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Sharma AE, Dickson M, Singer S, Hameed MR, Agaram NP. GLI1 Coamplification in Well-Differentiated/Dedifferentiated Liposarcomas: Clinicopathologic and Molecular Analysis of 92 Cases. Mod Pathol 2024; 37:100494. [PMID: 38621503 DOI: 10.1016/j.modpat.2024.100494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/22/2024] [Accepted: 04/08/2024] [Indexed: 04/17/2024]
Abstract
GLI1(12q13.3) amplification is identified in a subset of mesenchymal neoplasms with a distinct nested round cell/epithelioid phenotype. MDM2 and CDK4 genes are situated along the oncogenic 12q13-15 segment, amplification of which defines well-differentiated liposarcoma (WDLPS)/dedifferentiated liposarcoma (DDLPS). The 12q amplicon can occasionally include GLI1, a gene in close proximity to CDK4. We hereby describe the first cohort of GLI1/MDM2/CDK4 coamplified WD/DDLPS. The departmental database was queried retrospectively for all cases of WD/DDLPS having undergone next-generation (MSK-IMPACT) sequencing with confirmed MDM2, CDK4, and GLI1 coamplification. Clinicopathologic data was obtained from a review of the medical chart and available histologic material. Four hundred eighty-six WD/DDLPS cases underwent DNA sequencing, 92 (19%) of which harbored amplification of the GLI1 locus in addition to that of MDM2 and CDK4. These included primary tumors (n = 60), local recurrences (n = 29), and metastases (n = 3). Primary tumors were most frequently retroperitoneal (47/60, 78%), mediastinal (4/60, 7%), and paratesticular (3/60, 5%). Average age was 63 years, with a male:female ratio of 3:2. The cohort was comprised of DDLPS (86/92 [93%], 6 of which were WDLPS with early dedifferentiation) and WDLPS without any longitudinal evidence of dedifferentiation (6/92, 7%). One-fifth (13/86, 17%) of DDLPS cases showed no evidence of a well-differentiated component in any of the primary, recurrent, or metastatic specimens. Dedifferentiated areas mostly showed high-grade undifferentiated pleomorphic sarcoma-like (26/86,30%) and high-grade myxofibrosarcoma-like (13/86,16%) morphologies. A disproportionately increased incidence of meningothelial whorls with/without osseous metaplasia was observed as the predominant pattern in 16/86 (19%) cases, and GLI1-altered morphology as described was identified in a total of 10/86 (12%) tumors. JUN (1p32.1), also implicated in the pathogenesis of WD/DDLPS, was coamplified with all 3 of MDM2, CDK4, and GLI1 in 7/91 (8%) cases. Additional loci along chromosomal arms 1p and 6q, including TNFAIP3, LATS1, and ESR1, were also amplified in a subset of cases. In this large-scale cohort of GLI1 coamplified WD/DDLPS, we elucidate uniquely recurrent features including meningothelial whorl-like and GLI-altered morphology in dedifferentiated areas. Assessment of tumor location (retroperitoneal or mediastinal), identification of a well-differentiated liposarcoma component, and coamplification of other spatially discrete genomic segments (1p and 6q) might aid in distinction from tumors with true driver GLI1 alterations.
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Affiliation(s)
- Aarti E Sharma
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Pathology, Hospital for Special Surgery, New York, New York
| | - Mark Dickson
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Samuel Singer
- Department of Surgical Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Meera R Hameed
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Narasimhan P Agaram
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
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Yu Z, Li R, Yuan Z, Ye J, He P, Li P, Sun Y, Zhao X. Identification of predictors for short-term recurrence: comprehensive analysis of 296 retroperitoneal liposarcoma cases. World J Surg Oncol 2024; 22:46. [PMID: 38321480 PMCID: PMC10845741 DOI: 10.1186/s12957-024-03328-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 01/30/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND The short-term (≤ 1 year) recurrence (STR) is the primary determinant impacting both the life quality and survival duration in patients who have undergone surgical resection for retroperitoneal liposarcoma (RPLS), a condition with intricate and ambiguous pathogenesis. The purpose of this study was to analyze the risk factors associated with STR in cases of RPLS and primary retroperitoneal liposarcoma (PRPLS). METHODS For this retrospective observational study, a total of 296 RPLS cases were selected as research subjects, who experienced tumor recurrence during the follow-up period. The Local recurrence-free survival (LRFS) rates were estimated using the Kaplan-Meier method and subsequently compared between groups utilizing the log-rank test. The subsequent analyses involved univariate and multivariate logistic regression to identify predictors of STR in RPLS cases. Additionally, a logistic regression model was constructed for PRPLS. RESULTS The 1-, 3-, and 5-year LRFS rates of the 296 RPLS cases were 51.7%, 16.9%, and 7.1%, respectively. In the univariate analysis, several factors were found to be associated with STR, including preoperative neutrophil/lymphocyte ratio (NLR), smoking history, surgical frequency, combined organ excision, operative time, intraoperative bleeding, transfer to the intensive care unit (ICU), multiple primary tumors, tumor shape and capsule characteristics, histological subtype, and presence of tumor necrosis. The elevated preoperative NLR, surgical frequency of ≥ 3 times, transfer to the ICU, presence of multiple primary tumors, and tumor necrosis were identified as independent risk factors for STR in surgically resected RPLS. Conversely, diabetes, intact tumor capsule, and well-differentiated histological subtype appeared to be independent protective factors. Analysis for PRPLS revealed that tumor capsule and tumor necrosis were independent predictors of STR. CONCLUSIONS The elevated preoperative NLR, surgical frequency of ≥ 3 times, transfer to the ICU, presence of multiple primary tumors, tumor necrosis, and tumor capsule were expected to serve as predictive factors of STR for surgical resected RPLS and PRPLS.
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Affiliation(s)
- Zhiyuan Yu
- Medical School of Chinese PLA, Beijing, China
- Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing, China
- School of Medicine, Nankai University, Tianjin, China
| | - Rui Li
- Medical School of Chinese PLA, Beijing, China
- Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing, China
- School of Medicine, Nankai University, Tianjin, China
| | - Zhen Yuan
- Medical School of Chinese PLA, Beijing, China
- Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing, China
- School of Medicine, Nankai University, Tianjin, China
| | - Jiahu Ye
- Outpatient Department of Hongshankou, Jingbei Medical District, Chinese PLA General Hospital, Beijing, China
| | - Ping He
- Medical School of Chinese PLA, Beijing, China
- Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing, China
- School of Medicine, Nankai University, Tianjin, China
| | - Peiyu Li
- Medical School of Chinese PLA, Beijing, China
- Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing, China
- School of Medicine, Nankai University, Tianjin, China
| | - Yan Sun
- Department of General Surgery, Second Affiliated Hospital of Harbin Medical University, Heilongjiang Province, Harbin, China.
| | - Xudong Zhao
- Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing, China.
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Deng H, Gao J, Xu X, Liu G, Song L, Pan Y, Wei B. Predictors and outcomes of recurrent retroperitoneal liposarcoma: new insights into its recurrence patterns. BMC Cancer 2023; 23:1076. [PMID: 37936091 PMCID: PMC10631151 DOI: 10.1186/s12885-023-11586-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 10/29/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND The clinical profiles of recurrent retroperitoneal liposarcoma (RLS) need to be explored. The recurrence patterns of RLS are controversial and ambiguous. METHODS A total of 138 patients with recurrent RLS were finally recruited in the study. The analysis of overall survival (OS) and recurrence-free survival (RFS) was performed by Kaplan‒Meier analysis. To identify independent prognostic factors, all significant variables on univariate Cox regression analysis (P ≤ 0.05) were subjected to multivariate Cox regression analysis. The corresponding nomogram model was further built to predict the survival status of patients. RESULTS Among patients, the 1-, 3-, and 5-year OS rates were 70.7%, 35.9% and 30.9%, respectively. The 1-, 3- and 5-year RFS rates of the 55 patients who underwent R0 resection were 76.1%, 50.8% and 34.4%, respectively. The multivariate analysis revealed that resection method, tumor size, status of pathological differentiation, pathological subtypes and recurrence pattern were independent risk factors for OS or RFS. Patients with distant recurrence (DR) pattern usually had multifocal tumors (90.5% vs. 74.7%, P < 0.05); they were prone to experience changes of pathological differentiation (69.9% vs. 33.3%, P < 0.05) and had a better prognosis than those with local recurrence (LR) pattern. R0 resection and combined organ resection favored the survival of patients with DR pattern in some cases. CONCLUSIONS Patients with DR pattern had better prognosis, and they may benefit more from aggressive combined resection than those with LR pattern. Classifying the recurrence patterns of RLS provides guidance for individualized clinical management of recurrent RLS.
