Association between occupational exposures and sarcoma incidence and mortality: systematic review and meta-analysis

Global patterns and burden of soft tissue and extraosseous sarcomas: trends from 1990 to 2021

BACKGROUND

Soft tissue sarcomas (STS) are a rare group of malignant tumors originating from soft tissues. The study systematically evaluates the global burden of soft tissue and extraosseous sarcomas from 1990 to 2021 across diverse populations.

METHODS

We examined incidence, mortality, and disability-adjusted life years (DALYs) using data from the Global Burden of Disease (GBD) 2021 database. Estimated annual percentage change (EAPC) assessed trends from 1990 to 2021. Cross-country inequality was evaluated using the socio-demographic index (SDI), inequality slope index, and concentration index. Decomposition analysis identified key drivers of changes in disease burden. Frontier analysis pinpointed countries with potential for improvement, while Bayesian age-period-cohort (BAPC) projected trends through 2036.

RESULTS

Although the absolute numbers of cases, deaths, and DALYs increased, the global age-standardized incidence rate (ASIR), mortality (ASMR), and DALYs (ASDR) decreased. Males consistently exhibited higher rates than females, with the highest rates in individuals aged 95 and older. In high-SDI regions, ASIR slightly increased, whereas ASMR and ASDR decreased. The gap between high- and low-SDI countries widened over time. Projections indicate that by 2036, absolute numbers will increase, while age-standardized rates will further decline.

CONCLUSIONS

Despite the increasing absolute burden, the global age-standardized rates have declined, likely reflecting multiple contributing factors. However, the persistent disparities underscore the need for improved access to care and targeted public health interventions to mitigate the global burden.

Trends in the incidence, survival, and prognostic nomogram of angiosarcoma in the United States

This study aimed to investigate the epidemiological trends of angiosarcoma and to establish a tool to estimate its prognosis. Data from the Surveillance, Epidemiology, and End Results (SEER) database (1975-2016) were used to assess trends in the epidemiology of angiosarcoma, and a nomogram was established based on independent prognostic factors. The age-adjusted incidence of angiosarcoma gradually increased from 0.13/100,000 in 1975 to 0.33/100,000 in 2016 (annual percentage change [2.4]). The most significant increase was observed in patients aged ≥ 60 years. The same increasing trend was observed across all the stages and grades. The limited-duration prevalence increased from 0.0003% in 1992 to 0.0013% in 2016 (P < .05). In multivariable analyses, age, sex, marital status, grade, historical stage, surgery, site, and tumor size were independent prognostic factors for angiosarcoma. The concordance index of the nomogram was significantly higher than that of the American Joint Committee on Cancer (AJCC) 6th edition and the AJCC 7th edition (0.74 vs 0.61 vs 0.66, respectively). Calibration analysis showed optimal agreement between nomogram predictions and actual observations. The incidence and prevalence of angiosarcoma has increased over the past 40 years. We established a nomogram to predict the overall survival of patients with angiosarcoma.

Carcinogenic health outcomes associated with endocrine disrupting chemicals exposure in humans: A wide-scope analysis

Endocrine-disrupting chemicals (EDCs) are persistent and pervasive compounds that pose serious risks. Numerous studies have explored the effects of EDCs on human health, among which tumors have been the primary focus. However, because of study design flaws, lack of effective exposure levels of EDCs, and inconsistent population data and findings, it is challenging to draw clear conclusions on the effect of these compounds on tumor-related outcomes. Our study is the first to systematically integrate observational studies and randomized controlled trials from over 20 years and summarize over 300 subgroup associations. We found that most EDCs promote tumor development, and that exposure to residential environmental pollutants may be a major source of pesticide exposure. Furthermore, we found that phytoestrogens exhibit antitumor effects. The findings of this study can aid in the development of global EDCs regulatory health policies and alleviate the severe risks associated with EDCs exposure.

Long-Term Effect of Temperature Increase on Liver Cancer in Australia: A Bayesian Spatial Analysis

BACKGROUND

While some evidence has potentially linked climate change to carcinogenic factors, the long-term effect of climate change on liver cancer risk largely remains unclear.

OBJECTIVES

Our objective is to evaluate the long-term relationship between temperature increase and liver cancer incidence in Australia.

METHODS

We mapped the spatial distribution of liver cancer incidence from 2001 to 2019 in Australia. A Bayesian spatial conditional autoregressive (CAR) model was used to estimate the relationships between the increase in temperature at different lags and liver cancer incidence in Australia, after controlling for chronic hepatitis B prevalence, chronic hepatitis C prevalence, and the Index of Relative Socio-economic Disadvantage. Spatial random effects obtained from the Bayesian CAR model were also mapped.

