Laboratory, David Geffen School of Medicine, University of California, Los Angeles, 615 Charles E. Young. Dr. South, Los Angeles, CA, 90095, USA.
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31
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Wang H, Sun W, Sun M, Fu Z, Zhou C, Wang C, Zuo D, Zhou Z, Wang G, Zhang T, Xu J, Chen J, Wang Z, Yin F, Duan Z, Hornicek FJ, Cai Z, Hua Y. Corrigendum to "HER4 promotes cell survival and chemoresistance in osteosarcoma via interaction with NDRG1" [Biochim. Biophys. Acta Mol. Basis Dis. 1864 (2018) 1839-1849]. Biochim Biophys Acta Mol Basis Dis 2020; 1866:165755. [PMID: 32173158 DOI: 10.1016/j.bbadis.2020.165755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Hongsheng Wang
- Department of Orthopedics, Shanghai General Hospital, School of Medicine Shanghai Jiao Tong University, Shanghai, China; Shanghai Bone Tumor Institution, Shanghai, China
| | - Wei Sun
- Department of Orthopedics, Shanghai General Hospital, School of Medicine Shanghai Jiao Tong University, Shanghai, China; Shanghai Bone Tumor Institution, Shanghai, China
| | - Mengxiong Sun
- Department of Orthopedics, Shanghai General Hospital, School of Medicine Shanghai Jiao Tong University, Shanghai, China; Shanghai Bone Tumor Institution, Shanghai, China
| | - Zeze Fu
- Department of Orthopedics, Shanghai General Hospital, School of Medicine Shanghai Jiao Tong University, Shanghai, China; Shanghai Bone Tumor Institution, Shanghai, China
| | - Chenghao Zhou
- Department of Orthopedics, Shanghai General Hospital, School of Medicine Shanghai Jiao Tong University, Shanghai, China; Shanghai Bone Tumor Institution, Shanghai, China
| | - Chongren Wang
- Department of Orthopedics, Shanghai General Hospital, School of Medicine Shanghai Jiao Tong University, Shanghai, China; Shanghai Bone Tumor Institution, Shanghai, China; Department of Orthopedics, Yangpu Hospital, Tongji University, Shanghai, China
| | - Dongqing Zuo
- Department of Orthopedics, Shanghai General Hospital, School of Medicine Shanghai Jiao Tong University, Shanghai, China; Shanghai Bone Tumor Institution, Shanghai, China
| | - Zifei Zhou
- Department of Orthopedics, Shanghai General Hospital, School of Medicine Shanghai Jiao Tong University, Shanghai, China; Shanghai Bone Tumor Institution, Shanghai, China
| | - Gangyang Wang
- Department of Orthopedics, Shanghai General Hospital, School of Medicine Shanghai Jiao Tong University, Shanghai, China; Shanghai Bone Tumor Institution, Shanghai, China
| | - Tao Zhang
- Department of Orthopedics, Shanghai General Hospital, School of Medicine Shanghai Jiao Tong University, Shanghai, China; Shanghai Bone Tumor Institution, Shanghai, China
| | - Jing Xu
- Department of Orthopedics, Shanghai General Hospital, School of Medicine Shanghai Jiao Tong University, Shanghai, China; Shanghai Bone Tumor Institution, Shanghai, China
| | - Jian Chen
- Department of Orthopedics, Shanghai General Hospital, School of Medicine Shanghai Jiao Tong University, Shanghai, China; Shanghai Bone Tumor Institution, Shanghai, China
| | - Zhuoying Wang
- Department of Orthopedics, Shanghai General Hospital, School of Medicine Shanghai Jiao Tong University, Shanghai, China; Shanghai Bone Tumor Institution, Shanghai, China
| | - Fei Yin
- Department of Orthopedics, Shanghai General Hospital, School of Medicine Shanghai Jiao Tong University, Shanghai, China; Shanghai Bone Tumor Institution, Shanghai, China
| | - Zhenfeng Duan
- Center for Sarcoma and Connective Tissue Oncology, Massachusetts General Hospital and Harvard Medical School, USA
| | - Francis J Hornicek
- Department of Orthopedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Zhengdong Cai
- Department of Orthopedics, Shanghai General Hospital, School of Medicine Shanghai Jiao Tong University, Shanghai, China; Shanghai Bone Tumor Institution, Shanghai, China.
| | - Yingqi Hua
- Department of Orthopedics, Shanghai General Hospital, School of Medicine Shanghai Jiao Tong University, Shanghai, China; Shanghai Bone Tumor Institution, Shanghai, China.
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Hsiue PP, Kelley BV, Chen CJ, Stavrakis AI, Lord EL, Shamie AN, Hornicek FJ, Park DY. Surgical treatment of metastatic spine disease: an update on national trends and clinical outcomes from 2010 to 2014. Spine J 2020; 20:915-924. [PMID: 32087389 DOI: 10.1016/j.spinee.2020.02.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 01/30/2020] [Accepted: 02/13/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Metastatic spine disease (MSD) is becoming more prevalent as medical treatment for cancers advance and extend survival. More MSD patients are treated surgically to maintain neurological function, ambulation, and quality of life. PURPOSE The purpose of this study was to use a large, nationally representative database to examine the trends, patient outcomes, and health-care resource utilization associated with surgical treatment of MSD. DESIGN This was an epidemiologic study using national administrative data from the Nationwide Readmissions Database (NRD). PATIENT SAMPLE All patients in the NRD from 2010 to 2014 who underwent spinal surgery were included in the study. OUTCOME MEASURES Mortality, blood transfusion, complications, length of stay, cost, and discharge location during index hospitalization as well as hospital readmission and revision surgery within 90-days of surgery were analyzed. METHODS International Classification of Diseases, Ninth Revision, (ICD-9) codes was used to identify patients of interest within the NRD from 2010 to 2014. Patients were separated into two cohorts - those with MSD and those without. Trends for surgical treatment of MSD were assessed and outcomes measures for both cohorts were analyzed and compared. RESULTS The number of surgical treatments for MSD increased from 6,007 in 2010 to 7,032 in 2014 (p-trend<.0001) which represented a 17.1% increase. During index hospitalization, MSD patients had an increased risk of mortality (odds ratio [OR]=3.22, 95% confidence interval [CI]: 2.85-3.63, p<.0001), blood transfusion (OR=2.93, 95% CI: 2.66-3.23, p<.0001), any complication (OR=1.24, 95% CI: 1.18-1.31, p<.0001), and discharge to skilled nursing facility (OR=1.51, 95% CI:1.41-1.61, p<.0001). MSD patients had longer average length of stay (13.05 vs. 4.56 days, p<.0001) and cost ($49,421.75 vs. $26,190.37, p<.0001) during index hospitalization. Furthermore, MSD patients had an increased risk of hospital readmission (OR=2.82, 95% CI: 2.68-2.96, p<.0001), readmission for surgical site infection (OR=2.38, 95% CI: 2.20-2.58, p<.0001), and readmission with neurologic deficits (OR=1.62, 95% CI: 1.27-2.06, p<.0001) despite a decreased risk of revision fusion (OR=0.71, 95% CI: 0.53-0.96, p=.026). CONCLUSIONS The number of MSD patients who undergo surgical treatments is increasing. Not only do these patients have worse outcomes during index hospitalization, but they are also at an increased risk of hospital readmission for surgical site infection and neurologic complications. These findings stress the need for multidisciplinary perioperative treatment plans that mitigate risks and facilitate quick, effective recovery in these unique, at-risk patients.