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Affiliation(s)
- Huan Deng
- Department of Gastrointestinal Surgery, Peking University First Hospital, Beijing, 100034, China
- Department of General Surgery, the First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, 100853, China
| | - Jingwang Gao
- Department of General Surgery, the First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, 100853, China
| | - Xingming Xu
- Department of General Surgery, the First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, 100853, China
| | - Guibin Liu
- Department of General Surgery, the First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, 100853, China
| | - Liqiang Song
- Department of General Surgery, the First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, 100853, China
| | - Yisheng Pan
- Department of Gastrointestinal Surgery, Peking University First Hospital, Beijing, 100034, China.
| | - Bo Wei
- Department of General Surgery, the First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, 100853, China.
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Lawless A, Zhou DDX, McDonough J, Lo H, Mar J, Lazarakis S, Ward I, Connor J, Thompson SR, Coker D, Johnston A, Gyorki DE, Hong AM. The role of radiation therapy in the management of primary retroperitoneal sarcoma: A systematic review and clinical practice guidelines from the Australia and New Zealand Sarcoma Association. Cancer Treat Rev 2023; 120:102620. [PMID: 37657126 DOI: 10.1016/j.ctrv.2023.102620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 08/25/2023] [Accepted: 08/28/2023] [Indexed: 09/03/2023]
Abstract
While surgery is the mainstay of treatment for localised retroperitoneal sarcoma, the use of radiotherapy (RT) remains controversial. This systematic review aimed to evaluate the role of RT for retroperitoneal sarcoma. A systematic review using the population, intervention, comparison, and outcome model from 1990 to 2022 identified 66 studies (a mixture of preoperative and postoperative RT); one randomised controlled trial (RCT) with two publications, 18 registry studies, and 46 retrospective studies. In the RCT of preoperative RT, there was no difference in local/abdominal recurrence. The pooled analysis of this RCT and a retrospective study showed a significant abdominal recurrence free survival benefit with preoperative RT in low grade liposarcoma. The RCT and the majority of retrospective series found RT did not improve recurrence free survival (11 of 16 no difference in combined local and distant RFS, 11 of 13 no difference in distant metastasis free survival), disease specific survival (9 of 12 studies) or overall survival (33 of 49 studies). The majority of studies found no association between RT and perioperative morbidity. In summary, preoperative RT may improve local control for low grade (well-differentiated or grades 1-2 dedifferentiated) liposarcoma, but not other histological subtypes. There is no strong evidence that perioperative RT provides an overall survival benefit. Patients with low grade retroperitoneal liposarcoma can be considered for preoperative RT to improve abdominal recurrence free survival. The rationale and level of evidence in this scenario should be carefully discussed by the multidisciplinary team with patients. RT should not be routinely recommended for other histological subtypes.
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Affiliation(s)
- Anna Lawless
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Australia; Department of Radiation Oncology, Chris O'Brien Lifehouse, Camperdown, NSW 2050, Australia
| | - Deborah Di-Xin Zhou
- NHMRC Clinical Trials Centre, The University of Sydney, NSW 2006, Australia; Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, NSW 2050, Australia
| | - Joshua McDonough
- Mental Health and Suicide Prevention Research and Education Group, Clinical and Health Sciences, University of South Australia, Adelaide, SA 5000, Australia
| | - Helen Lo
- Department of Radiation Oncology, Chris O'Brien Lifehouse, Camperdown, NSW 2050, Australia
| | - Jasmine Mar
- Australia and New Zealand Sarcoma Association, Parkville, Victoria 3010, Australia
| | - Smaro Lazarakis
- Health Sciences Library, Royal Melbourne Hospital, Parkville, Victoria 3010, Australia
| | - Iain Ward
- Christchurch Hospital, Christchurch 8011, New Zealand
| | - Joanna Connor
- Te Pūriri o Te Ora, Auckland City Hospital, 2 Park Road, Grafton, Auckland 1023, New Zealand
| | - Stephen R Thompson
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, NSW 2031, Australia; School of Clinical Medicine, UNSW Sydney, Randwick Clinical Campus, Australia
| | - David Coker
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Australia; Department of Melanoma and Surgical Oncology, and Upper Gastrointestinal Surgery, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia
| | - Andrew Johnston
- North Island Sarcoma Service, Auckland City Hospital, Auckland 1023, New Zealand
| | - David E Gyorki
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC 3000, Australia
| | - Angela M Hong
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Australia; Department of Radiation Oncology, Chris O'Brien Lifehouse, Camperdown, NSW 2050, Australia.
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Deng H, Xu X, Gao J, Huang J, Liu G, Song L, Wei B. Predictors and outcomes of recurrent retroperitoneal liposarcoma with multiple tumors. Front Med (Lausanne) 2023; 10:1161494. [PMID: 37746091 PMCID: PMC10514494 DOI: 10.3389/fmed.2023.1161494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 08/29/2023] [Indexed: 09/26/2023] Open
Abstract
Background Retroperitoneal liposarcoma (RLS) is a rare but severe disease. Repeated postoperative recurrence with multiple tumors is a therapeutic dilemma. The clinical outcomes and survival predictors of recurrent RLS with multiple tumors remain to be explored. Methods Patients with recurrent RLS were retrospectively analyzed. Univariate and multivariate analysis was performed to find independent prognostic factors that were correlated with Overall survival (OS) or progression-free survival (PFS). Factors significant in univariate analysis were further included into multivariate Cox proportional hazards regression model. The nomogram model was built to predict the survival status of patients. Variables that were significant in multivariable analysis were added to the internally validated nomogram models. The analysis of OS and PFS was performed by Kaplan-Meier analysis and log-rank test. Results A total of 113 recurrent RLS patients with multiple tumors were enrolled in the study. The 1-, 3-, and 5-years OS (PFS) rates were 70.7% (76.1%), 35.9% (76.1%), and 30.9% (76.1%), respectively. Univariate and multivariate analyses showed that number of surgeries, resection methods, tumor size, status of pathological differentiation, pathological subtypes, and recurrence patterns were important prognostic factors for OS or PFS (each p < 0.05). Nomogram models were established to efficiently predict the prognostic status of patients. Patients with the local recurrence (LR) pattern had a poor prognosis and would derive no survival benefit from combined organ resection and R0/R1 resection (each p < 0.05). Conclusion RLS patients recurrence with multiple tumors had a poor prognosis. Those patients should be followed up more frequently after surgery. The strategies of aggressive resection may not improve the survival of patients with LR pattern in the retroperitoneum. Prognostic factors in the efficient nomogram models should be considered in the individualized clinical management of recurrent RLS with multiple tumors.