RESULTS

The research showed that the distribution of liver cancer in Australia is spatially clustered, most areas in Northern Territory and Northern Queensland have higher incidence and relative risk. The increase in temperature at the lag of 30 years was found to correlate with the increase in liver cancer incidence in Australia, with a posterior mean of 30.57 [95% Bayesian credible interval (CrI): 0.17, 58.88] for the univariate model and 29.50 (95% CrI: 1.27, 58.95) after controlling for confounders, respectively. The results were not highly credible for other lags.

DISCUSSION

Our Bayesian spatial analysis suggested a potential relationship between temperature increase and liver cancer. To our knowledge, this research marks the first attempt to assess the long-term effect of global warming on liver cancer. If the relationship is confirmed by other studies, these findings may inform the development of prevention and mitigation strategies based on climate change projections. https://doi.org/10.1289/EHP14574.

A Review on Canine and Human Soft Tissue Sarcomas: New Insights on Prognosis Factors and Treatment Measures

Soft tissue sarcomas (STSs) represent a diverse group of tumors arising from mesenchymal cells, affecting both humans and animals, including dogs. Although STSs represent a class of rare tumors, especially in humans, they pose significant clinical challenges due to their potential for local recurrence and distant metastasis. Dogs, as a model for human STSs, offer several advantages, including exposure to similar environmental risk factors, genetic diversity among breeds, and the spontaneous development of tumors. Furthermore, canine tumors closely mimic the heterogeneity and complexity of human tumors, making them valuable for research into disease progression and treatment effectiveness. Current treatment approaches for STSs in both dogs and humans primarily involve surgery, radiation therapy, and chemotherapy, with treatment decisions based on tumor characteristics and patient factors. However, the development of novel therapeutic strategies is essential, given the high failure rate of new drugs in clinical trials. To better design new tailored treatments, comprehension of the tumor microenvironment (TME) is fundamental, since it plays a crucial role in STS initiation and progression by modulating tumor behavior, promoting angiogenesis, and suppressing immune responses. Notably, TME features include cancer-associated fibroblasts (CAFs), extracellular matrix (ECM) alterations, and tumor-associated macrophages (TAMs) that, depending on their polarization state, can affect immune responses and thus the patient's prognosis. In this review, new therapeutical approaches based on immunotherapy will be deeply explored as potential treatment options for both dogs and humans with STSs. In conclusion, this review provides an overview of the current understanding of STSs in dogs and humans, emphasizing the importance of the TME and potential treatment strategies.

The association between ambient air pollution exposure and connective tissue sarcoma risk: a nested case-control study using a nationwide population-based database

A nationwide population-based database was utilized in a nested case-control study to explore the association between ambient air pollution exposure and the likelihood of developing connective tissue sarcoma. The study examined 280 cases of connective tissue sarcoma diagnosed between 2000 and 2012. A random sample of 1120 control subjects was selected from a subpopulation of claim records without a connective tissue sarcoma diagnosis in a 1:4 ratio. The control subjects were selected based on similar characteristics as the connective tissue sarcoma patients, including gender, birth year, and the year of diagnosis of the case group with medical records. Risk factors for connective tissue sarcoma were collected for analysis. Our data on exposure to air pollutants was collected from Taiwan's Air Quality Monitoring Network, which has been gathering air quality data from a growing network of sampling stations (now 76) throughout the country since 1997. It was discovered that the risk of connective tissue sarcoma was significantly increased by the Charlson comorbidity index (CCI), elevated levels of specific air pollution indices (e.g., total hydrocarbons (THC), fine particulate matter (PM2.5), and O3_8 (the annual mean of the daily maximum 8-h average concentration of O3), the High Pollutant Standards Index (hPSI) (the percentage of days in a given year in Taiwan where the PSI exceeds 100), and an insurable monthly wage over US$1100. Further investigation is needed to explore the involvement of these air pollutants in the formation of connective tissue sarcoma.

Gender Differences in Soft Tissue and Bone Sarcoma: A Narrative Review

Sarcomas, uncommon malignancies, stem from mesenchymal tissues, distinct from epithelial tissues, originating in the embryonic mesodermal layer. These sarcomas have been categorized as either bone or soft tissue sarcomas, depending on their originating tissue. The majority of sarcomas occur sporadically with their etiology being unknown, but there are several, well-established genetic predisposition syndromes and some environmental exposures associated with specific sarcomas. Recently, many studies have shown that sarcomas, in analogy with colorectal, skin, head and neck, esophageal, lung, and liver carcinomas, also have a male sex predilection. Significant gender differences have already been observed in childhood sarcomas. Among the tumors strongly associated with the male sex, childhood sarcomas have been identified as being particularly sensitive to the biological differences between the sexes, with special regard to soft tissue sarcomas. As the biological mechanisms underlying the sex differences in the incidence of soft tissue sarcomas remain largely unexplored, this review aims to highlight the factors underlying these differences to inform prevention and treatment.

