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Xie L, Cai Z, Lu H, Meng F, Zhang X, Luo K, Su X, Lei Y, Xu J, Lou J, Wang H, Du Z, Wang Y, Li Y, Ren T, Xu J, Sun X, Tang X, Guo W. Distinct genomic features between osteosarcomas firstly metastasing to bone and to lung. Heliyon 2023; 9:e15527. [PMID: 37205995 PMCID: PMC10189180 DOI: 10.1016/j.heliyon.2023.e15527] [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: 10/08/2022] [Revised: 03/26/2023] [Accepted: 04/12/2023] [Indexed: 05/21/2023] Open
Abstract
Background Osteosarcoma initially metastasing to bone only shows distinct biological features compared to osteosarcoma that firstly metastasizes to the lung, which suggests us underlying different genomic pathogenetic mechanism. Methods We analyzed whole-exome sequencing (WES) data for 38 osteosarcoma with paired samples in different relapse patterns. We also sought to redefine disease subclassifications for osteosarcoma based on genetic alterations and correlate these genetic profiles with clinical treatment courses to elucidate potential evolving cladograms. Results We investigated WES of 12/38 patients with high-grade osteosarcoma (31.6%) with initial bone metastasis (group A) and 26/38 (68.4%) with initial pulmonary metastasis (group B), of whom 15/38 (39.5%) had paired samples of primary lesions and metastatic lesions. We found that osteosarcoma in group A mainly carries single-nucleotide variations displaying higher tumor mutation burden and neoantigen load and more tertiary lymphoid structures, while those in group B mainly exhibits structural variants. High conservation of reported genetic sequencing over time in their evolving cladograms. Conclusions Osteosarcoma with mainly single-nucleotide variations other than structural variants might exhibit biological behavior predisposing toward bone metastases as well as better immunogenicity in tumor microenvironment.
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Affiliation(s)
- Lu Xie
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing 100044, China
| | - Zhenyu Cai
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing 100044, China
| | - Hezhe Lu
- State Key Laboratory of Membrane Biology, Institute of Zoology, Chinese Academy of Sciences, No. A3 Datun Road, Chaoyang District, Beijing 100101, China
| | - Fanfei Meng
- Shanghai OrigiMed Co., Ltd, Shanghai, No. 3576 Zhaolou Road, Minhang District, Shanghai, 201112, China
| | - Xin Zhang
- Shanghai OrigiMed Co., Ltd, Shanghai, No. 3576 Zhaolou Road, Minhang District, Shanghai, 201112, China
| | - Kun Luo
- Shanghai OrigiMed Co., Ltd, Shanghai, No. 3576 Zhaolou Road, Minhang District, Shanghai, 201112, China
| | - Xiaoxing Su
- Berry Oncology Corporation, Fuzhou, 350200, China
| | - Yan Lei
- Berry Oncology Corporation, Fuzhou, 350200, China
| | - Jiuhui Xu
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing 100044, China
| | - Jingbing Lou
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing 100044, China
| | - Han Wang
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing 100044, China
| | - Zhiye Du
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing 100044, China
| | - Yunfan Wang
- Pathology Department, Peking University Shougang Hospital, No. 9 Jinyuanzhuang Road, Shijingshan District, Beijing, 100144, China
| | - Yuan Li
- Radiology Department & Nuclear Medicine Department, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Tingting Ren
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing 100044, China
| | - Jie Xu
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing 100044, China
| | - Xin Sun
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing 100044, China
| | - Xiaodong Tang
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing 100044, China
- Corresponding author.
| | - Wei Guo
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing 100044, China
- Corresponding author.
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Gotta J, Bochennek K, Klingebiel T, Bielack S, Wild PJ, Demes MC, Gradhand E. Metachronous Osteosarcoma, A Differential Diagnosis to be Considered in Children With Osteosarcoma: A Review of Literature and a Case From Our Center. J Pediatr Hematol Oncol 2023; 45:105-110. [PMID: 36251795 PMCID: PMC10030169 DOI: 10.1097/mph.0000000000002560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 07/21/2022] [Indexed: 11/27/2022]
Abstract
Metachronous osteosarcomas (MOS) are currently defined as tumors that arise in a way and site unusual for typical metastasis. In this article, we reviewed the recent literature on the occurrence of metachronous osteosarcoma and presented a case from our center. Our patient, a 10-year-old girl, presented with metachronous osteoblastic osteosarcoma of the left distal femur ∼5 years after the successful treatment for osteosarcoma of the right distal femur. Even after several relapses, complete remission (CR) was achieved after the first osteosarcoma and after the metachronous osteosarcoma. The literature research revealed that metachronous osteosarcoma occurs in 3.4 to 5.4% of osteosarcoma patients. The time interval between the diagnosis of the initial osteosarcoma and the metachronous tumor ranged from 0.2 to 14.3 years (median 2.5 y). MOS appears to have differences in localization and metastatic spread, as well as a different survival pattern compared with primary osteosarcoma and osteosarcoma recurrence. Survival (median 4.3 y, range 0 to 24.6 y) appears to be associated with the time interval to diagnosis of MOS. In particular, early MOS (<24 mo after primary diagnosis) seem to have a poorer prognosis. Therefore, the occurrence of MOS at oncological unusual sites should be considered as a differential diagnosis in osteosarcoma survivors.