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Affiliation(s)
- Huan Deng
- Department of Gastrointestinal Surgery, Peking University First Hospital, Beijing, China
- Department of General Surgery, The First Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Xingming Xu
- Department of General Surgery, The First Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Jingwang Gao
- Department of General Surgery, The First Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Jun Huang
- Department of General Surgery, The First Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Guibin Liu
- Department of General Surgery, The First Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Liqiang Song
- Department of General Surgery, The First Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Bo Wei
- Department of General Surgery, The First Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China
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Qiu M, Lin DR, Xiong ZK. Survival of a patient with five recurrences of retroperitoneal liposarcoma over a period of 13 years: A case report and review. Oncol Lett 2023; 26:367. [PMID: 37559572 PMCID: PMC10407717 DOI: 10.3892/ol.2023.13953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/28/2023] [Indexed: 08/11/2023] Open
Abstract
Retroperitoneal liposarcoma (RPLS) is a rare tumor that occurs in the retroperitoneal region and accounts for ~0.2% of all malignant tumor incidence. The present study describes the treatment of a surviving patient with RPLS that recurred five times in 13 years. This case has a long survival time and numerous relapses, which is a rare occurrence. The 40-year-old female patient was admitted to Shaoxing Second Hospital (Shaoxing, China) with an abdominal mass. Abdominal computed tomography (CT) scan revealed multiple liposarcoma recurrences in the abdominal, pelvic and retroperitoneal areas. As the diagnosis of RPLS was the fifth recurrence, cytoreductive surgery was performed and post-operative pathology suggested mixed liposarcoma. The patient underwent six cycles of doxorubicin and ifosfamide regimen chemotherapy and targeted therapy with anlotinib following surgery; no evidence of disease progression was found on abdominal CT scan during follow-up. The present study also reviewed the literature in terms of the clinical diagnosis, treatment, pathological characteristics and similar cases of liposarcoma with the aim of improving diagnosis and treatment.
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Affiliation(s)
- Miao Qiu
- Department of Tumor Radiotherapy, Shaoxing Second Hospital, Shaoxing, Zhejiang 312000, P.R. China
| | - De-Rong Lin
- Department of Tumor Radiotherapy, Shaoxing Second Hospital, Shaoxing, Zhejiang 312000, P.R. China
| | - Zhong-Kui Xiong
- Department of Tumor Radiotherapy, Shaoxing Second Hospital, Shaoxing, Zhejiang 312000, P.R. China
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Yu Z, Zhao X, Gao J, Zhou S, Li P, Liu N. Correlation Analysis Between Demographic, Surgical, and Pathological Characteristics with Local Recurrence-Free Survival for Surgical Resected Retroperitoneal Liposarcoma. World J Surg 2023; 47:1946-1955. [PMID: 37071133 DOI: 10.1007/s00268-023-07009-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND As the leading cause of mortality for retroperitoneal liposarcoma (RPLS) cases, postoperative recurrence has complicated and unclear risk factors. This study was conducted to explore the correlations between demographic, surgical, and pathological characteristics with local recurrence-free survival (LRFS) for surgical resected RPLS. METHODS RPLS cases that underwent radical operation were considered to be included in this analysis. LRFS rates were estimated based on the Kaplan-Meier method and were compared between groups by the log-rank test. Cox proportional hazard regression models were constructed to identified the predictors of LRFS. Subsequently, the independent predictors acquired from multivariate analyses were used to construct a nomogram. RESULTS 348 RPLS cases who underwent radical operation were included. Of the 348 cases, 333 had tumor recurrence or with a follow-up period ≥5 years. Thus, 296 (88.9%) of the 333 cases had recurrent disease, and the median LRFS duration of 296 recurrence cases was 17.0 (95% confidence interval (CI) 13.2-20.8) months. Multivariate analysis identified the preoperative neutrophil/lymphocyte ratio (NLR), surgical frequency, operative time, tumor shape, histological subtype, and tumor necrosis as independent predictors of LRFS. Based on above independent predictors, a nomogram was constructed to predict the 1-, 3-, and 5-year LRFS of surgical resected RPLS. CONCLUSION Elevated preoperative NLR, ≥2nd time surgical frequency, extended operation time, irregular tumor shape, no well-differentiated histological subtype, and tumor necrosis could be used as predictors of LRFS for surgical resected RPLS.
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Affiliation(s)
- Zhiyuan Yu
- School of Medicine, Nankai University, Tianjin, China
- Medical School of Chinese PLA, Beijing, China
- Senior Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
| | - Xudong Zhao
- Senior Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
| | - Jingwang Gao
- Medical School of Chinese PLA, Beijing, China
- Senior Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
| | - Sixin Zhou
- Senior Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
| | - Peiyu Li
- School of Medicine, Nankai University, Tianjin, China.
- Medical School of Chinese PLA, Beijing, China.
- Senior Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China.
| | - Na Liu
- Medical School of Chinese PLA, Beijing, China.
- Senior Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China.
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Bettoli P, Liu Z, Jara N, Bakal F, Wong W, Terlizzi M, Sargos P, Zilli T, Thariat J, Sole S, Ploussard G, Goyal S, Chung P, Berlin A, Sole C. Primary Bladder Sarcoma: A multi-institutional experience from the Rare Cancer Network. Arch Ital Urol Androl 2023; 95:11533. [PMID: 37491942 DOI: 10.4081/aiua.2023.11533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 07/01/2023] [Indexed: 07/27/2023] Open
Abstract
PURPOSE OR OBJECTIVE Primary sarcoma of the urinary bladder (SUB) is a rare but aggressive form of bladder cancer (BCa). Available evidence on SUB is limited to case reports and small series. The aim of the present multi-institutional study was to assess the clinical features, treatments, and outcomes of patients with SUB. MATERIALS AND METHODS Using a standardized database, 7 institutions retrospectively collected the demographics, risk factors, clinical presentation, treatment modalities and follow-up data on patients with SUB between January 1994 and September 2021. The main inclusion criteria included BCa with soft tissue tumor histology and sarcomatoid differentiation. RESULTS Fifty-three patients (38 men and 15 women) were identified. Median follow-up was 18 months (range 1-263 months). Median age at presentation was 69 years (range 16-89 years). Twenty-six percent of patients had a prior history of pelvic radiotherapy (RT), and 37% were previous smokers. The main presenting symptoms at diagnosis were hematuria (52%), pelvic pain (27%), and both hematuria and pelvic pain (10%). American Joint Committee on Cancer (AJCC) 8 th edition stage II, III and IV at diagnosis were 21%, 63% and 16%, respectively. Treatment modalities included surgery alone (45%), surgery plus neo- or adjuvant-chemotherapy (17%), surgery plus neo- or adjuvant-RT (11%), RT with concurrent chemotherapy (4%), neo-adjuvant chemotherapy plus surgery plus adjuvant RT (2%) and palliative treatment (21%). Rates of local and distant recurrences were 49% and 37%, respectively. Five-year overall survival and progression-free survival (PFS) were 66.5% and 37.6%, respectively. No statistically significant differences in PFS between the treatment modalities were observed. CONCLUSIONS Primary SUB is a heterogeneous disease group, commonly presenting at advanced stages and exhibiting aggressive disease evolution. In contrast to urothelial carcinoma, the primary pattern of recurrence of SUB is local, suggesting the need for multimodal approaches. Continuous international collaborative efforts seem warranted to provide guidance on how to best tailor treatments based on SUB-specific indices.
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Affiliation(s)
- Piero Bettoli
- Department of Radiation Oncology, Fundación Arturo López Pérez, Santiago; Facultad de Medicina, Universidad de Los Andes, Santiago.
| | - ZhihuiAmy Liu
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON.
| | - Natalia Jara
- Department of Radiation Oncology, Instituto de Radiomedicina, Santiago.
| | - Federico Bakal
- Department of Radiation Oncology, Fundación Arturo López Pérez, Santiago.
| | - William Wong
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix.
| | - Mario Terlizzi
- Department of Radiation Oncology, Institute Bergonie, Bordeaux.
| | - Paul Sargos
- Department of Radiation Oncology, Institute Bergonie, Bordeaux.
| | - Thomas Zilli
- Department of Radiation Oncology, Geneva University Hospital, Geneva.
| | - Juliette Thariat
- Department of Radiation Therapy, Centre Francoise Baclese, Caen.
| | - Sebastian Sole
- Department of Radiation Oncology, Instituto de Radiomedicina, Santiago; Facultad de Medicina, Universidad Diego Portales, Santiago.
| | | | - Sharad Goyal
- Department of Radiation Oncology, George Washington University Hospital, Washington DC.
| | - Peter Chung
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON.
| | - Alejandro Berlin
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON.
| | - Claudio Sole
- Department of Radiation Oncology, Instituto de Radiomedicina, Santiago; Facultad de Medicina, Universidad Diego Portales, Santiago.