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Affiliation(s)
- Peter P Hsiue
- Department of Orthopedic Surgery, David Geffen School of Medicine at the University of California Los Angeles, 1250 16th St Suite 3142, Santa Monica, Los Angeles, CA, USA
| | - Benjamin V Kelley
- Department of Orthopedic Surgery, David Geffen School of Medicine at the University of California Los Angeles, 1250 16th St Suite 3142, Santa Monica, Los Angeles, CA, USA
| | - Clark J Chen
- Department of Orthopedic Surgery, David Geffen School of Medicine at the University of California Los Angeles, 1250 16th St Suite 3142, Santa Monica, Los Angeles, CA, USA
| | - Alexandra I Stavrakis
- Department of Orthopedic Surgery, David Geffen School of Medicine at the University of California Los Angeles, 1250 16th St Suite 3142, Santa Monica, Los Angeles, CA, USA
| | - Elizabeth L Lord
- Department of Orthopedic Surgery, David Geffen School of Medicine at the University of California Los Angeles, 1250 16th St Suite 3142, Santa Monica, Los Angeles, CA, USA
| | - Arya N Shamie
- Department of Orthopedic Surgery, David Geffen School of Medicine at the University of California Los Angeles, 1250 16th St Suite 3142, Santa Monica, Los Angeles, CA, USA
| | - Francis J Hornicek
- Department of Orthopedic Surgery, David Geffen School of Medicine at the University of California Los Angeles, 1250 16th St Suite 3142, Santa Monica, Los Angeles, CA, USA
| | - Don Y Park
- Department of Orthopedic Surgery, David Geffen School of Medicine at the University of California Los Angeles, 1250 16th St Suite 3142, Santa Monica, Los Angeles, CA, USA.
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Cote GM, DeLaney TF, Miao R, Schwab JH, Raskin K, Lozano Calderón S, Mullen JT, Haynes AB, Hornicek FJ, Chen YL, Choy E. Updated 5-year local control (LC), metastasis-free survival (MFS), and overall survival (OS) data from a phase I study of nilotinib plus radiation (RT) in high-risk chordoma. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e23505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e23505 Background: Chordomas are malignant tumors arising from remnant notochordal tissue. Despite improved local control with preoperative/postoperative RT, progression-free survival and OS remain poor in patients (pts) with high-risk features. Chordoma has been identified to express and activate platelet-derived growth factor receptor signaling. We conducted a phase 1 trial to identify the maximum tolerated dose (MTD), safety, and feasibility of nilotinib with RT as either preoperative or definitive treatment for patients with high-risk chordoma. Enclosed is an updated report on LC, MFS, and OS. Methods: We recruited 23 pts with nonmetastatic chordoma to the phase I and dose expansion arms of the study. High-risk was defined as the presence of any of the following: local recurrence after surgery, previous intralesional resection, unplanned incomplete resection, unresectable/marginally resectable disease, or declining surgery due to excessive morbidity. Pts were treated with nilotinib and concurrent RT to 50.4 Gy relative biological effectiveness (RBE) followed by surgery and postoperative RT to a cumulative dose up to 70.2 Gy RBE or definitively up to 77.4 Gy RBE without surgery. On completion of RT, pts were eligible to continue nilotinib until disease progression. Results: The dose escalation arm of the study identified nilotinib 200 mg daily as the maximum tolerated dose (MTD). Eighteen evaluable pts were treated with nilotinib plus RT at the MTD. The objective best response rate was 6% (1 of 18 pts). The 4 and 5-year LC rates were 94.3% (95% CI 83.2-100) and 70.7% (95% CI 20.8-100), respectively. The MFS rate was 74.3 at 4 and 5 years (95% CI 51.8-96.7). The 4 and 5-year OS rates were 70.2% (95% CI 44.4-95.9) and 54.6% (95% CI 20.5-88.6). Conclusions: In updated data from a cohort of high-risk chordoma pts nilotinib 200 mg/d with RT +/- surgery, with long-term follow-up, local control and distant metastasis free survival remains favorable. Clinical trial information: NCT01407198 . [Table: see text]
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Affiliation(s)
| | | | | | | | - Kevin Raskin
- Orthopaedic Oncology, Massachusetts General Hospital, Boston, MA
| | | | | | | | - Francis J. Hornicek
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | | | - Edwin Choy
- Massachusetts General Hospital, Boston, MA
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34
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Miao R, Wang H, Choy E, Cote GM, Raskin K, Schwab JH, Hornicek FJ, DeLaney TF, Chen YL. Conditional survival of patients with nonmetastatic bone osteosarcoma. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e23511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e23511 Background: Conditional survival provides a dynamic prediction of prognosis for patients surviving a defined period of time after diagnosis. This study aimed to determine the conditional survival and prognostic factors over time among patients with non-metastatic bone osteosarcoma. Methods: We reviewed 714 bone osteosarcoma patients treated from 1985 to 2016. Patients with metastatic disease at diagnosis or limited follow up were excluded, resulting in 587 cases for analysis. Clinical and pathological variables were recorded. Predictive variables included age at diagnosis, gender, previous radiation history, tumor site, tumor size, histologic subtype, histologic grade, resection margin, chemotherapy, and radiation therapy. The multivariate Cox proportional hazards regression was used to analyze prognostic factors of conditional overall survival and progression-free survival at baseline and 5 years after diagnosis. Results: The estimated 5-year conditional overall survival increased from 71.0% (95% CI: 67.5%-75.0%) at baseline to 86.9% (95% CI: 82.6%-90.5%) at 5 years, which means if a patient with non-metastatic bone osteosarcoma survived 5 years, the chance of surviving another 5 years was 86.9%. If the patient was progression-free for 5 years, the 5-year conditional overall survival was even higher, 93.2% (95% CI: 89.5%-96.4%), and the 5-year conditional progression-free survival improved from 57.1% (95% CI: 53.3%-61.0%) at baseline to 91.2% (95% CI: 87.5%-94.6%) at 5 years. Prognostic factors for mortality and disease progression change as survival time increases. At baseline, age (p < 0.001 and p = 0.003), histologic subtype (p < 0.001 and p = 0.001), grade (p < 0.001 and p < 0.001), tumor size (p = 0.002 and p = 0.002), resection margin (p < 0.001 and p < 0.001) and chemotherapy (p = 0.001 and p = 0.001) were predictive of both overall survival and progression-free survival. However, only age (p < 0.001) and histologic subtype (p = 0.015) remained significant for mortality and resection margin (p = 0.001) for disease progression at 5 years. Conclusions: The survival probability of osteosarcoma improves as survival time increases. Estimates of conditional survival can provide useful information for individualized surveillance strategies, risk evaluation, patient counseling, and making clinical decisions.
