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Ren Y, Zhang Z, Shang L, You X. Surgical Resection of Primary Ewing's Sarcoma of Bone Improves Overall Survival in Patients Presenting with Metastasis. Med Sci Monit 2019; 25:1254-1262. [PMID: 30770526 PMCID: PMC6387471 DOI: 10.12659/msm.913338] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background Metastatic Ewing’s sarcoma (ES) of bone has a poor prognosis. Because there have been few previous studies on the prognostic factors and clinical outcome in patients with ES who have metastases at presentation, the aim of this study was to use the Surveillance, Epidemiology, and End Results (SEER) database to compare the clinical outcome following single and combined radiation treatment and surgery. Material/Methods The SEER database was used to identify patients with ES who presented with bone involvement and metastasis between 1973 to 2015. Prognostic analysis was performed using the Kaplan-Meier method and the Cox proportional hazards regression model. Results There were 643 patients identified from the SEER database. The 5-year overall survival (OS) and cancer-specific survival (CSS) rates were 33.1% and 34.3%, respectively and the median OS and CSS were 29.0±1.9 and 29.0±2.1 months, respectively. Multivariate analysis identified age <20 years and surgical resection of the primary tumor to be significantly associated with improved OS. Radiation therapy was not an independent predictor of OS or CSS. Radiation therapy alone resulted in a significantly reduced the OS and CSS compared with surgical resection alone. Combined surgery and radiation therapy of the primary tumor did not significantly improve the OS or CSS of patients with ES and metastatic disease when compared with surgery alone. Conclusions Age <20 years and surgical resection of the primary tumor were significantly associated with improved OS in patients with primary ES of bone who presented with metastasis.
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Affiliation(s)
- Yingqing Ren
- Department of Orthopaedics, The Affiliated Yangming Hospital of Ningbo University, Yuyao People's Hospital of Zhejiang Province, Yuyao, Zhejiang, China (mainland)
| | - Zhida Zhang
- Department of Orthopaedics, The Affiliated Yangming Hospital of Ningbo University, Yuyao People's Hospital of Zhejiang Province, Yuyao, Zhejiang, China (mainland)
| | - Liyong Shang
- Department of Orthopaedics, The Affiliated Yangming Hospital of Ningbo University, Yuyao People's Hospital of Zhejiang Province, Yuyao, Zhejiang, China (mainland)
| | - Xinmao You
- Department of Orthopaedics, The Affiliated Yangming Hospital of Ningbo University, Yuyao People's Hospital of Zhejiang Province, Yuyao, Zhejiang, China (mainland)
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Lim SM, Yoo CJ, Han JW, Cho YJ, Kim SH, Ahn JB, Rha SY, Shin SJ, Chung HC, Yang WI, Shin KH, Rho JK, Kim HS. Incidence and Survival of Pediatric Soft Tissue Sarcomas: Comparison between Adults and Children. Cancer Res Treat 2014; 47:9-17. [PMID: 25143049 PMCID: PMC4296854 DOI: 10.4143/crt.2013.157] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 11/13/2013] [Indexed: 11/21/2022] Open
Abstract
Purpose Pediatric-type sarcomas such as rhabdomyosarcoma (RMS), Ewing sarcoma (EWS), primitive neuroectodermal tumor (PNET), and desmoplastic small round-cell tumor (DSRCT) are rare in adults, with limited studies on their prognosis and optimal treatment strategies. We aimed to examine the outcome of children and adult patients with RMS, EWS, PNET, and DSRCT and relevant prognostic factors. Materials and Methods We retrospectively reviewed 220 pediatric-type sarcoma patients at a single institution between 1985 and 2011. Comparisons were made in order to examine differences in demographics, disease characteristics, and survival. Survival analyses were performed using the Kaplan-Meier method with log-rank tests and Cox proportional hazards models. Results A total of 220 consecutive patients were identified at our institute. Median age was 15.6 years (range, 0 to 81 years) and there were 108 children (49%) and 112 adult patients (51%). According to histological classification, 106 patients (48.2%) had RMS, 60 (27.3%) had EWS, 50 (22.7%) had PNET, and 4 (1.8%) had DSRCT. With a median follow-up period of 6.6 years, the estimated median overall survival (OS) of all patients was 75 months (95% confidence interval [CI], 27.2 to 122.8 months) and median event-free survival (EFS) for all patients was 11 months (95% CI, 8.8 to 13.2 months). No significant difference in OS and EFS was observed between adults and children. In multivariate analysis, distant metastasis (hazard ratio [HR], 1.617; 95% CI, 1.022 to 2.557; p=0.040) and no debulking surgery (HR, 1.443; 95% CI, 1.104 to 1.812; p=0.012) showed independent association with worse OS. Conclusion Metastatic disease and no surgical treatment are poor prognostic factors for OS among pediatric-type sarcomas for both adults and children.