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Affiliation(s)
| | - Konrad Bochennek
- Department for Children and Adolescents Medicine, University Hospital Frankfurt, Frankfurt am Main
| | - Thomas Klingebiel
- Department for Children and Adolescents Medicine, University Hospital Frankfurt, Frankfurt am Main
| | - Stefan Bielack
- Center for Pediatric, Adolescent and Women’s Medicine, Olgahospital, Department of Pediatrics 5 (Oncology, Hematology, Immunology), Klinikum Stuttgart, Stuttgart, Germany
| | - Peter J. Wild
- Dr Senckenberg Institute of Pathology
- Frankfurt Institute for Advanced Studies (FIAS)
- Wildlab, University Hospital MVZ GmbH, Frankfurt am Main
| | - Melanie C. Demes
- Dr Senckenberg Institute of Pathology
- Wildlab, University Hospital MVZ GmbH, Frankfurt am Main
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Mittal A, Pushpam D, Ganguly S, Kumar VS, Khan SA, Bakhshi S. Controversies and Challenges in the Management of Osteosarcoma-an Indian Perspective. Indian J Surg Oncol 2022; 13:939-955. [PMID: 36687236 PMCID: PMC9845467 DOI: 10.1007/s13193-021-01486-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 11/30/2021] [Indexed: 01/25/2023] Open
Abstract
Osteosarcoma (OGS) is the most common primary bone tumor in children and adolescents which requires a multidisciplinary approach to management. Although chemotherapy and surgery can cure more than half of localized OGS cases, the unique challenges faced by resource-limited countries like India make this outcome difficult to achieve. Various questions in the management of OGS including role of high-dose methotrexate (HDMTX) in neoadjuvant setting, triplet vs doublet chemotherapy, intensification of chemotherapy based on response in setting of doublet, and indigenous prosthesis in setting of limb salvage need to be defined. Similarly, in the metastatic and recurrent setting, questions regarding intent of treatment, indications of chemotherapy, timing of surgery, and role of targeted therapies need clarification. Lack of randomized trials from India makes definite conclusions difficult, but an attempt can be made to define the best approach in the Indian scenario from available evidence. Hence, a critical review of literature from India and the West was done to define possible management approaches and highlight the lacuna for future research.
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Affiliation(s)
- Abhenil Mittal
- Department of Medical Oncology, DR BRAIRCH, AIIMS, New Delhi, 110029 India
| | - Deepam Pushpam
- Department of Medical Oncology, DR BRAIRCH, AIIMS, New Delhi, 110029 India
| | - Shuvadeep Ganguly
- Department of Medical Oncology, DR BRAIRCH, AIIMS, New Delhi, 110029 India
| | | | - Shah Alam Khan
- Department of Orthopedics, AIIMS, New Delhi, 110029 India
| | - Sameer Bakhshi
- Department of Medical Oncology, DR BRAIRCH, AIIMS, New Delhi, 110029 India
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Odri GA, Tchicaya-Bouanga J, Yoon DJY, Modrowski D. Metastatic Progression of Osteosarcomas: A Review of Current Knowledge of Environmental versus Oncogenic Drivers. Cancers (Basel) 2022; 14:cancers14020360. [PMID: 35053522 PMCID: PMC8774233 DOI: 10.3390/cancers14020360] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/06/2022] [Accepted: 01/10/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Osteosarcomas are heterogeneous bone tumors with complex genetic and chromosomic alterations. The numerous patients with metastatic osteosarcoma have a very poor prognosis, and only those who can have full surgical resection of the primary tumor and of all the macro metastasis can survive. Despite the recent improvements in prediction and early detection of metastasis, big efforts are still required to understand the specific mechanisms of osteosarcoma metastatic progression, in order to reveal novel therapeutic targets. Abstract Metastases of osteosarcomas are heterogeneous. They may grow simultaneously with the primary tumor, during treatment or shortly after, or a long time after the end of the treatment. They occur mainly in lungs but also in bone and various soft tissues. They can have the same histology as the primary tumor or show a shift towards a different differentiation path. However, the metastatic capacities of osteosarcoma cells can be predicted by gene and microRNA signatures. Despite the identification of numerous metastasis-promoting/predicting factors, there is no efficient therapeutic strategy to reduce the number of patients developing a metastatic disease or to cure these metastatic patients, except surgery. Indeed, these patients are generally resistant to the classical chemo- and to immuno-therapy. Hence, the knowledge of specific mechanisms should be extended to reveal novel therapeutic approaches. Recent studies that used DNA and RNA sequencing technologies highlighted complex relations between primary and secondary tumors. The reported results also supported a hierarchical organization of the tumor cell clones, suggesting that cancer stem cells are involved. Because of their chemoresistance, their plasticity, and their ability to modulate the immune environment, the osteosarcoma stem cells could be important players in the metastatic process.