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Affiliation(s)
- Ruoyu Miao
- Massachusetts General Hospital, Boston, MA
| | | | - Edwin Choy
- Massachusetts General Hospital, Boston, MA
| | | | - Kevin Raskin
- Orthopaedic Oncology, Massachusetts General Hospital, Boston, MA
| | | | - Francis J. Hornicek
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
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Feng W, Dean DC, Hornicek FJ, Spentzos D, Hoffman RM, Shi H, Duan Z. Myc is a prognostic biomarker and potential therapeutic target in osteosarcoma. Ther Adv Med Oncol 2020; 12:1758835920922055. [PMID: 32426053 PMCID: PMC7222246 DOI: 10.1177/1758835920922055] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 04/03/2020] [Indexed: 12/14/2022] Open
Abstract
Background Over the past four decades, outcomes for osteosarcoma patients have plateaued as there have been few emerging therapies showing clinical results. Thus, the identification of novel biomarkers and therapeutic strategies are urgently needed to address these primary obstacles in patient care. Although the Myc-oncogene has known roles in oncogenesis and cancer cell growth, its expression and function in osteosarcoma are largely unknown. Methods Expression of Myc was determined by Western blotting of osteosarcoma cell lines and patient tissues, and by immunohistochemistry of a unique osteosarcoma tissue microarray (TMA) constructed from 70 patient samples with extensive follow-up data. Myc specific siRNA and inhibitor 10058-F4 were applied to examine the effect of Myc inhibition on osteosarcoma cell proliferation. The clonogenicity and migration activity was determined by clonogenic and wound-healing assays. A mimic in vivo assay, three-dimensional (3D) cell culture model, was performed to further validate the effect of Myc inhibition on osteosarcoma cell tumorigenic markers. Results Myc was significantly overexpressed in human osteosarcoma cell lines compared with normal human osteoblasts, and also highly expressed in fresh osteosarcoma tissues. Higher Myc expression correlated significantly with metastasis and poor prognosis. Through the addition of Myc specific siRNA and inhibitor, we significantly reduced Myc protein expression, resulting in decreased osteosarcoma cell proliferation. Inhibition of Myc also suppressed the migration, clonogenicity, and spheroid growth of osteosarcoma cells. Conclusion Our results support Myc as an emerging prognostic biomarker and therapeutic target in osteosarcoma therapy.
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Affiliation(s)
- Wenlong Feng
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Dylan C Dean
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Francis J Hornicek
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Dimitrios Spentzos
- Department of Orthopaedic Surgery, Musculoskeletal Oncology Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert M Hoffman
- AntiCancer Inc., San Diego, CA, USA Department of Surgery, University of California, San Diego, CA, USA
| | - Huirong Shi
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, Henan 450052, China
| | - Zhenfeng Duan
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, 615 Charles, E. Young. Dr. South, Los Angeles, CA 90095, USA
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Thanindratarn P, Li X, Dean DC, Nelson SD, Hornicek FJ, Duan Z. Establishment and Characterization of a Recurrent Osteosarcoma Cell Line: OSA 1777. J Orthop Res 2020; 38:902-910. [PMID: 31736134 DOI: 10.1002/jor.24528] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 11/12/2019] [Indexed: 02/04/2023]
Abstract
Osteosarcoma (OSA) is the most common primary bone malignancy overall and is responsible for considerable adolescent mortality. Approximately 850 patients are newly diagnosed with OSA in the United States each year. While the 5-year survival rate for localized OSA has improved from <20% over 40 years ago to over 65% today, progress has dwindled over the past three decades. Therapeutic stagnation has occurred, in part, as a result of limited preclinical models and the overall heterogeneity of OSA among patients. In this study, we report the establishment and characterization of a novel OSA cell line: OSA 1777. This cell line was isolated from the recurrent tumor specimen of a 19-year-old female who initially experienced 99% tumor necrosis after neoadjuvant chemotherapy and eventually had local recurrence and metastases. We present OSA 1777 growth characteristics, tumor markers, chemotherapeutic sensitivities, and oncogenic spheroid formation. In a two-dimensional (2D) monolayer culture, OSA 1777 exhibited a spindle shape and 60 h doubling time. STR DNA profiling revealed a unique genomic identity not matching any existing human cancer cell lines from the ATCC or DSMZ databases. Consistent with the mesenchymal origin, western blot was positive for vimentin and negative for the carcinoma marker cytokeratin. Within three-dimensional (3D) culture, the cells formed spheroids of similar patterning and smaller size compared with MNNG-HOS and U2OS cell lines. The chemotherapeutic drug sensitivity of OSA 1777 was evaluated in both 2D and 3D culture systems. In summary, we report OSA 1777 as a novel biological model of OSA amenable to future studies focused on OSA that recurs despite an initially strong chemotherapeutic response. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:902-910, 2020.
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Affiliation(s)
- Pichaya Thanindratarn
- Department of Orthopedic Surgery, Sarcoma Biology Laboratory, David Geffen School of Medicine, University of California, Los Angeles, California
- Department of Orthopedic Surgery, Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Xiaoyang Li
- Department of Orthopedic Surgery, Sarcoma Biology Laboratory, David Geffen School of Medicine, University of California, Los Angeles, California
- Department of Orthopedic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dylan C Dean
- Department of Orthopedic Surgery, Sarcoma Biology Laboratory, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Scott D Nelson
- Department of Pathology, University of California, Los Angeles, California
| | - Francis J Hornicek
- Department of Orthopedic Surgery, Sarcoma Biology Laboratory, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Zhenfeng Duan
- Department of Orthopedic Surgery, Sarcoma Biology Laboratory, David Geffen School of Medicine, University of California, Los Angeles, California
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Lietz CE, Garbutt C, Barry WT, Deshpande V, Chen YL, Lozano-Calderon SA, Wang Y, Lawney B, Ebb D, Cote GM, Duan Z, Hornicek FJ, Choy E, Petur Nielsen G, Haibe-Kains B, Quackenbush J, Spentzos D. MicroRNA-mRNA networks define translatable molecular outcome phenotypes in osteosarcoma. Sci Rep 2020; 10:4409. [PMID: 32157112 PMCID: PMC7064533 DOI: 10.1038/s41598-020-61236-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 02/03/2020] [Indexed: 12/30/2022] Open
Abstract
There is a lack of well validated prognostic biomarkers in osteosarcoma, a rare, recalcitrant disease for which treatment standards have not changed in over 20 years. We performed microRNA sequencing in 74 frozen osteosarcoma biopsy samples, constituting the largest single center translationally analyzed osteosarcoma cohort to date, and we separately analyzed a multi-omic dataset from a large NCI supported national cooperative group cohort. We validated the prognostic value of candidate microRNA signatures and contextualized them in relevant transcriptomic and epigenomic networks. Our results reveal the existence of molecularly defined phenotypes associated with outcome independent of clinicopathologic features. Through machine learning based integrative pharmacogenomic analysis, the microRNA biomarkers identify novel therapeutics for stratified application in osteosarcoma. The previously unrecognized osteosarcoma subtypes with distinct clinical courses and response to therapy could be translatable for discerning patients appropriate for more intensified, less intensified, or alternate therapeutic regimens.
