Bayesian unsupervised clustering identifies clinically relevant osteosarcoma subtypes

Post-treatment late and long-term effects in bone sarcoma: A scoping review

Despite the fact that chemotherapy for bone sarcomas (e.g. Ewing sarcoma, osteosarcoma) has well-reported toxicities and that surgical intervention is frequently life altering, follow-up care to monitor for late and long-term effects beyond that of oncological surveillance in former patients is variable. Anecdotal evidence suggests that inconsistent follow-up means some former bone sarcoma patients are left to cope with post-treatment late and long-term effects with limited support. Here, we performed a scoping review to provide a more empirical identification of the knowledge gaps and to provide an overview of the peer reviewed academic literature reporting the late and long-term effects of treatment for bone sarcoma. JBI Scoping Review Network guidelines for charting, analysis and data extraction were followed. Literature searches were conducted in Medline (Ovid), Cochrane CENTRAL, EMBASE (Ovid), CINAHL, PsycINFO, Proquest and Web of Science (Clarivate Analytics) from March 2024 to September 2024. Paper titles and abstracts were screened by two independent reviewers followed by full text analysis by the lead researcher. Seventy-four peer reviewed articles were included in the analysis. Most studies were of a retrospective study design, some up to 20 years of follow-up and included chemotherapy, surgery and sometimes radiotherapy as the treatment modality. Our analysis identified secondary malignancies, cardio- and nephrotoxicity, lower bone mineral density and microarchitectural deterioration, cancer related fatigue and motor neuropathies as the major physical late and long-term effects requiring dedicated follow-up. In some cases, follow-up may need to span decades, especially given the increasing population of former patients. Our results form the evidence-based foundations for future work that might include late and long-term effect follow-up service mapping exercises and expanded clinical recommendations.

Targeting metastasis in paediatric bone sarcomas

Paediatric bone sarcomas (e.g. Ewing sarcoma, osteosarcoma) comprise significant biological and clinical heterogeneity. This extreme heterogeneity affects response to systemic therapy, facilitates inherent and acquired drug resistance and possibly underpins the origins of metastatic disease, a key component implicit in cancer related death. Across all cancers, metastatic models have offered competing accounts on when dissemination occurs, either early or late during tumorigenesis, whether metastases at different foci arise independently and directly from the primary tumour or give rise to each other, i.e. metastases-to-metastases dissemination, and whether cell exchange occurs between synchronously growing lesions. Although it is probable that all the above mechanisms can lead to metastatic disease, clinical observations indicate that distinct modes of metastasis might predominate in different cancers. Around 70% of patients with bone sarcoma experience metastasis during their disease course but the fundamental molecular and cell mechanisms underlying spread are equivocal. Newer therapies such as tyrosine kinase inhibitors have shown promise in reducing metastatic relapse in trials, nonetheless, not all patients respond and 5-year overall survival remains at ~ 50%. Better understanding of potential bone sarcoma biological subgroups, the role of the tumour immune microenvironment, factors that promote metastasis and clinical biomarkers of prognosis and drug response are required to make progress. In this review, we provide a comprehensive overview of the approaches to manage paediatric patients with metastatic Ewing sarcoma and osteosarcoma. We describe the molecular basis of the tumour immune microenvironment, cell plasticity, circulating tumour cells and the development of the pre-metastatic niche, all required for successful distant colonisation. Finally, we discuss ongoing and upcoming patient clinical trials, biomarkers and gene regulatory networks amenable to the development of anti-metastasis medicines.

Exploratory Analysis of Molecular Subtypes in Early-Stage Osteosarcoma: Identifying Resistance and Optimizing Therapy

Background: Osteosarcoma (OS) is a highly aggressive bone malignancy with limited treatment options and poor prognosis. This exploratory study aimed to identify molecular subtypes of early-stage, treatment-naive OS to guide precise therapeutic strategies. Methods: We analyzed RNA-seq data obtained from tumor tissues from 102 OS patients using a non-negative matrix factorization algorithm (NMF) to classify the tumors into three subtypes: S1, S2, and S3. Differential gene expression was evaluated using DESeq2, followed by functional enrichment analysis with clusterProfiler and CancerHallmarks. The tumor microenvironment was assessed through ESTIMATE and CIBERSORT, and drug sensitivity was predicted using OncoPredict. SAOS-2 and MG63 cells, representing the S1 subtype, were used in the viability essays to determine the effect of hesperidin, a natural phenolic compound noted for its anti-cancer potential, alone and in combination with doxorubicin and 5-fluorouracil. Results: This study revealed three OS subtypes: S1 was enriched in cell cycle regulation, vesicular transport, and RNA metabolism while S2 and S3 were enriched in pathways related to extracellular matrix organization and protein translation, respectively. S1 displayed high tumor purity, significant chemoresistance, and overexpression of KIF20 A, correlating with poor prognosis. AURKB, a hesperidin target, was implicated in S1 pathogenesis. In vitro, hesperidin significantly reduced the viability of SAOS-2 and MG63 cells and enhanced doxorubicin efficacy. Conclusions: Our findings support the molecular subclassification of OS, emphasizing subtype-specific mechanisms of tumor progression and chemoresistance, with hesperidin offering potential as a therapeutic adjunct for high-risk OS patients.

Correlation of multiple peripheral blood parameters with metastasis and invasion of papillary thyroid cancer: a retrospective cohort study

OBJECTIVE

Papillary thyroid cancer (PTC) progression is characterized by lymph node metastasis and thyroid capsular invasion. This study aimed to identify high-risk PTC populations for these events based on peripheral blood test parameters and to determine the associated factors.

METHODS

This retrospective study analyzed data from 4557 PTC patients. Principal component analysis (PCA) and cluster analysis were performed on 45 peripheral blood test results. High- and low-risk clusters were defined based on metastasis and invasion prevalence. Univariate and multivariate analyses identified parameters significantly differentiating the clusters, examining their association with tumor progression.

RESULTS

Preoperative blood tests stratified patients into two distinct clusters. Cluster 0 demonstrated significantly higher rates of metastasis and invasion than Cluster 1, defining it as the high-risk group. PCA identified four principal components significantly differentiating the clusters. Analysis of these components revealed key peripheral blood parameters. Multivariable logistic regression identified six parameters associated with increased risk of Cluster 0: alanine aminotransferase, free triiodothyronine, thrombin time, hemoglobin, hematocrit, and leukocyte count. Conversely, aspartate aminotransferase and neutrophil count were associated with decreased risk.

CONCLUSION

These findings suggest that peripheral blood parameters may provide insights into the progression of thyroid tumors and highlight potential avenues for exploring the underlying mechanisms of PTC. However, given the retrospective nature of this study and the potential for selection bias, further prospective studies are necessary to validate these results and confirm their predictive value in clinical practice.