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Affiliation(s)
- Guillaume Anthony Odri
- INSERM UMR 1132, Biologie de l’os et du Cartilage (BIOSCAR), Lariboisière Hospital, UFR de Médecine, Faculté de Santé, University of Paris, 75010 Paris, France; (J.T.-B.); (D.J.Y.Y.); (D.M.)
- Service de Chirurgie Orthopédique et Traumatologique, DMU Locomotion, Lariboisière Hospital, 75010 Paris, France
- Correspondence:
| | - Joëlle Tchicaya-Bouanga
- INSERM UMR 1132, Biologie de l’os et du Cartilage (BIOSCAR), Lariboisière Hospital, UFR de Médecine, Faculté de Santé, University of Paris, 75010 Paris, France; (J.T.-B.); (D.J.Y.Y.); (D.M.)
| | - Diane Ji Yun Yoon
- INSERM UMR 1132, Biologie de l’os et du Cartilage (BIOSCAR), Lariboisière Hospital, UFR de Médecine, Faculté de Santé, University of Paris, 75010 Paris, France; (J.T.-B.); (D.J.Y.Y.); (D.M.)
- Service de Chirurgie Orthopédique et Traumatologique, DMU Locomotion, Lariboisière Hospital, 75010 Paris, France
| | - Dominique Modrowski
- INSERM UMR 1132, Biologie de l’os et du Cartilage (BIOSCAR), Lariboisière Hospital, UFR de Médecine, Faculté de Santé, University of Paris, 75010 Paris, France; (J.T.-B.); (D.J.Y.Y.); (D.M.)
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Meazza C, Bastoni S, Scanagatta P. What is the best clinical approach to recurrent/refractory osteosarcoma? Expert Rev Anticancer Ther 2020; 20:415-428. [PMID: 32379504 DOI: 10.1080/14737140.2020.1760848] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Osteosarcoma is the most common malignant bone tumor. It is currently treated with pre-and postoperative chemotherapy, associated with surgical resection of the tumor.Area covered: Relapses occur in about one in three patients presenting with localized disease, and three in four of those with metastases at diagnosis. Relapsing disease carries a very poor prognosis, with 5-year survival rates ranging between 13% and 40%.Expert opinion: Patients with unilateral lung involvement or solitary lung metastases and a recurrence-free interval (RFI) longer than 24 months have a better prognosis, and could be managed with surgical resection and close observation. Complete surgical resection of all sites of disease remains essential to survival: patients unable to achieve complete remission have a catastrophic overall survival rate. The role of second-line chemotherapy is not at all clear, and no controlled studies are available on this topic. It is worth considering for patients unable to achieve complete surgical remission, and those with multiple metastases and/or a RFI <24 months. Given their dismal prognosis, patients with multiple sites of disease not amenable to complete surgical resection should also be considered for innovative therapeutic approaches.