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Affiliation(s)
- Christopher E Lietz
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Cassandra Garbutt
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Illumina, Inc., San Diego, United States
| | - William T Barry
- Department of Biostatistics and Computational Biology, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, United States
| | - Vikram Deshpande
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Yen-Lin Chen
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Santiago A Lozano-Calderon
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Yaoyu Wang
- Department of Biostatistics and Computational Biology, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, United States
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, United States
| | - Brian Lawney
- Department of Biostatistics and Computational Biology, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, United States
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, United States
| | - David Ebb
- Pediatric Hematology-Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Gregory M Cote
- Department of Hematology/Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Zhenfeng Duan
- Department of Orthopaedic Surgery, UCLA, Los Angeles, CA, United States
| | | | - Edwin Choy
- Department of Hematology/Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - G Petur Nielsen
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Benjamin Haibe-Kains
- Department of Medical Biophysics, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - John Quackenbush
- Department of Biostatistics and Computational Biology, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, United States
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, United States
| | - Dimitrios Spentzos
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
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Houdek MT, Hevesi M, Schwab JH, Yaszemski MJ, Griffin AM, Healey JH, Ferguson PC, Hornicek FJ, Boland PJ, Sim FH, Rose PS, Wunder JS. Association between patient age and the risk of mortality following local recurrence of a sacral chordoma. J Surg Oncol 2020; 121:267-271. [PMID: 31758570 PMCID: PMC7242148 DOI: 10.1002/jso.25774] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 11/08/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND Local recurrence (LR) of sacral chordoma is a difficult problem and the mortality risk associated with LR remains poorly described. The purpose of this study was to evaluate the risk of mortality in patients with LR and determine if patient age is associated with mortality. METHODS A total of 218 patients (144 male, 69 female; mean age 59 ± 15 years) with sacrococcygeal chordomas were reviewed. Cumulative incidence functions and competing risks for death due to disease and nondisease mortality were employed to analyze mortality trends following LR. RESULTS The 10-year overall survival (OS) was 55%. Patients with LR had 44% 10-year OS, similar to patients without (59%; P = .38). The 10-year OS between those less than 55 compared with ≥55 years were similar (69% vs 48%; P = .52). The 10-year death due to disease was worse in patients with LR compared with those without (44% vs 84%; P < .001). In patients without LR, patients ≥55 years were 1.6-fold more likely to experience death due to other causes. CONCLUSIONS Patients with an LR are more likely to die due to disease. Advanced patient age was associated with higher all-cause mortality following resection of sacral chordoma. LR of chordoma was associated with increased disease-specific mortality, regardless of age.
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Affiliation(s)
- Matthew T. Houdek
- Mayo Clinic, Department of Orthopedic Surgery, Rochester, MN,Corresponding Author: , 200 First St. SW, Rochester, MN 55905, (507) 284-2511
| | - Mario Hevesi
- Mayo Clinic, Department of Orthopedic Surgery, Rochester, MN
| | - Joseph H. Schwab
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital, Boston, MA
| | | | - Anthony M. Griffin
- University Musculoskeletal Oncology Unit Mount Sinai Hospital, Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - John H. Healey
- Orthopaedic Surgery Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center and Weill College of Medicine, Cornell University, New York, NY
| | - Peter C. Ferguson
- University Musculoskeletal Oncology Unit Mount Sinai Hospital, Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Francis J. Hornicek
- Department of Orthopedic Surgery, University of California Los Angeles, Los Angeles, CA
| | - Patrick J. Boland
- Orthopaedic Surgery Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center and Weill College of Medicine, Cornell University, New York, NY
| | - Franklin H. Sim
- Mayo Clinic, Department of Orthopedic Surgery, Rochester, MN
| | - Peter S. Rose
- Mayo Clinic, Department of Orthopedic Surgery, Rochester, MN
| | - Jay S. Wunder
- University Musculoskeletal Oncology Unit Mount Sinai Hospital, Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
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Zhao J, Dean DC, Hornicek FJ, Yu X, Duan Z. Emerging next-generation sequencing-based discoveries for targeted osteosarcoma therapy. Cancer Lett 2020; 474:158-167. [PMID: 31987920 DOI: 10.1016/j.canlet.2020.01.020] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/18/2020] [Accepted: 01/20/2020] [Indexed: 12/28/2022]
Abstract
Osteosarcoma (OS) is the most common primary bone malignancy and is frequently lethal via metastasis to the lung. While surgical techniques and adjuvant chemotherapies have emerged to combat this deadly cancer, the 5-year survival rate has plateaued over the past four decades. Therapeutic progress has been notably poor because past technologies have not been able to reveal obscured OS biomarkers and targets. With the advent and implementation of large-scale next-generation sequencing (NGS) studies, various somatic mutations and copy number changes involved in OS progression and metastasis have surfaced. These findings have significantly expanded the amount of genome-informed pathways and candidate genes suitable for targeting in pre-clinical models. Furthermore, NGS analyses comparing primary and matched pulmonary metastatic tumor tissues have catalogued previously unknown prognostic biomarkers in OS. In this review, we delineate the most recent findings in NGS for OS therapy and how this technology has advanced personalized therapy.
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Affiliation(s)
- Jie Zhao
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, 250355, China; Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA; Department of Orthopaedic Surgery, The 960th Hospital of the PLA Joint Logistics Support Force, Jinan, Shandong, 250031, China.
| | - Dylan C Dean
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA.
| | - Francis J Hornicek
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA.
| | - Xiuchun Yu
- Department of Orthopaedic Surgery, The 960th Hospital of the PLA Joint Logistics Support Force, Jinan, Shandong, 250031, China.
| | - Zhenfeng Duan
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA.
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Thanindratarn P, Dean DC, Nelson SD, Hornicek FJ, Duan Z. Chimeric antigen receptor T (CAR-T) cell immunotherapy for sarcomas: From mechanisms to potential clinical applications. Cancer Treat Rev 2020; 82:101934. [DOI: 10.1016/j.ctrv.2019.101934] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 11/13/2019] [Accepted: 11/19/2019] [Indexed: 02/07/2023]
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Wei R, Dean DC, Thanindratarn P, Hornicek FJ, Guo W, Duan Z. Cancer testis antigens in sarcoma: Expression, function and immunotherapeutic application. Cancer Lett 2019; 479:54-60. [PMID: 31634526 DOI: 10.1016/j.canlet.2019.10.024] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/23/2019] [Accepted: 10/15/2019] [Indexed: 02/06/2023]
Abstract
Sarcomas are a group of heterogeneous malignancies of mesenchymal origin. Patient outcomes remain especially grim for those with recurrent or metastatic disease, and current therapeutic strategies have not significantly improved outcomes over the past few decades. This has led to a number of studies assessing novel therapies. Cancer testis antigens (CTAs) are tumor-associated antigens with physiologic expression in the testis and various malignancies, including sarcomas. Genes encoding CTAs include MAGE, NY-ESO-1, PRAME, TRAG-3/CSAGE, and SSX. The importance and function of CTAs in tumorigenesis have gained recognition in recent years. They are also proving as robust diagnostic and prognostic biomarkers. Therapeutically, antigens derived from CTAs are highly recognizable by T lymphocytes and therefore capable of generating a potent antitumor immune response. CTAs are, therefore, promising targets for novel immunotherapies. Here we review the emerging works on expression, function, and immunotherapeutic application of CTAs in sarcoma therapy.