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Jo SJ, Park SSW, Yoo GS, Kim KD, Lim SH, Kim J, Kim MJ, Yu JI, Park JB, Lee KW. Effect of pre-operative radiation therapy on surgical outcome in retroperitoneal sarcoma. Front Surg 2023; 10:1209698. [PMID: 37377670 PMCID: PMC10291121 DOI: 10.3389/fsurg.2023.1209698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
Background A high rate of locoregional recurrence is one of the major difficulties in successful treatment of retroperitoneal sarcoma (RPS). Although pre-operative radiation therapy (RT) is considered a potential way to improve local recurrence, concerns about the associated treatment toxicity and risk of peri-operative complications need to be addressed. Hence, this study investigates the safety of pre-operative RT (preRTx) for RPS. Methods A cohort of 198 patients with RPS who had undergone both surgery and RT was analyzed for peri-operative complications. They were divided into three groups according to the RT scheme: (1) preRTx group, (2) post-operative RT without tissue expander, and (3) post-operative RT with tissue expander. Results The preRTx was overall well tolerated and did not affect the R2 resection rate, operative time, and severe post-operative complications. However, the preRTx group was associated with higher incidence of post-operative transfusion and admission to intensive care unit (p = 0.013 and p = 0.036, respectively), where preRTx was an independent risk factor only for the post-operative transfusion (p = 0.009) in multivariate analysis. The median radiation dose was the highest in preRTx group, although no significant difference was demonstrated in overall survival and local recurrence rate. Conclusion This study suggests that the preRTx does not add significant post-operative morbidity to the patients with RPS. In addition, radiation dose elevation is achievable with the pre-operative RT. However, a meticulous intra-operative bleeding control is recommended in those patients, and further high-quality trials are warranted to evaluate the long-term oncological outcomes.
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Affiliation(s)
- Sung Jun Jo
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sean S W Park
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Gyu Sang Yoo
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyeong Deok Kim
- Department of Surgery, Inha University Hospital, Inha University School of Medicine, Incheon, Republic of Korea
| | - So Hee Lim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jinseob Kim
- Department of Epidemiology, School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Min Jung Kim
- Department of Surgery, Seoul Medical Center, Seoul, Republic of Korea
| | - Jeong Il Yu
- Department of Surgery, Seoul Medical Center, Seoul, Republic of Korea
| | - Jae Berm Park
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyo Won Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Yu ZY, Gao JW, Liu N, Zhou SX, Zhao XD, Li PY. Predictive factors and a novel nomogram for recurrence of primary retroperitoneal liposarcoma: Comprehensive analysis of 128 cases. Oncol Lett 2023; 25:257. [PMID: 37485421 PMCID: PMC10360145 DOI: 10.3892/ol.2023.13843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 04/17/2023] [Indexed: 07/25/2023] Open
Abstract
Since primary retroperitoneal liposarcoma (PRPLS) is rare in the clinic, related clinical studies are lacking. The present study was designed to investigate the predictive factors of short-term (≤1 year) recurrence (STR) and construct a novel nomogram of local recurrence-free survival (LRFS) for surgically resected PRPLS. A total of 128 PRPLS cases who underwent radical surgery were retrospectively analyzed. Based on the interval from the operation to tumor recurrence, the predictors of STR were screened using univariate and multivariate logistic regression analyses. Cox proportional hazard regression models were applied to identify the predictors of LRFS. Furthermore, the independent predictors acquired from multivariate analyses were used to construct a nomogram. Multivariate logistic regression analysis revealed that age ≥55 years [odds ratio (OR)=5.607, P=0.010], operative time ≥260 min (OR=9.716, P=0.005) and tumor necrosis (OR=3.781, P=0.037) were independent risk factors of STR for PRPLS. In the Cox regression analysis, clinical symptoms [hazard ratio (HR)=1.746, P=0.017], resection method (OR=0.370, P=0.021) and de-differentiated histological subtype (HR=1.975, P=0.048) were identified as independent predictors of LRFS. Subsequently, the independent predictors acquired from multivariate analyses were used to construct a nomogram for LRFS. Age, operative time, tumor necrosis, clinical symptoms, resection method and histological subtype were related to recurrence for surgically resected PRPLS and a novel nomogram was constructed based on the above predictors.
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Affiliation(s)
- Zhi-Yuan Yu
- School of Medicine, Nankai University, Tianjin 300071, P.R. China
- Medical School of Chinese People's Liberation Army, Beijing 100853, P.R. China
- Department of General Surgery, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing 100853, P.R. China
| | - Jing-Wang Gao
- Medical School of Chinese People's Liberation Army, Beijing 100853, P.R. China
- Department of General Surgery, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing 100853, P.R. China
| | - Na Liu
- Medical School of Chinese People's Liberation Army, Beijing 100853, P.R. China
- Department of General Surgery, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing 100853, P.R. China
| | - Si-Xin Zhou
- Department of General Surgery, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing 100853, P.R. China
| | - Xu-Dong Zhao
- Department of General Surgery, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing 100853, P.R. China
| | - Pei-Yu Li
- School of Medicine, Nankai University, Tianjin 300071, P.R. China
- Medical School of Chinese People's Liberation Army, Beijing 100853, P.R. China
- Department of General Surgery, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing 100853, P.R. China
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11
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Paik B, Seo CJ, Tan JWS, Juan WKD, Soo KC, Ong CAJ, Chia CS, Wong JSM. A systematic review of margin status in retroperitoneal liposarcomas: Does the R0 margin matter? Front Oncol 2022; 12:891710. [PMID: 36033535 PMCID: PMC9404241 DOI: 10.3389/fonc.2022.891710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
Retroperitoneal liposarcomas (RPLPSs) are a rare tumor group for which current guidelines recommend aggressive en bloc resection to attain microscopically negative (R0) margins. To ensure R0 margins, resection of adherent or adjacent organs is often required. However, it is still unclear if R0 margins confer any additional benefit to patients over a grossly negative but microscopically positive (R1) margin. We performed a systematic search of PubMed and Embase databases for studies including patients receiving R0 or R1 resection for RPLPS. Nine retrospective cohort studies, one prospective cohort study, and 49 case reports/case series were included. A total of 552 patients with RPLPS were evaluated: 346 underwent R0 resection and 206 underwent R1 resection. In the R0 group, 5-year overall survival (OS) ranged from 58.3% to 85.7%; local recurrence (LR) ranged from 45.5% to 52.3%. In the R1 group, 5-year OS ranged from 35% to 55.3%; LR ranged from 66.7% to 91.7%. Among cohort studies, OS, disease-free survival (DFS), LR rate, and LR-free survival (LRFS) were significantly associated with R0 resections. Assessment of case series and reports suggested that the R0 margin led to a slightly higher morbidity than that of R1. In conclusion, this review found the R0 margin to be associated with reductions in LR rates and improved OS when compared with the R1 margins, though accompanied by slight increases in morbidity. The roles of tumor histotype and perioperative chemotherapy or radiotherapy were not well-elucidated in this review.