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Affiliation(s)
- Sun Min Lim
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Cheol Joo Yoo
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Woo Han
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Jin Cho
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Soo Hee Kim
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Joong Bae Ahn
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Sun Young Rha
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Joon Shin
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Cheol Chung
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Woo Ick Yang
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Kyoo-Ho Shin
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Kyung Rho
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Hyo Song Kim
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
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Koohbanani B, Han G, Reed D, Zhao Q, Yi D, Henderson-Jackson E, Bui MM. Ethnicity and age disparities in Ewing sarcoma outcome. Fetal Pediatr Pathol 2013; 32:246-52. [PMID: 23043418 DOI: 10.3109/15513815.2012.721480] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This institutional retrospective review studied Ewing sarcomas from 1987-2011. Among 135 patients, 127 (19 Hispanic and 108 white/non-Hispanic) were analyzed (excluding small sample sized groups) finding 15% Hispanic, 85% non-Hispanic, 27% <18 years, 21% >40 years and 1-272 months follow-up (median 41). Age was significantly associated with overall survival (OS) (p = 0.01), whereby <18 years had a higher probability of 5-year survival (OS 61%) than >40 years (OS 37.6%). Ethnicity was marginally statistically significant (OS, p = 0.065); whereby median survival was clinically significant (white non-Hispanic 63 months and Hispanic 23 months). Hispanic ethnicity and older age are independent poor prognostic factors.
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Lee JA, Kim DH, Cho J, Lim JS, Koh JS, Yoo JY, Kim MS, Kong CB, Song WS, Cho WH, Lee SY, Jeon DG. Treatment outcome of Korean patients with localized Ewing sarcoma family of tumors: a single institution experience. Jpn J Clin Oncol 2011; 41:776-82. [PMID: 21415003 DOI: 10.1093/jjco/hyr033] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Controversy exists about the treatment outcomes of the Ewing sarcoma family of tumors among low-incidence populations. We evaluated whether Korean Ewing sarcoma family of tumors patients have poorer outcomes than Euro-American patients. METHODS We retrospectively analyzed the clinicopathologic characteristics and outcomes of patients with localized Ewing sarcoma family of tumors treated at Korea Cancer Center Hospital between 1986 and 2008. RESULTS Seventy-six patients (48 male, 28 female) of median age 20 years (range: 1-69 years) were evaluated. Tumors were located in central-axial parts of the body in 33 cases (43.4%) and extremity in 43 cases (56.6%). Pelvis and femur were the most frequently involved sites. Histologic response to preoperative chemotherapy was analyzed in 48 cases and there were 32 (66.7%) good responders and 16 (33.3%) poor responders. For a median follow-up of 37.9 months (range: 0.9-260.6 months), 5-year overall survival and event-free survival rates were 58.9 ± 6.1 and 52.6 ± 6.1%, respectively. A poor histologic response to preoperative chemotherapy (P= 0.01) and a tumor location in a central-axial body region (P= 0.008) were found to be related to a poorer event-free survival. CONCLUSIONS Survival of our Ewing sarcoma family of tumors patients was not inferior to those reported for Euro-American cases. Collaborative studies are necessary for further improvements of outcome and we believe that our data provide a basis for future studies targeting Ewing sarcoma family of tumors.
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Affiliation(s)
- Jun Ah Lee
- Department of Orthopedic Surgery, Korea Cancer Center Hospital, 215-4 Gongneung-Dong, Nowon-Gu, 139-706 Seoul, Republic of Korea
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Lee JA, Kim DH, Lim JS, Koh JS, Kim MS, Kong CB, Song WS, Cho WH, Lee SY, Jeon DG. Soft-tissue Ewing sarcoma in a low-incidence population: comparison to skeletal Ewing sarcoma for clinical characteristics and treatment outcome. Jpn J Clin Oncol 2010; 40:1060-7. [PMID: 20513751 DOI: 10.1093/jjco/hyq080] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE Due to the low incidence, treatments for Korean soft tissue Ewing sarcoma patients have been heterogeneous, and reported data are limited. In this study, we retrospectively analyzed soft tissue Ewing cases treated at our institution. METHODS We analyzed the clinicopathologic characteristics and treatment outcome of soft tissue Ewing sarcoma patients and compared with those of skeletal cases. RESULTS Twenty-seven soft tissue Ewing sarcoma cases were evaluated. Patients with soft tissue Ewing sarcoma were older than patients with skeletal tumors (P = 0.03), and tended to have metastasis at diagnosis (P = 0.12). However, sex ratios, pathologies, tumor volumes, and histologic response to preoperative chemotherapy were not different in the two groups. The 5-year overall survival (49.0%) and event-free survival (45.6%) of soft tissue Ewing sarcoma patients were similar to those of skeletal tumor patients (51.8% and 46.0%, respectively). Presence of metastasis at diagnosis and poor histologic response to preoperative chemotherapy were associated with an adverse outcome for both groups. Similar to skeletal tumors, central tumor location, pathology and tumor volume tended to be related to the survival of soft tissue Ewing sarcoma. However, age and the use of a modality other than surgery to achieve local control did not influence the survival of soft tissue Ewing sarcoma patients. CONCLUSIONS Our data could provide a basis to design a collaborative or multinational study targeting Ewing sarcoma family tumors.