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Affiliation(s)
- Ran Wei
- Department of Orthopedic Surgery, Sarcoma Biology Laboratory, David Geffen School of Medicine at UCLA, 615 Charles E. Young Dr. South, Los Angeles, CA, 90095, USA; Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China.
| | - Dylan C Dean
- Department of Orthopedic Surgery, Sarcoma Biology Laboratory, David Geffen School of Medicine at UCLA, 615 Charles E. Young Dr. South, Los Angeles, CA, 90095, USA.
| | - Pichaya Thanindratarn
- Department of Orthopedic Surgery, Sarcoma Biology Laboratory, David Geffen School of Medicine at UCLA, 615 Charles E. Young Dr. South, Los Angeles, CA, 90095, USA.
| | - Francis J Hornicek
- Department of Orthopedic Surgery, Sarcoma Biology Laboratory, David Geffen School of Medicine at UCLA, 615 Charles E. Young Dr. South, Los Angeles, CA, 90095, USA.
| | - Wei Guo
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China.
| | - Zhenfeng Duan
- Department of Orthopedic Surgery, Sarcoma Biology Laboratory, David Geffen School of Medicine at UCLA, 615 Charles E. Young Dr. South, Los Angeles, CA, 90095, USA.
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Dea N, Fisher CG, Reynolds JJ, Schwab JH, Rhines LD, Gokaslan ZL, Bettegowda C, Sahgal A, Lazáry Á, Luzzati A, Boriani S, Gasbarrini A, Laufer I, Charest-Morin R, Wei F, Teixeira W, Germscheid NM, Hornicek FJ, DeLaney TF, Shin JH. Current treatment strategy for newly diagnosed chordoma of the mobile spine and sacrum: results of an international survey. J Neurosurg Spine 2019; 30:119-125. [PMID: 30497218 DOI: 10.3171/2018.6.spine18362] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 06/21/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe purpose of this study was to investigate the spectrum of current treatment protocols for managing newly diagnosed chordoma of the mobile spine and sacrum.METHODSA survey on the treatment of spinal chordoma was distributed electronically to members of the AOSpine Knowledge Forum Tumor, including neurosurgeons, orthopedic surgeons, and radiation oncologists from North America, South America, Europe, Asia, and Australia. Survey participants were pre-identified clinicians from centers with expertise in the treatment of spinal tumors. The suvey responses were analyzed using descriptive statistics.RESULTSThirty-nine of 43 (91%) participants completed the survey. Most (80%) indicated that they favor en bloc resection without preoperative neoadjuvant radiation therapy (RT) when en bloc resection is feasible with acceptable morbidity. The main area of disagreement was with the role of postoperative RT, where 41% preferred giving RT only if positive margins were achieved and 38% preferred giving RT irrespective of margin status. When en bloc resection would result in significant morbidity, 33% preferred planned intralesional resection followed by RT, and 33% preferred giving neoadjuvant RT prior to surgery. In total, 8 treatment protocols were identified: 3 in which en bloc resection is feasible with acceptable morbidity and 5 in which en bloc resection would result in significant morbidity.CONCLUSIONSThe results confirm that there is treatment variability across centers worldwide for managing newly diagnosed chordoma of the mobile spine and sacrum. This information will be used to design an international prospective cohort study to determine the most appropriate treatment strategy for patients with spinal chordoma.
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Affiliation(s)
- Nicolas Dea
- 1Division of Spine Surgery, Vancouver General Hospital and The University of British Columbia, Vancouver, British Columbia, Canada
| | - Charles G Fisher
- 1Division of Spine Surgery, Vancouver General Hospital and The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jeremy J Reynolds
- 2Oxford Spinal Unit, Oxford University Hospital, Oxford, United Kingdom
| | - Joseph H Schwab
- 3Department of Orthopaedics, Massachusetts General Hospital, Boston, Massachusetts
| | - Laurence D Rhines
- 4Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ziya L Gokaslan
- 5Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, and The Miriam Hospital, Providence, Rhode Island
| | - Chetan Bettegowda
- 6Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Arjun Sahgal
- 7Department of Radiation Oncology, University of Toronto and Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Áron Lazáry
- 8National Center for Spinal Disorders and Buda Health Center, Budapest, Hungary
| | - Alessandro Luzzati
- 9Centro Di Chirurgia Oncologia Ortopedica e Ricostruttiva del Rachide (CCOORR) and
| | - Stefano Boriani
- 10GSpine4 Spine Surgery Division, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Alessandro Gasbarrini
- 11Unit of Oncologic and Degenerative Spine Surgery, Rizzoli Institute, Bologna, Italy
| | - Ilya Laufer
- 12Department of Neurological Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Feng Wei
- 14Department of Orthopaedics, Peking University Third Hospital, HaiDian District, Beijing, China
| | - William Teixeira
- 15Department of Neurosurgery, Institute of Cancer of the State of São Paulo, São Paulo, Brazil
| | | | - Francis J Hornicek
- 17Department of Orthopaedic Surgery, University of California, Los Angeles Medical Center, Los Angeles, California; and
| | | | - John H Shin
- 19Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts
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Paulino Pereira NR, Janssen SJ, Stoop N, Hartveldt S, Chen YLE, DeLaney TF, Hornicek FJ, Schwab JH. Physical Function and Quality of Life After Resection of Mobile Spine Chondrosarcoma. Global Spine J 2019; 9:743-753. [PMID: 31552156 PMCID: PMC6745645 DOI: 10.1177/2192568219830330] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES (1) To assess patient-reported outcomes-physical function, pain, and quality of life-in patients who underwent resection of a mobile spine chondrosarcoma. (2) To assess complications (90 days), readmissions, reoperations, oncological outcomes, and neurologic status. METHODS Thirty-three patients with spinal conventional chondrosarcoma resection between 1984 and 2014 at one hospital were included. The primary outcome measures were-minimally 6 months after surgery-the EuroQol 5 Dimensions (EQ5D), PROMIS-Physical Function, PROMIS-Pain Intensity, and Oswestry (ODI) Disability Index, or Neck (NDI) Disability established in 14 out of 20 alive (70.0%) patients. Complications, readmission, reoperations, oncological outcomes, and neurological status were reported for the complete cohort of 33 patients. RESULTS After spine chondrosarcoma resection, patients (n = 14) reported worse physical function (median 43, range 22-61, P = .026), worse quality of life (median EQ5D 0.70, range 0.04-1, P = .022), and comparable pain intensity (median 47, range 31-56, P = .362) when compared with US general population values. The median NDI/ODI was 25 (range 0-72) indicating mild to moderate disability. Patients undergoing reoperation had worse patient-reported outcomes than those who did not. Eighteen (55.5%) out of 33 patients suffered complications (90 days), 14 (42.4%) had unplanned readmission, and 13 (39.4%) underwent reoperation. Intralesional resection was associated with increased readmission, reoperation, and recurrence rate. CONCLUSIONS Chondrosarcoma affects quality of life and physical function and its treatment frequently results in complications and reoperations. Our findings can be used to inform future patients about expected outcomes.