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Affiliation(s)
- Benjamin Paik
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Chin Jin Seo
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore
- Sing Health Duke-NUS Surgery Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Joey Wee-Shan Tan
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore
- Laboratory of Applied Human GenetiCJS, Division of Medical Sciences, National Cancer Centre Singapore, Singapore, Singapore
| | - Wen Kai Darryl Juan
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore
| | - Khee Chee Soo
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore
| | - Chin-Ann Johnny Ong
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore
- Sing Health Duke-NUS Surgery Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- Laboratory of Applied Human GenetiCJS, Division of Medical Sciences, National Cancer Centre Singapore, Singapore, Singapore
- Sing Health Duke-NUS Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- Institute of Molecular and Cell Biology, ASTAR Research Entities, Singapore, Singapore
| | - Claramae Shulyn Chia
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore
- Sing Health Duke-NUS Surgery Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- Sing Health Duke-NUS Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Jolene Si Min Wong
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore
- Sing Health Duke-NUS Surgery Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- Sing Health Duke-NUS Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- *Correspondence: Jolene Si Min Wong, j
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12
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Villano AM, Farma JM. ASO Author Reflections: Retroperitoneal Soft Tissue Sarcoma: A Call for Collaboration and Scientific Inquiry. Ann Surg Oncol 2021; 29:2286-2287. [PMID: 34657199 DOI: 10.1245/s10434-021-10914-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 09/16/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Anthony M Villano
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.
| | - Jeffrey M Farma
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
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13
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Villano AM, Vidri RJ, Vo ET, Greco SH, Howell KJ, von Mehren M, Farma JM. National Trends in Treatment for Retroperitoneal Soft Tissue Sarcoma: A Modern Appraisal of Variability in Therapeutic Strategies. Ann Surg Oncol 2021; 29:2275-2285. [PMID: 34635978 DOI: 10.1245/s10434-021-10908-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/31/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Little level 1 evidence exists to guide multimodality treatment in retroperitoneal soft tissue sarcoma (RPS), which may lead to significant variation in therapeutic approaches. This analysis aimed to describe national RPS treatment trends and explore potential variability among low-/high-volume hospitals (LVH/HVHs). PATIENTS AND METHODS In total, 5992 patients who underwent resection for primary RPS were retrospectively identified in the National Cancer Database (2004-2017). Time trend analyses examined rates of multivisceral resection (MVR), radiation, and chemotherapy use. LVHs were defined as those carrying out fewer than ten resections per year (N = 5433), whereas HVHs were defined as those carrying out ten or more (N = 559). Descriptive statistics and logistic regression models compared trends between groups. RESULTS MVR was more frequent at HVHs (63.7% versus 43.5%, p < 0.001). Use of radiation varied widely by hospital volume. HVHs more frequently employed preoperative radiation as compared with LVHs (14.7% versus 8.1%, p < 0.001). Throughout the study period, LVHs increased utilization of preoperative radiation (2.6% to 12.0%, p < 0.001) whereas rates at HVHs remained stable. Overall, LVHs utilized postoperative radiation significantly more frequently as compared with HVHs (14.7% versus 2.7%, respectively, p < 0.001). Postoperative radiation at LVHs remained stable until 2013 and sharply declined thereafter (16.7% to 6.9%, p < 0.001). Rates of postoperative radiation use at HVHs remained lower than those at LVHs at all time points. CONCLUSIONS Strategies for resection and radiation use at LVHs have trended towards those of HVHs. Current national implementation of preoperative radiation, MVR, and chemotherapy remains heterogeneous. These findings inform future trial design and support standardization of care.
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Affiliation(s)
- Anthony M Villano
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.
| | - Roberto J Vidri
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Elaine T Vo
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Stephanie H Greco
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Krisha J Howell
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Margaret von Mehren
- Department of Hematology and Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Jeffrey M Farma
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
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14
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Cheung KT, Mitchell C, Wong E. Retroperitoneal liposarcoma in a nonagenarian. AUTOPSY AND CASE REPORTS 2020; 11:e2020224. [PMID: 34277489 PMCID: PMC8101656 DOI: 10.4322/acr.2020.224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 08/09/2020] [Indexed: 12/19/2022] Open
Abstract
Retroperitoneal liposarcomas are rare tumors arising from the soft tissue of the retroperitoneum and are of mesenchymal cell origin. They can reach a large size prior to causing symptoms and generally have a poor prognosis. We present the case of a 93-year-old lady presenting with a large retroperitoneal liposarcoma at the site of a previous colonic anastomosis for the adenocarcinoma treatment. It caused minimal symptoms initially, but surgical resection was undertaken when the tumor was found to be growing significantly in size. However, due to the tumor's location and its invasion into surrounding structures, the resection was not feasible and subsequently abandoned. A retroperitoneal liposarcoma arising from the site of a previous colonic resection has not been previously described. A review of the diagnosis and current management of these lesions is also given.
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Affiliation(s)
- King Tung Cheung
- Monash University, Eastern Health Clinical School, Box Hill, Victoria, Australia
| | - Catherine Mitchell
- Peter MacCallum Cancer Centre, Department of Pathology, Melbourne, Victoria, Australia
| | - Enoch Wong
- Monash University, Eastern Health Clinical School, Box Hill, Victoria, Australia
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15
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Hwang H, Kwon YH, Lim HK, Kim J, Park KJ. Retroperitoneal sarcomas: Outcomes of repeated resections. KOREAN JOURNAL OF CLINICAL ONCOLOGY 2020; 16:96-103. [PMID: 36945717 PMCID: PMC9942735 DOI: 10.14216/kjco.20015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 08/18/2020] [Accepted: 11/18/2020] [Indexed: 11/07/2022]
Abstract
Purpose Retroperitoneal sarcomas (RPS) are rare malignant tumors arising from mesenchymal cells. The objective of this study was to review the treatment experiences and to identify prognostic factors for overall survival (OS) after primary resection and subsequent reoperations for recurrences. Methods The medical records of patients who underwent resection for RPS at our institution between June 2002 and December 2016 were retrospectively reviewed. Univariate and multivariable Cox proportional hazards modeling was used to assess the prognostic factors for OS. Results A total of 48 patients were enrolled. On multivariable analysis in primary resection group, the FNCLCC (Fédération Nationale des Centres de Lutte Contre le Cancer) grade was a significant prognostic factor for OS (P=0.006). The patients who received chemotherapy after primary resection were significantly associated with poor prognosis (P=0.009). The 5-year OS rate after primary resection (n=48) were 58.1% and the 5-year cumulative reoperation rate after primary resection was 62.5%. After second resection for recurrence after primary resection (n=23), the 5-year OS rate was 64.3%. There was a tendency towards decreased surgery-free survival rate as the number of repeated resections for recurrent RPS increased. In the subset of patients (n=16) who underwent more than 3 repeated resections at our institute, the 5-year OS rate was 75.0%, indicating that repeated resections are not associated with worse outcome. Conclusion Only low tumor grade was an independent favorable prognostic factor for OS. Although the prognosis for RPS remains poor, repeated resections for recurrence are not associated with poor prognosis. Aggressive surgical strategies for recurred RPS patients are warranted.
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Affiliation(s)
- Hyeonuk Hwang
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Yoon-Hye Kwon
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Han-Ki Lim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jeesun Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Kyu Joo Park
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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16
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Yan Y, Xia S, Teng D, Hu S, Li S, Wang Y, Du X, Li R. Resection outcomes for primary and local recurrent retroperitoneal liposarcoma patients. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1450. [PMID: 33313195 PMCID: PMC7723604 DOI: 10.21037/atm-20-6316] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background The clinical characteristics of primary retroperitoneal liposarcoma (PR RPLPS) and local recurrent retroperitoneal liposarcoma (LR RPLPS) cases were compared to determine the related factors involved in postoperative survival. Methods A total of 90 patients who underwent surgery between 2006 and 2013 were included in this study. Clinicopathological data that was prospectively gathered was analyzed to identify factors associated with overall survival (OS) and progression-free survival (PFS). Results The PR cases showed a higher complete resection rate when compared to the LR group. The LR group showed a greater number that were poorly differentiated and highly malignant. More blood loss was observed in the LR compared to the PR group. Multivariate analysis suggested that blood loss and tumor grade were prognostic factors for OS and PFS of the PR group, but extent of resection was a prognostic factor only for OS. In the LR group, the extent of resection was a significant prognostic factor associated with OS, whereas tumor grade was associated with PFS. Conclusions Complete surgical resection is the most important factor for the survival of RPLPS patients. Tumor grade is an independent prognostic factor for PFS. In PR RPLPS, poor tumor classification and increased intraoperative bleeding are associated with a poor prognosis.