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Affiliation(s)
- Jun Ah Lee
- Department of Pediatrics, Korea Cancer Center Hospital, Seoul, Republic of Korea
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Lee J, Hoang BH, Ziogas A, Zell JA. Analysis of prognostic factors in Ewing sarcoma using a population-based cancer registry. Cancer 2010; 116:1964-73. [PMID: 20151425 DOI: 10.1002/cncr.24937] [Citation(s) in RCA: 132] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Ewing sarcoma is a high-grade malignancy that most often occurs in children. Because its occurrence in adults has been historically low, few studies have been published on the epidemiology of Ewing sarcoma in this group of patients. By using data from a large, population-based cancer registry, the authors designed the present study to examine the outcome of children and adult patients with Ewing sarcoma and relevant prognostic factors. METHODS A retrospective analysis of Ewing sarcoma patient cases in the California Cancer Registry database was performed to identify incident patient cases diagnosed between 1989-2007. Comparisons were made to examine differences in demographics, disease characteristics, treatment, and survival. Survival analyses were performed using Kaplan-Meier method with log-rank tests and Cox proportional hazards models. RESULTS Seven hundred and twenty-five incident patient cases of Ewing sarcoma were identified, including 372 (51.3%) children and 353 (48.7%) adults. Hispanic race was associated with young age (P = .001) and lower socioeconomic status (SES; P = .0001). Pelvic involvement was associated with large tumor size (>8 cm; P < .0001), an increased incidence of metastasis (P < .0002), and poorer survival (P < .0001). After adjusting for clinically relevant factors, statistically significant decreased overall survival was seen with adults (hazard ratio [HR], 1.71; 95% confidence interval [CI], 1.35-2.17), Hispanics (HR, 1.33; 95% CI, 1.01-1.75), metastatic disease (HR, 2.74; 95% CI, 2.14-3.49), large tumor size (HR, 1.65; 95% CI, 1.17-2.34), no surgical treatment, and low SES. CONCLUSIONS The authors determined that adult age, Hispanic race, metastatic disease, large tumor size, and low SES are poor prognostic factors for overall survival among Ewing sarcoma patient cases.
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Affiliation(s)
- Joe Lee
- Department of Orthopaedic Surgery, University of California at Irvine, Irvine, California 92697-7550, USA
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Yonemori K, Yamaguchi U, Kaneko M, Uno H, Takeuchi M, Ando M, Fujiwara Y, Hosono A, Makimoto A, Hasegawa T, Yokoyama R, Nakatani F, Kawai A, Beppu Y, Chuman H. Prediction of response and prognostic factors for Ewing family of tumors in a low incidence population. J Cancer Res Clin Oncol 2007; 134:389-95. [PMID: 17687565 DOI: 10.1007/s00432-007-0295-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2007] [Accepted: 07/13/2007] [Indexed: 12/01/2022]
Abstract
PURPOSE There is some unknown reason Ewing family of tumors (EFTs) is much less common on Asia and Africa than in the Western Caucasian population. This study analyzed the prediction of response and prognostic factors for Ewing family of tumors (EFTs) in an Asian population with a low incidence. METHODS We retrospectively reviewed 94 patients with EFTs between 1978 and 2006. Fifteen patients received local therapy only. Statistical analyses were performed for 79 patients, including those who received systemic chemotherapy, to identify factors related to chemotherapy responsiveness, event-free survival, and overall survival. RESULTS Of the 79 patients whose records were analyzed, the 5-year event-free rate and overall survival (OS) rate were 41 and 54%, respectively. The response rate to first-line chemotherapy was 61% in 70 patients with assessable lesions. A significant predictor of response was existence of a non-pelvic primary tumor (P = 0.04). Significant prognostic factors for OS were age, performance status, and metastases at the time of diagnosis (P < 0.01, respectively). Fifty-four patients had disease progression or recurrence after first-line treatment. The time to progression was 3.4 months after salvage treatment. Progression during first-line treatment was significantly associated with time to progression after salvage treatment (P = 0.01). All patients treated without chemotherapy in first-line treatment were recurred with poor prognosis. CONCLUSION A non-pelvic primary tumor was a favorable predictor of responsiveness to chemotherapy. Chemo-resistant patients might less benefit from second line chemotherapy. Chemotherapy in first-line treatment should not be omitted, even if primary tumor was extirpated completely.
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Affiliation(s)
- Kan Yonemori
- Breast and Medical Oncology Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
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