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Affiliation(s)
- Nuno Rui Paulino Pereira
- Massachusetts General Hospital, Harvard Medical School, Boston, MA,
USA,Nuno Rui Paulino Pereira, Room 3.946, Yawkey
Building, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
| | - Stein J. Janssen
- Massachusetts General Hospital, Harvard Medical School, Boston, MA,
USA
| | - Nicky Stoop
- Massachusetts General Hospital, Harvard Medical School, Boston, MA,
USA
| | - Stefan Hartveldt
- Massachusetts General Hospital, Harvard Medical School, Boston, MA,
USA
| | - Yen-Lin E. Chen
- Massachusetts General Hospital, Harvard Medical School, Boston, MA,
USA
| | - Thomas F. DeLaney
- Massachusetts General Hospital, Harvard Medical School, Boston, MA,
USA
| | | | - Joseph H. Schwab
- Massachusetts General Hospital, Harvard Medical School, Boston, MA,
USA
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Abstract
Ovarian cancer is one of the most common gynecological malignancies. Upon initial diagnosis, the majority of patients present with widespread metastatic growth within the peritoneal cavity. This metastatic growth occurs in stages, with the formation of a pre-metastatic niche occurring prior to macroscopic tumor cell invasion. Exosomes released by the primary ovarian tumor are small extracellular vesicles which prepare the distant tumor microenvironment for accelerated metastatic invasion. They regulate intercellular communication between tumor cells and normal stroma, cancer-associated fibroblasts, and local immune cells within the tumor microenvironment. In this review, we highlight the emerging roles of ovarian cancer exosomes as coordinators of pre-metastatic niche formation, biomarkers amenable to liquid biopsy, and targets of chemotherapy.
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Affiliation(s)
- Wenlong Feng
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, 450052 Henan China
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, 615 Charles, E. Young. Dr. South, Los Angeles, CA 90095 USA
| | - Dylan C. Dean
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, 615 Charles, E. Young. Dr. South, Los Angeles, CA 90095 USA
| | - Francis J. Hornicek
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, 615 Charles, E. Young. Dr. South, Los Angeles, CA 90095 USA
| | - Huirong Shi
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, 450052 Henan China
| | - Zhenfeng Duan
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, 450052 Henan China
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, 615 Charles, E. Young. Dr. South, Los Angeles, CA 90095 USA
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Eckardt MA, Graham DS, Singh AS, Chmielowski B, Federman N, Kalbasi A, Bernthal NM, Bukata SV, Hornicek FJ, Yanagawa J, Levine BD, Motamedi K, Seeger LL, Eckardt JJ, Eilber FR, Dry SM, Nelson SD, Eilber FC. Pathologic discordance in sarcomas: Prospective comparison of external and sarcoma center pathologic diagnosis. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.11020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
11020 Background: With more than 80 different histologic subtypes, sarcomas are a unique pathologic challenge. As therapeutic decisions have become histology-specific, obtaining an accurate pathologic diagnosis is critical in guiding treatment decisions. The aim of this study is to determine the discordance between the diagnosis rendered by an external non-specialized pathologist and pathologic re-review by a specialized sarcoma pathologist at a high-volume sarcoma center. Methods: Patients who presented at the UCLA Multidisciplinary Sarcoma Conference (MSC) in 2017 that had a pathologic diagnosis from an outside facility were included in this study. All specimens underwent pathologic re-review at UCLA by an experienced sarcoma pathologist. The pathology was classified as concordant (identical diagnoses), minor discordance (difference with minor impact on prognosis/therapy) and major discordance (difference with significant impact on prognosis/therapy). Results: 1350 patients were presented at the UCLA MSC in 2017. Of the 635 new patients, 196 presented with an outside pathologic diagnosis and underwent pathologic re-review at UCLA. 44% (n = 87) were concordant, 22% (n = 43) had minor discordance, and 34% (n = 66) had major discordance. Major discordance included substantial discrepancies in histologic subtype (n = 24, 36%), benign/malignant mismatch (n = 23, 35%), diagnostic from non-diagnostic (n = 12, 18%) and major grading discrepancy (n = 7, 11%). Major discordance was most often seen in biopsies [needle (n = 27, 32%), incisional (n = 30, 44%)] as compared to resection (n = 9, 21%). Conclusions: 56% of external non-specialized sarcoma pathologic diagnoses were discordant from specialized sarcoma pathologist review, 34% of which were major discordances. Pathologic re-review of a presumed sarcoma by a specialized sarcoma pathologist is critical for both patient care and investigational studies. [Table: see text]
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Affiliation(s)
- Mark A. Eckardt
- Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Danielle S. Graham
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Arun S. Singh
- Division of Hematology-Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Bartosz Chmielowski
- Division of Hematology-Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Noah Federman
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Anusha Kalbasi
- Department of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Nicholas M. Bernthal
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Susan V. Bukata
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Francis J. Hornicek
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Jane Yanagawa
- Division of Thoracic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Benjamin D. Levine
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Kambiz Motamedi
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Leanne L. Seeger
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Jeffrey J. Eckardt
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Frederick R. Eilber
- Division of Surgical Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Sarah M. Dry
- Department of Pathology & Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Scott D. Nelson
- Department of Pathology & Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Frederick C. Eilber
- Division of Surgical Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA
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Miao R, Wang H, Jacobson A, Lietz AP, Choy E, Raskin KA, Schwab JH, Deshpande V, Nielsen GP, DeLaney TF, Cote GM, Hornicek FJ, Chen YLE. Radiation-induced and neurofibromatosis-associated malignant peripheral nerve sheath tumors (MPNST) have worse outcomes than sporadic MPNST. Radiother Oncol 2019; 137:61-70. [PMID: 31078939 DOI: 10.1016/j.radonc.2019.03.015] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 03/06/2019] [Accepted: 03/18/2019] [Indexed: 01/30/2023]
Abstract
BACKGROUND Malignant peripheral nerve sheath tumors (MPNST) may be sporadic or associated with neurofibromatosis or prior radiation. MPNST may behave aggressively with a high rate of local recurrence and distant metastasis. METHODS In an IRB approved protocol, we reviewed the clinical characteristics, treatment, and outcomes of 280 patients treated for MPNST at Massachusetts General Hospital (MGH) between 1960 and 2016. RESULTS There were 138 men and 142 women with a median age of 41 (range: 3-95) years. Tumors were classified as neurofibromatosis-associated (nfMPNST, n = 77), radiation-induced (rMPNST, n = 21), or sporadic (sMPNST, n = 182) MPNST. The median time to development of rMPNST from prior radiation was 15 years. With a median follow-up of 43.1 months, the median overall survival (OS) was 65.3 months. Older age, nfMPNST, rMPNST, increased tumor size, lymph node involvement, metastatic disease, intermediate to high grade, radiotherapy alone, and R2 resection were related to worse OS, whereas surgery with radiotherapy was associated with improved OS. Among the 251 patients without metastasis, nfMPNST, rMPNST, and increased tumor size were correlated with worse metastasis-free survival; nfMPNST, radiotherapy alone, and R1/R2 resection were associated with local recurrence, whereas surgery with adjuvant radiotherapy was related to improved local control in patients with R1/R2 resection. CONCLUSIONS Both radiation-induced and neurofibromatosis-associated MPNSTs have poorer prognosis than sporadic MPNSTs. Complete resection of the tumor is a significant prognostic factor for MPNST. The addition of radiotherapy after surgery should be considered especially when the surgical margins are positive.