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Affiliation(s)
- Yang Yan
- Department of General Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Shaoyou Xia
- Department of General Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Da Teng
- Department of General Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Shidong Hu
- Department of General Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Songyan Li
- Department of General Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yufeng Wang
- Department of Patient Admission Management, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xiaohui Du
- Department of General Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Rong Li
- Department of General Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing, China
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What Are the Results of Resection of Localized Dedifferentiated Liposarcomas in the Extremities? Clin Orthop Relat Res 2020; 478:2550-2561. [PMID: 33112583 PMCID: PMC7594912 DOI: 10.1097/corr.0000000000001338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Dedifferentiated liposarcoma (DDLPS) is a rare malignancy that transitions from an atypical lipomatous tumor to a sarcoma with a variable morphologic appearance. The behavior of this tumor in the retroperitoneum is aggressive, but the behavior of DDLPS in the extremities is less well-defined because it is rare. Few reports have assessed the imaging features and clinical outcomes of primary DDLPS in the extremities. QUESTIONS/PURPOSES In patients with primary DDLPS of the extremity, we asked the following questions: (1) How frequently do additional primary malignancies occur in patients with DDLPS? (2) What is the rate of overall survival, metastases, and local recurrence in DDLPS? (3) What factors are associated with metastasis-free survival and local recurrence in DDLPS? METHODS We defined DDLPS as a biphasic neoplasm that transitions from an atypical lipomatous tumor (ALT) to a sarcoma of variable morphologic appearance and histologic grades. We retrospectively evaluated the medical records of patients with DDLPS of the extremities who underwent surgery in our institution between 2003 and 2017. During that time, 16 patients were treated for this diagnosis; one was excluded from this study because the patient did not have an MRI, leaving 15 patients (nine men, six women; their median [range] age was 67 years [42 to 87]) for evaluation. All had a minimum of 2 years follow-up (median [range] 54 months [25 to 136]); 14 of 15 have been seen in the last 5 years (one patient, who was doing well at the time, was lost after 9 years of follow-up). In 11 patients, MRI demonstrated two components: an ALT component with high intensity on both T1-weighed and T2-weighted sequences and a dedifferentiated component low-to-intermediate intensity on T1-weighed and heterogeneous hyperintensity on T2-weighted sequence. Nine patients were evaluated using 2-deoxy-2-18F-fluoro-D-glucose positron emission tomography (FDG-PET) combined with CT (PET/CT). PET/CT showed a biphasic pattern with a close relationship to MRI findings. The dedifferentiated component presented with high FDG uptake (median [range] maximum standardized uptake value 5.1 [1.9 to 22.6]), while the atypical lipomatous tumor component showed almost no FDG uptake. In all patients, immunohistochemical studies of p16 and cyclin-dependent kinase-4 (CDK4) were investigated. Positive staining for both p16 and CDK4 were seen in 13 of 15 patients.We retrospectively evaluated the electronic medical records of all patients in our institution for the presence of additional primary malignancies, local recurrence-free survival, metastasis-free survival, and overall survival. The survival rate was estimated using the Kaplan-Meier method. The Wilcoxon exact test was used to determine the prognostic importance of the following survival variables: age, sex, maximum tumor size, radiotherapy, and surgical margin. RESULTS Seven additional primary malignancies developed in five of 15 patients (two lung cancers, two sarcomas, one renal cell cancer, one uterine cancer, and one non-Hodgkin lymphoma). The 3- and 5-year metastasis-free survival rates were 86% (95% CI 0.67 to 1.00) and 75% (95% CI 0.49 to 1.00), respectively. With the numbers available, we found no factors associated with metastasis-free survival. The 3- and 5-year overall survival rates were 100% (95% CI 1.00 to 1.00) and 88% (95% CI 0.65 to 1.00), respectively. Three of 15 patients had local recurrence. The 3- and 5-year local recurrence-free survival rates were 86% (95% CI 0.67 to 1.00) and 75% (95% CI 0.49 to 1.00), respectively. Large (> 15 cm) tumors were more likely to have a local recurrence (p = 0.04). CONCLUSIONS In this small series, we found that the extremities are a favorable site for DDLPS compared with the retroperitoneum, although we did not directly compare the two sites. This rare tumor has a relatively high likelihood of being associated with other malignancies. We believe patients should be assessed and monitored carefully for this possibility. In the future, larger studies are needed to better define predictors of local recurrence, although the tumor's size may be associated with a greater propensity for local recurrence. LEVEL OF EVIDENCE Level II, prognostic study.
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18
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What Is the Role of Neoadjuvant Radiation Therapy for Retroperitoneal Sarcoma? Adv Surg 2020; 54:273-284. [PMID: 32713436 DOI: 10.1016/j.yasu.2020.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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19
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Zhang S, Yan L, Cui C, Wang Z, Wu J, Zhao M, Dong B, Guan X, Tian X, Hao C. Identification of TYMS as a promoting factor of retroperitoneal liposarcoma progression: Bioinformatics analysis and biological evidence. Oncol Rep 2020; 44:565-576. [PMID: 32627015 PMCID: PMC7336505 DOI: 10.3892/or.2020.7635] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 05/14/2020] [Indexed: 12/24/2022] Open
Abstract
Retroperitoneal liposarcoma (RLPS) is one of the most common types of retroperitoneal sarcomas, and has a high recurrence rate. There is an urgent need to further explore its pathogenesis and develop more effective treatment strategies. The aim of the present study was to identify potential driver genes of RLPS through bioinformatics analysis and molecular biology to elucidate potential targets that are suitable for further analysis for the treatment of RLPS. Differentially expressed genes (DEGs) between liposarcoma and normal fatty (NF) tissues were identified based on microarray data through bioinformatics analysis, and thymidylate synthase (TYMS) was selected from the DEGs, based on high content screening (HCS). TYMS expression was evaluated in RLPS tumor tissues and cell lines. A total of 21 RLPS tissues and 10 NF frozen tissues were used for reverse transcription-quantitative PCR, and 47 RLPS formalin-fixed specimens were used for immunohistochemical analysis. The effect of TYMS downregulation on cell proliferation, apoptosis, cell cycle progression, and cell migration and invasion were evaluated using lentivirus-mediated short hairpin RNA. The underlying mechanisms of TYMS in RLPS were examined by protein microarray and verified by western blotting. A total of 855 DEGs were identified. TYMS knockdown had the most notable effect on the proliferative capacity of RLPS cells according to the HCS results. TYMS mRNA expression levels were higher in RLPS tissues compared with NF tissues (P<0.001). TYMS expression was higher in high-grade RLPS tissues compared with low-grade RLPS tissues (P=0.003). The patients with positive TYMS expression had a worse overall survival (OS) and disease-free survival (DFS) compared with the patients with negative TYMS expression (OS, P=0.024; DFS, P=0.030). The knockdown of TYMS reduced proliferation, promoted apoptosis, facilitated cell cycle progression from G1 to S phase, and reduced cell migration and invasion of RLPS cells. Protein microarray analysis and western blotting showed that the Janus Kinase/Signal transducers and activators of transcription pathway was downregulated following TYMS knockdown. In conclusion, TYMS expression is upregulated in RLPS tissues, and downregulation of TYMS reduces RLPS progression.