Sex Differences in Soft Tissue Sarcoma: Incidence, Clinicopathological Profile, Survival, and Costs

Background: There are evident sex differences in the incidence of and mortality rates for several tumors. Soft tissue sarcomas (STSs) account for no more than 1% of all malignancies in adults. This study aimed to provide a comprehensive overview of the sex differences in the epidemiology of STSs and the related costs. Methods: This retrospective population-based study draws on epidemiological data regarding cases of STS collected by the cancer registry of the Italian Veneto region for the years 1990-2018. A joinpoint regression analysis was performed to identify significant changes in the trends of the standardized incidence rates in males and females. Bivariate and survival analyses were conducted to assess differences in clinicopathological characteristics and short-term mortality by sex. Direct health care costs incurred over 2 years after a diagnosis of STS were calculated, stratified by sex. Results: The incidence rates of STS at any age were higher for males; only among males the incidence rates showed a tendency to slightly increase. No significant sex differences came to light in short-term mortality or clinicopathological profile, except for the cancer site. Health care costs in the 2 years after a diagnosis of STS were not sex related. Conclusion: The STS incidence was found to be higher for males and showed a rising trend over the last three decades only for males. These findings could result from the occupational exposure to environmental mutagens mainly involving men. Sex did not affect the survival or the clinicopathological STS profile.

Cutaneous vascular tumors: an updated review

Cutaneous vascular tumors constitute a heterogeneous group of entities that share overlapping morphologic and immunohistochemical features, which can be diagnostically challenging for pathologists and dermatopathologists. Our understanding and knowledge of vascular neoplasms have improved over time, resulting in both a refinement of their classification by the International Society for the Study of Vascular Anomalies (ISSVA) and an improvement in the accurate diagnosis and clinical management of vascular neoplasms. This review article aims to summarize the updated clinical, histopathological, and immunohistochemical characteristics of cutaneous vascular tumors, as well as to highlight their associated genetic mutations. Such entities include infantile hemangioma, congenital hemangioma, tufted angioma, spindle cell hemangioma, epithelioid hemangioma, pyogenic granuloma, Kaposiform hemangioendothelioma, retiform hemangioendothelioma, pseudomyogenic hemangioendothelioma, Kaposi sarcoma, angiosarcoma, and epithelioid hemangioendothelioma.

Genetic and environmental reprogramming of the sarcoma epigenome

Sarcomas are rare and heterogenous mesenchymal tumors occurring in soft tissue and bone. The World Health Organization Classification of sarcomas comprises more than hundred different entities which are very diverse in their molecular, genetic and epigenetic signatures as they are in their clinical presentations and behaviors. While sarcomas can be associated with an underlying hereditary cancer predisposition, most sarcomas developed sporadically without identifiable cause. Sarcoma oncogenesis involves complex interactions between genetic, epigenetic and environmental factors which are intimately related and intensively studied. Several molecular discoveries have been made over the last decades leading to the development of new therapeutic avenues. Sarcoma research continues its effort toward a more specific and personalized approach to all sarcoma sub-types to improve patient outcomes and this through world-wide collaboration. This chapter on "Genetic and Environmental Reprogramming of the Sarcoma Epigenome" provides a comprehensive review of general concepts and epidemiology of sarcoma as well as a detailed description of the genetic, molecular and epigenetic alterations seen in sarcomas, their therapeutic implications and ongoing research. This review also presents evidenced-based data on the environmental and occupational factors possibly involved in the etiology of sarcomas and a brief discussion on the role of the microbiome in sarcoma.

Epidemiological Trend Analysis and Survival Data of Balinese with Soft-Tissue Sarcoma in 2015–2021

BACKGROUND: Soft tissue sarcoma (STS) has a very heterogen features of its nature, subtypes, and clincial behaviour among population. Regardless, the epidemiology data of soft tissue sarcoma is very limited in developing countries, including Indonesia. AIM: To decribe the incidence and mortality trend analysis, as long as the survival data in Bali from 2015 to 2020. METHODS: This is a case control study including all subjects with STS in Denpasar, Bali, Indonesia from January 2015 to September 2021. Data about demographics, clinical, and survival timing data were collected from Cancer Registry. Soft tissue sarcoma diagnosis was confirmed after histopathological examination. Joinpoint regression was used for crude rate trend analysis. Data was analyzed by SPSS 22.0, using Kaplan-Meier for survival analysis. RESULTS: Ninety three subjects with STS were included in this study. Most patients died at the end of the study (65.6%) with median survival of only 30 months. The trend of STS age-standardized incidence and mortality rate was increasing from 2015 to 2018, then declining until 2020. The survival rate varies among the soft tissue sarcoma subtypes and location. It was better in the group without metastases, underwent therapy, but not statistically significant. CONCLUSION: Soft tissue sarcoma showed a diversity of demographic and clinical parameters. The incidence and mortality rate has plateued in 2018, but then declining. The survival rate diversed regarding of the STS subtype, location, metastasis, and treatment given.