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Affiliation(s)
- Ruoyu Miao
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, USA.
| | - Haotong Wang
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, USA.
| | - Alex Jacobson
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, USA
| | - Anna P Lietz
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, USA.
| | - Edwin Choy
- Department of Medical Oncology, Massachusetts General Hospital, Boston, USA; Harvard Medical School, Boston, USA.
| | - Kevin A Raskin
- Department of Orthopedic Oncology, Massachusetts General Hospital, Boston, USA; Harvard Medical School, Boston, USA.
| | - Joseph H Schwab
- Department of Orthopedic Oncology, Massachusetts General Hospital, Boston, USA; Harvard Medical School, Boston, USA.
| | - Vikram Deshpande
- Department of Pathology, Massachusetts General Hospital, Boston, USA; Harvard Medical School, Boston, USA.
| | - G Petur Nielsen
- Department of Pathology, Massachusetts General Hospital, Boston, USA; Harvard Medical School, Boston, USA.
| | - Thomas F DeLaney
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, USA; Harvard Medical School, Boston, USA.
| | - Gregory M Cote
- Department of Medical Oncology, Massachusetts General Hospital, Boston, USA; Harvard Medical School, Boston, USA.
| | - Francis J Hornicek
- Department of Orthopedic Oncology, Massachusetts General Hospital, Boston, USA; Harvard Medical School, Boston, USA; Department of Orthopedic Surgery, University of California Los Angeles, USA.
| | - Yen-Lin E Chen
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, USA; Harvard Medical School, Boston, USA.
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van Wulfften Palthe ODR, Tromp I, Ferreira A, Fiore A, Bramer JAM, van Dijk NC, DeLaney TF, Schwab JH, Hornicek FJ. Sacral chordoma: a clinical review of 101 cases with 30-year experience in a single institution. Spine J 2019; 19:869-879. [PMID: 30445184 DOI: 10.1016/j.spinee.2018.11.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 10/31/2018] [Accepted: 11/01/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND Local recurrence rates are high in sacral chordoma patients. Adjuvant radiotherapy may play a role in increasing local control. Patients with locally recurrent tumors continue to comprise a significant proportion of the sacral chordoma population and appear to have worse prognosis than those with primary tumors. High-quality studies comparing presentation and treatments for primary and first local recurrent sacral chordoma tumors are sparse. PURPOSE To determine: whether there is a difference in how primary and tumors at first recurrence present; the overall survival, local relapse-free survival, and distant relapse-free survival rates and prognostic factors for patients presenting with a primary tumor; overall survival, local relapse-free survival, and distant relapse-free survival rates and prognostic factors for patients presenting with a first local relapse; if there any differences in overall survival, local relapse-free survival, and distant relapse-free survival rates between patients presenting with a primary tumor and those with a first local relapse. STUDY DESIGN Retrospective case series. PATIENT SAMPLE One hundred one sacral chordoma cases. OUTCOME MEASURE Overall survival, local relapse-free survival, and distant relapse-free survival rates. METHODS Between 1978 and 2013, 131 patients with sacral chordoma were seen. Of them, 17 patients (13%) presented with a history of more than one local recurrence. One patient (1%) presented with multiple distant metastases. Ten patients (8%) had less than 36 months of follow-up and had no event (eg, death, local recurrence, or distant metastasis). A total of 102 patients met our inclusion criteria: patients with primary or first recurrent tumors, without metastatic disease, who underwent surgery and with at least 36 months of follow-up. One patient (1%) died intraoperatively; therefore, 101 patients were included in the present analysis. Cox proportional hazards regression analysis was performed for primary and local recurrent tumor separately and to compare primary and local recurrent tumors. RESULTS We analyzed 73 primary and 28 first time recurrent sacral chordomas. Tumor size at presentation was different for primary and recurrent tumors (primary median size: 158 cm3, interquartile range [IQR]: 46-634; recurrent median size: 39 cm3, IQR: 14-175; p=.001). Overall survival at 5 and 10years for the primary tumors was 79% and 59%, respectively. Local relapse-free survival at 5years was 86%. For primary tumors, not receiving radiation was an independent predictor for worse local relapse-free survival (hazard ratio [HR]: 0.20; 95% confidence interval [CI]: 0.0043-0.90; p=.004) and increased tumor size was an independent predictor for both worse overall survival (HR: 1.68; 95% CI: 1.38-2.42; p=.004) and worse distant relapse-free survival (HR: 2.25; 95% CI: 1.47-3.44; p<.001). For recurrent tumors, the 5- and 10-year overall survival was 65% and 40%, respectively. Local relapse-free survival at 5years was 79% for recurrent tumors. On bivariate analysis, increased tumor size was a significant predictor for worse survival (LR median: 338 mL; IQR: 218-503 mL; no LR median: 26 mL; IQR: 9-71 mL). A trend was seen toward better distant relapse survival for tumors presenting as a primary tumor (HR: 0.51; 95% CI: 0.25-1.06; p=.072). CONCLUSION Using a combination of surgical resection and adjuvant radiotherapy allowed us to obtain a good overall survival, local relapse-free survival, and distant relapse-free survival in patients presenting with either a primary tumor or with a first time local recurrent tumor.
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Affiliation(s)
- Olivier D R van Wulfften Palthe
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital - Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA.
| | - Isabel Tromp
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital - Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA
| | - Al Ferreira
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital - Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA
| | - Anne Fiore
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital - Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA
| | - Jos A M Bramer
- Department of Orthopaedic Surgery, Amsterdam Medical Center - University Of Amsterdam, Meidreef 9, 1105 AZ, Amsterdam-Zuidoost, The Netherlands
| | - Niek C van Dijk
- Department of Orthopaedic Surgery, Amsterdam Medical Center - University Of Amsterdam, Meidreef 9, 1105 AZ, Amsterdam-Zuidoost, The Netherlands
| | - Thomas F DeLaney
- Department of Radiation Oncology, Massachusetts General Hospital - Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA
| | - Joseph H Schwab
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital - Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA
| | - Francis J Hornicek
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital - Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA
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Wang J, Dean DC, Hornicek FJ, Shi H, Duan Z. Cyclin-dependent kinase 9 (CDK9) is a novel prognostic marker and therapeutic target in ovarian cancer. FASEB J 2019; 33:5990-6000. [PMID: 30726104 PMCID: PMC6463912 DOI: 10.1096/fj.201801789rr] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Despite surgical and chemotherapeutic advances over the past few decades, the prognosis for ovarian cancer remains very poor. Although cyclin-dependent kinase (CDK) 9 has an established pathogenic role in various cancers, its function in ovarian cancer remains poorly defined. The purpose of this study was to evaluate the expression of CDK9 and its therapeutic potential in ovarian cancer. CDK9 expression was determined by immunohistochemistry in a unique ovarian cancer tissue microarray constructed with paired primary, metastatic, and recurrent tumor tissues from 26 ovarian cancer patients. CDK9 was highly expressed in human ovarian cancer cell lines and was also elevated in metastatic and recurrent ovarian tumor tissue compared with patient-matched primary ovarian tumor tissue. In addition, increased CDK9 significantly correlated with poor patient prognosis. Inhibition of CDK9 by small interfering RNA or CDK9 inhibitor functionally suppressed RNA transcription elongation, induced apoptosis, and reduced proliferation of ovarian cancer cells. Inhibition of CDK9 also suppressed ovarian cancer cell spheroid growth, clonogenicity formation, and migration activity. Our results reveal CDK9 as a novel prognostic biomarker and a promising therapeutic target for preventing metastasis and recurrence while also improving the overall clinical outcome for ovarian cancer patients.-Wang, J., Dean, D. C., Hornicek, F. J., Shi, H., Duan, Z. Cyclin-dependent kinase 9 (CDK9) is a novel prognostic marker and therapeutic target in ovarian cancer.