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Affiliation(s)
- Sha Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Hepato‑Pancreato‑Biliary Surgery, Peking University Cancer Hospital and Institute, Beijing 100142, P.R. China
| | - Liang Yan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Hepato‑Pancreato‑Biliary Surgery, Peking University Cancer Hospital and Institute, Beijing 100142, P.R. China
| | - Can Cui
- Department of Breast Oncology, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, P.R. China
| | - Zhen Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Hepato‑Pancreato‑Biliary Surgery, Peking University Cancer Hospital and Institute, Beijing 100142, P.R. China
| | - Jianhui Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Hepato‑Pancreato‑Biliary Surgery, Peking University Cancer Hospital and Institute, Beijing 100142, P.R. China
| | - Min Zhao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Pathology, Peking University Cancer Hospital and Institute, Beijing 100142, P.R. China
| | - Bin Dong
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Central Laboratory, Peking University Cancer Hospital and Institute, Beijing 100142, P.R. China
| | - Xiaoya Guan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Hepato‑Pancreato‑Biliary Surgery, Peking University Cancer Hospital and Institute, Beijing 100142, P.R. China
| | - Xiuyun Tian
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Hepato‑Pancreato‑Biliary Surgery, Peking University Cancer Hospital and Institute, Beijing 100142, P.R. China
| | - Chunyi Hao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Hepato‑Pancreato‑Biliary Surgery, Peking University Cancer Hospital and Institute, Beijing 100142, P.R. China
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Luo P, Cai W, Yang L, Wu Z, Chen Y, Zhang R, Yan W, Shi Y, Wang C. Retroperitoneal dedifferentiated liposarcoma: Analysis of 61 cases from a large institution. J Cancer 2018; 9:3831-3838. [PMID: 30410585 PMCID: PMC6218781 DOI: 10.7150/jca.25715] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 07/20/2018] [Indexed: 01/13/2023] Open
Abstract
Background: To describe the clinical features of retroperitoneal dedifferentiated liposarcoma (RP DDLS) and further evaluate the prognostic factors. Methods: The clinicopathological variables and treatment strategies of 61 RP DDLS patients who underwent surgical resections at a single institution between September 2005 and September 2016 were reviewed. Kaplan-Meier and Cox regression methods were conducted for survival analyses. Results: The average patients' age was 52 years (range, 27-81), and there was almost no gender predilection (30 males vs. 31 females). 51 (83.6%) patients got gross tumor resections (R0/R1 resection), and the median tumor size was 19 cm (range, 4.3-50 cm). 39(63.9%) patients were with intermediate-grade sarcoma and 22(36.1%) were with high-grade sarcoma. The median intraoperative blood loss was 400 ml (range, 50-2700ml). 19 (31.1%) patients presented multifocal diseases. Tumors were removed intactly in 42 (68.9%) patients. In order to obtain gross tumor resections, 33 (54.1%) of the patients underwent excisions of at least one adjacent organ, of which kidney (n=21, 63.6%) was the most common one. 6 (9.8%) patients developed distant metastases during follow-up. The overall 5-year progression-free survival (PFS) rate was 3.7%, with the median PFS of 19 months. The 5-year overall survival (OS) rate was 43.5%, with the median OS of 58 months. Updating to November 2017, 30 (49.2%) patients remained alive. The median follow-up time was 49 months. Multivariate analysis using Cox proportional hazards model revealed that tumor grade, blood loss, resection extent, and tumor integrity were independently associated with OS (p=0.032, p=0.018, p=0.020, p=0.005, respectively). Tumor grade, tumor integrity and multifocality were significant predictors for PFS (p=0.013, p=0.080, p=0.009, p=0.028, respectively). Conclusion: Intermediate-grade histology, intraoperative blood loss < 400 ml, complete tumor resection, and tumor integrity were independently associated with better OS. Intermediate-grade histology, tumor integrity and unifocal disease independently predicted favorable PFS.
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Affiliation(s)
- Peng Luo
- Department of Bone and Soft Tissue Sarcomas, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Weiluo Cai
- Department of Bone and Soft Tissue Sarcomas, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Lingge Yang
- Department of Bone and Soft Tissue Sarcomas, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhiqiang Wu
- Department of Bone and Soft Tissue Sarcomas, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yong Chen
- Department of Bone and Soft Tissue Sarcomas, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ruming Zhang
- Department of Bone and Soft Tissue Sarcomas, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wangjun Yan
- Department of Bone and Soft Tissue Sarcomas, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yingqiang Shi
- Department of Bone and Soft Tissue Sarcomas, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Chunmeng Wang
- Department of Bone and Soft Tissue Sarcomas, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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21
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Spinal Metastasis of Well-Differentiated Liposarcoma Component in Retroperitoneal Dedifferentiated Liposarcoma Treated by Minimally Invasive Surgery. Case Rep Orthop 2018; 2018:1708572. [PMID: 30123596 PMCID: PMC6079489 DOI: 10.1155/2018/1708572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 06/24/2018] [Indexed: 11/17/2022] Open
Abstract
Case Generally, well-differentiated liposarcoma (WDL) has recurrence potential but lacks metastatic potential. We present a rare case of spinal metastasis of WDL component in retroperitoneal dedifferentiated liposarcoma (DDL) treated by tumor curettage and L1 laminectomy followed by percutaneous pedicle screw fixation. Histological examination showed metastasis of the WDL component of DDL. The patient was ambulatory until death. Conclusion To our knowledge, no case of spinal metastasis of WDL component in retroperitoneal DDL has been reported. We should carefully consider characteristics of DDLs during treatment. Minimally invasive surgery may be a powerful tool in patients with spinal metastasis.
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22
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Zribi S, Bouassida M, Sassi S, Chtourou MF, Mighri MM, Touinsi H. [Giant retroperitoneal liposarcoma]. Presse Med 2018. [PMID: 29530297 DOI: 10.1016/j.lpm.2018.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Slim Zribi
- Mohamed-Tahar-Maamouri hospital, department of surgery, Nabeul, Tunisie; University-El-Manar, faculty of medicine of Tunis, Tunis, Tunisie
| | - Mahdi Bouassida
- Mohamed-Tahar-Maamouri hospital, department of surgery, Nabeul, Tunisie; University-El-Manar, faculty of medicine of Tunis, Tunis, Tunisie.
| | - Selim Sassi
- Mohamed-Tahar-Maamouri hospital, department of surgery, Nabeul, Tunisie; University-El-Manar, faculty of medicine of Tunis, Tunis, Tunisie
| | - Mohamed Fadhel Chtourou
- Mohamed-Tahar-Maamouri hospital, department of surgery, Nabeul, Tunisie; University-El-Manar, faculty of medicine of Tunis, Tunis, Tunisie
| | - Mohamed Mongi Mighri
- Mohamed-Tahar-Maamouri hospital, department of surgery, Nabeul, Tunisie; University-El-Manar, faculty of medicine of Tunis, Tunis, Tunisie
| | - Hassen Touinsi
- Mohamed-Tahar-Maamouri hospital, department of surgery, Nabeul, Tunisie; University-El-Manar, faculty of medicine of Tunis, Tunis, Tunisie
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23
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Mansfield SA, Pollock RE, Grignol VP. Surgery for Abdominal Well-Differentiated Liposarcoma. Curr Treat Options Oncol 2018; 19:1. [PMID: 29335908 DOI: 10.1007/s11864-018-0520-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OPINION STATEMENT Retroperitoneal sarcomas are rare tumors of which liposarcoma is the most common histology. Surgical resection remains the mainstay of therapy, particularly for the well-differentiated subtype. They can grow to massive size before causing symptoms or detection. Well-differentiated liposarcoma, while having a negligible metastatic rate, is fraught with a high local recurrence rate, despite a complete surgical resection. Reasons for this are not completely known but may be related to a field defect of the retroperitoneal fat creating a niche for recurrence. These tumors are classically chemo- and radio-resistant. Surgical therapy of recurrences can be challenging, but remains the treatment of choice for well-differentiated liposarcoma. In an attempt to improve on survival and recurrence rates for retroperitoneal liposarcoma, an extended resection approach has been promoted by a few groups. This involves the en bloc resection of contiguous organs that are not macroscopically involved. While this has improved local recurrence rates, benefit for overall survival has not been demonstrated. Interestingly, the improvement in local recurrence rate appeared to be driven by histology and was most improved in the well-differentiated subtype compared to historical data. However, for well-differentiated liposarcomas that are multifocal, this approach may be less useful. The application of this approach still requires further study in terms of balancing increased morbidity of extended resection against the potential for multiple surgeries for recurrence.