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Affiliation(s)
- Jinglu Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China;,Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California–Los Angeles, Los Angeles, California, USA
| | - Dylan C. Dean
- Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California–Los Angeles, Los Angeles, California, USA
| | - Francis J. Hornicek
- Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California–Los Angeles, Los Angeles, California, USA
| | - Huirong Shi
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China;,Correspondence: Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Rd., Zhengzhou, Henan 450052, China. E-mail:
| | - Zhenfeng Duan
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China;,Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California–Los Angeles, Los Angeles, California, USA,Correspondence: Department of Orthopaedic Surgery, David Geffen School of Medicine,University of California–Los Angeles, 615 Charles E. Young Dr. South, Los Angeles, CA 90095, USA. E-mail:
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Tang F, Min L, Seebacher NA, Li X, Zhou Y, Hornicek FJ, Wei Y, Tu C, Duan Z. Targeting mutant TP53 as a potential therapeutic strategy for the treatment of osteosarcoma. J Orthop Res 2019; 37:789-798. [PMID: 30667081 DOI: 10.1002/jor.24227] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 01/08/2019] [Indexed: 02/05/2023]
Abstract
Mutant TP53 is a promising therapeutic target in cancers. Considering the current challenges facing the clinical treatment of cancer, as well as the urgent need to identify novel therapeutic targets in osteosarcomas, we aimed to evaluate the clinical significance of mutant TP53 in osteosarcoma patients and to explore the therapeutic effect of targeting mutant TP53 in osteosarcomas. We performed a meta-analysis to investigate the relationship between mutant TP53 and the overall survival of patients with osteosarcoma. A CRISPR-Cas9 system and a TP53 inhibitor, NSC59984, were also used to specifically knock-out and inhibit mutant TP53 in the human osteosarcoma cell lines, KHOS, and KHOSR2. The meta-analysis demonstrated that mutations in the TP53 gene could be used to predict a poor 2-year survival in osteosarcoma patients. We also demonstrated that the expression of mutant TP53 in human osteosarcoma cell lines can be efficiently knocked-out using CRISPR-Cas9, and this decreased the proliferation, migration, and tumor formation activity of these osteosarcoma cells. Moreover, drug sensitivity to doxorubicin was increased in these TP53 knock-out osteosarcoma cells. NSC59984 also showed similar anti-tumor effects as CRISPR-Cas9 targeted TP53 in the osteosarcoma cells in vitro. We have also demonstrated that the knock-out or inhibition of mutant TP53 decreased the expression of the oncogene IGF-1R, anti-apoptotic proteins Bcl-2, and Survivin in osteosarcoma cells. Collectively, these results suggest that mutant TP53 is a promising therapeutic target in osteosarcomas. Therefore, further studies exploring novel strategies to target mutant TP53 may help improve the treatment outcomes of osteosarcoma patients in the clinic. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
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Affiliation(s)
- Fan Tang
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, P. R. China.,State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center, Chengdu, Sichuan, 610041, P. R. China.,Sarcoma Biology Laboratory, Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, 90095
| | - Li Min
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, P. R. China.,Sarcoma Biology Laboratory, Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, 90095
| | - Nicole A Seebacher
- Sarcoma Biology Laboratory, Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, 90095
| | - Xiaoyang Li
- Sarcoma Biology Laboratory, Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, 90095
| | - Yubin Zhou
- Sarcoma Biology Laboratory, Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, 90095
| | - Francis J Hornicek
- Sarcoma Biology Laboratory, Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, 90095
| | - Yuquan Wei
- State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center, Chengdu, Sichuan, 610041, P. R. China
| | - Chongqi Tu
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, P. R. China
| | - Zhenfeng Duan
- Sarcoma Biology Laboratory, Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, 90095
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50
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Houdek MT, Rose PS, Hevesi M, Schwab JH, Griffin AM, Healey JH, Petersen IA, DeLaney TF, Chung PW, Yaszemski MJ, Wunder JS, Hornicek FJ, Boland PJ, Sim FH, Ferguson PC. Low dose radiotherapy is associated with local complications but not disease control in sacral chordoma. J Surg Oncol 2019; 119:856-863. [PMID: 30734292 DOI: 10.1002/jso.25399] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 01/20/2019] [Accepted: 01/23/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND We reviewed the disease control and complications of the treatment of sacrococcygeal chordoma from four tertiary cancer centers with emphasis on the effects of radiotherapy in surgically treated patients. METHODS A total of 193 patients with primary sacrococcygeal chordoma from 1990 to 2015 were reviewed. There were 124 males, with a mean age of 59 ± 15 years and a mean follow-up of 7 ± 4 years. Eighty-nine patients received radiotherapy with a mean total dose of 61.8 ± 10.9 Gy. RESULTS The 10-year disease-free and disease-specific survival was 58% and 72%, respectively. Radiation was not associated with local recurrence (hazard ratio [HR], 1.13; 95% confidence interval [CI], 0.59-2.17; P = 0.71), metastases (HR, 0.93; 95% CI, 0.45-1.91; P = 0.85) or disease-specific survival (HR, 0.96; 95% CI, 0.46-2.00; P = 0.91). Higher doses (≥70 Gy; HR, 0.52; 95% CI, 0.20-1.32; P = 0.17) may be associated with reduced local recurrence. Radiotherapy was associated with wound complications (HR, 2.76; 95% CI, 1.64-4.82;, P < 0.001) and sacral stress fractures (HR, 4.73; 95% CI, 1.88-14.38; P < 0.001). CONCLUSIONS In this multicenter review, radiotherapy was not associated with tumor outcome but associated with complications. The routine use of radiotherapy with en-bloc resection of sacrococcygeal chordomas should be reconsidered in favor of a selective, individualized approach with a radiation dose of ≥70 Gy.
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Affiliation(s)
- Matthew T Houdek
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Peter S Rose
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Mario Hevesi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Joseph H Schwab
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital, Boston, Massachusetts
| | - Anthony M Griffin
- Division of Orthopaedic Surgery, Department of Surgery, University Musculoskeletal Oncology Unit Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - John H Healey
- Orthopaedic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center and Weill College of Medicine, Cornell University, New York, New York
| | - Ivy A Petersen
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Thomas F DeLaney
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Peter W Chung
- Department of Radiation Oncology, Princess Margaret Cancer Center, Toronto, Canada
| | | | - Jay S Wunder
- Division of Orthopaedic Surgery, Department of Surgery, University Musculoskeletal Oncology Unit Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Francis J Hornicek
- Department of Orthopedic Surgery, University of California Los Angeles, Los Angeles, California
| | - Patrick J Boland
- Orthopaedic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center and Weill College of Medicine, Cornell University, New York, New York
| | - Franklin H Sim
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Peter C Ferguson
- Division of Orthopaedic Surgery, Department of Surgery, University Musculoskeletal Oncology Unit Mount Sinai Hospital, University of Toronto, Toronto, Canada
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