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Affiliation(s)
- Sara A Mansfield
- Department of General Surgery, The Ohio State University, Columbus, OH, USA
| | - Raphael E Pollock
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, N924 Doan Hall, 410 West 10th Avenue, Columbus, OH, 43210, USA
| | - Valerie P Grignol
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, N924 Doan Hall, 410 West 10th Avenue, Columbus, OH, 43210, USA.
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24
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Eckert F, Braun LH, Traub F, Kopp HG, Sipos B, Lamprecht U, Müller AC, Paulsen F, Zips D. Radiotherapy and hyperthermia with curative intent in recurrent high risk soft tissue sarcomas. Int J Hyperthermia 2017; 34:980-987. [PMID: 28826283 DOI: 10.1080/02656736.2017.1369174] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Radiotherapy before or after resection is one of the pillars of treatment for localised high risk soft tissue sarcomas. Treatment intensification has been described with concurrent chemotherapy and hyperthermia. The aim of this study is to assess local control after multimodal treatment, focussing on the treatment of local recurrences after surgery only. PATIENTS AND METHODS Of 42 patients treated in a prospective protocol with radiotherapy and hyperthermia, nine were treated for isolated local recurrences without metastatic spread. Most patients were treated with trimodal therapy including chemotherapy with ifosfamide and underwent resection whenever possible. Median follow-up was 1.4 years. RESULTS The treatment was well tolerated. Estimated disease free survival, distant metastases free survival and local control for the whole cohort after 1.5 years were 66, 73 and 88%, respectively. Neoadjuvant vs. adjuvant treatment influenced local control with a trend to statistical significance. Resection status did not influence local control. The cohort of patients treated for local recurrence after surgery alone had a significantly impaired local control compared to multimodal treatment at primary diagnosis (100 vs. 52%, p < 0.001). CONCLUSIONS With multimodal therapy including radiotherapy and hyperthermia local tumour control is achievable even in locally recurrent tumours. The clear-cut difference of the treatment of local recurrence in contrast to primary diagnosis might either reflect difficulties in diagnosis and treatment of local recurrences or biological aggressiveness of recurrent tumours. However, we recommend to consider multimodal treatment at primary diagnosis of high risk soft tissue sarcomas.
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Affiliation(s)
- Franziska Eckert
- a Department of Radiation Oncology , Eberhard-Karls-University Tuebingen , Tuebingen , Germany.,b Center for Soft Tissue Sarcoma, GIST and bone tumors , Eberhard-Karls-University Tuebingen , Tuebingen , Germany
| | - Lore Helene Braun
- a Department of Radiation Oncology , Eberhard-Karls-University Tuebingen , Tuebingen , Germany
| | - Frank Traub
- b Center for Soft Tissue Sarcoma, GIST and bone tumors , Eberhard-Karls-University Tuebingen , Tuebingen , Germany.,c Department of Orthopaedic Surgery , Eberhard-Karls-University Tuebingen , Tuebingen , Germany
| | - Hans-Georg Kopp
- b Center for Soft Tissue Sarcoma, GIST and bone tumors , Eberhard-Karls-University Tuebingen , Tuebingen , Germany.,d Department of Medical Oncology , Eberhard-Karls-University Tuebingen , Tuebingen , Germany
| | - Bence Sipos
- b Center for Soft Tissue Sarcoma, GIST and bone tumors , Eberhard-Karls-University Tuebingen , Tuebingen , Germany.,e Institute for Pathology , Eberhard-Karls-University Tuebingen , Tuebingen , Germany
| | - Ulf Lamprecht
- a Department of Radiation Oncology , Eberhard-Karls-University Tuebingen , Tuebingen , Germany
| | - Arndt-Christian Müller
- a Department of Radiation Oncology , Eberhard-Karls-University Tuebingen , Tuebingen , Germany
| | - Frank Paulsen
- a Department of Radiation Oncology , Eberhard-Karls-University Tuebingen , Tuebingen , Germany.,b Center for Soft Tissue Sarcoma, GIST and bone tumors , Eberhard-Karls-University Tuebingen , Tuebingen , Germany
| | - Daniel Zips
- a Department of Radiation Oncology , Eberhard-Karls-University Tuebingen , Tuebingen , Germany
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25
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Zeng X, Liu W, Wu X, Gao J, Zhang P, Shuai X, Tao K. Clinicopathological characteristics and experience in the treatment of giant retroperitoneal liposarcoma: A case report and review of the literature. Cancer Biol Ther 2017; 18:660-665. [PMID: 28758856 DOI: 10.1080/15384047.2017.1345388] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Retroperitoneal liposarcoma (RPLS) is a rare tumor, especailly those over 20 kg that are called "giant liposarcoma," whose characteristics and treatments remain relatively unknown. Herein, we report a giant RPLS measuring 65 × 45 × 30 cm in diameter and 31 kg in weight, which we successfully performed complete excision through interdisciplinary cooperation. The patient had an uneventful postoperative course and was discharged without complications. Afterwards he underwent radiotherapy and had no evidence of tumor recurrence or symptoms of metastasis at 3-month CT scan and 8-month follow-up. We also first review the 13 cases reported in literature published in PubMed regarding giant RPLS. Giant RPLS commonly occurs in adults aged 40-60 y and presents atypical clinical manifestations. CT scan is the most useful examination and preoperative biopsy is controversial. Complete surgical resection still remains the principal treatment. Giant RPLS can also be removed, even reach to R0 excision, by a multidisciplinary team in a specialized center after meticulous planning even though its gigantic tumor size. Local radiotherapy following surgery may improve the rate of recurrence. Besides, closely follow-up and routine examinations are required.
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Affiliation(s)
- Xiangyu Zeng
- a Department of Gastrointestinal Surgery , Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| | - Weizhen Liu
- a Department of Gastrointestinal Surgery , Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| | - Xiuli Wu
- b Department of Pathology , Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| | - Jinbo Gao
- a Department of Gastrointestinal Surgery , Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| | - Peng Zhang
- a Department of Gastrointestinal Surgery , Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| | - Xiaoming Shuai
- a Department of Gastrointestinal Surgery , Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| | - Kaixiong Tao
- a Department of Gastrointestinal Surgery , Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
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26
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Maurice MJ, Yih JM, Ammori JB, Abouassaly R. Predictors of surgical quality for retroperitoneal sarcoma: Volume matters. J Surg Oncol 2017; 116:766-774. [DOI: 10.1002/jso.24710] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 05/13/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Matthew J. Maurice
- Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland Ohio
| | - Jessica M. Yih
- Urology Institute; University Hospitals Cleveland Medical Center; Cleveland Ohio
| | - John B. Ammori
- Department of Surgery; University Hospitals Cleveland Medical Center; Cleveland Ohio
| | - Robert Abouassaly
- Urology Institute; University Hospitals Cleveland Medical Center; Cleveland Ohio
- Division of Urology; Louis Stokes Cleveland VA Medical Center; Cleveland Ohio
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