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Affiliation(s)
- Cristina Meazza
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Stefano Bastoni
- Center for Oncological Orthopedic Surgery, ASST Azienda Ospedaliera Istituto G Pini-CTO, Milano, Italy
| | - Paolo Scanagatta
- Thoracic Surgery Division, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
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Rawal G, Ahluwalia C, Yadav AK, Arora R. Metachronous extraskeletal (soft tissue) epithelioid osteogenic sarcoma: a case report. J Med Case Rep 2019; 13:136. [PMID: 31068214 PMCID: PMC6507060 DOI: 10.1186/s13256-019-2070-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 04/03/2019] [Indexed: 11/26/2022] Open
Abstract
Background Metachronous osteosarcoma is a rare form of osteosarcoma. The occurrence of metachronous tumor in soft tissue is exceedingly rare. The pathogenesis of metachronous osteosarcoma, as to whether it represents multiple true primaries or metastatic disease, is still obscure. Case presentation A 49-year-old Indian man presented with progressively increasing swelling in his left hand of 2 months’ duration. An X-ray showed a soft tissue lesion. Contrast-enhanced computed tomography showed a soft tissue mass lesion, with peripheral enhancement and central necrotic areas in radial palmar soft tissue overlying second metacarpophalangeal region with no obvious bony osteolysis. Possibilities of acute abscess, resolving hematoma, or aggressive soft tissue mass lesion were suggested. An incision biopsy showed morphological features of epithelioid osteosarcoma, which was confirmed on immunohistochemistry. A detailed history revealed that our patient was diagnosed as having osteosarcoma of his right leg 3 years previously. Based on history, radiology, morphology, and immunohistochemistry, a final diagnosis of extraskeletal (soft tissue) epithelioid osteogenic sarcoma of the left hand occurring as a metachronous tumor 3 years after diagnosis of primary osteosarcoma in the right leg was given. Conclusion This is probably the first reported case of extraskeletal (soft tissue) epithelioid osteosarcoma occurring as a metachronous tumor 3 years after diagnosis of primary osteosarcoma in the right leg. The prognosis of metachronous skeletal osteosarcoma is poor as compared to that of relapse limited to lungs. In late metachronous osteosarcoma, combined-modality therapy comprising surgery and aggressive chemotherapy may affect long-term survival. Lifelong follow-up of surviving patients with osteosarcoma is necessary and if metachronous osteosarcoma is discovered, it should be treated with curative intent. Electronic supplementary material The online version of this article (10.1186/s13256-019-2070-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gireesha Rawal
- Department of Pathology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, 110029, India
| | - Charanjeet Ahluwalia
- Department of Pathology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, 110029, India.
| | - Amit Kumar Yadav
- Department of Pathology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, 110029, India
| | - Rashmi Arora
- Department of Pathology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, 110029, India
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7
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Zhao C, Li H, Wang L, Sun W. An Immunohistochemical Study of Stathmin 1 Expression in Osteosarcoma Shows an Association with Metastases and Poor Patient Prognosis. Med Sci Monit 2018; 24:6070-6078. [PMID: 30169496 PMCID: PMC6129035 DOI: 10.12659/msm.910953] [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: 12/18/2022] Open
Abstract
Background Osteosarcoma is the most common primary bone cancer and has a broad spectrum of histological subtypes. Stathmin 1 (STMN1) is a cytosolic phosphoprotein that is expressed in several types of cancer. The aim of this study was to evaluate the expression levels of STMN1 in osteosarcoma with clinicopathological characteristics and patient prognosis. Material/Methods The expression of STMN1 in tumor tissue from 94 patients with OS was detected and evaluated using an immunohistochemical score to divide the patients into low expression and high expression groups. Correlation between STMN1 expression and clinicopathological factors were analyzed with Fisher’s test, the prognostic value of expression levels of STMN1 in tumor tissue was evaluated by Kaplan-Meier univariate analysis, and independent prognostic factors were identified using the Cox regression model. Results Low expression of STMN1 was found in 43.62% of cases and high expression of STMN1 was found in 56.38% of cases of osteosarcoma. High tumor expression of STMN1 was significantly associated with the presence of metastases (P=0.028), Enneking surgical stage (P=0.030), tumor response to chemotherapy (P=0.011), and the site of tumor origin (P=0.023). High tumor expression of STMN1 was a prognostic marker in patients with osteosarcoma for poor prognosis (P=0.016), poor response to chemotherapy (P=0.004), the presence of metastases (P=0.003), advanced Enneking surgical stage (P=0.014), and the chondroblastic osteosarcoma subtype (P=0.004). The expression STMN1 was identified as an independent prognostic biomarker of osteosarcoma. Conclusions Increased expression of STMN1 in tumor tissue was an independent prognostic biomarker in patients with osteosarcoma.
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Affiliation(s)
- Changlei Zhao
- Department of Rehabilitation, Yidu Central Hospital, Weifang, Shandong, China (mainland)
| | - Hailing Li
- Department of Rehabilitation, Yidu Central Hospital, Weifang, Shandong, China (mainland)
| | - Lingling Wang
- Department of Geriatrics, Nursing Vocational College of Weifang, Weifang, Shandong, China (mainland)
| | - Wei Sun
- Department of Orthopedics, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China (mainland)
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9
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Ghosh J, Bajpai J. Chemotherapy for osteosarcoma: Adverse effects and remedial measures. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2017. [DOI: 10.1016/j.phoj.2017.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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10
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Zandueta C, Ormazábal C, Perurena N, Martínez-Canarias S, Zalacaín M, Julián MS, Grigoriadis AE, Valencia K, Campos-Laborie FJ, Rivas JDL, Vicent S, Patiño-García A, Lecanda F. Matrix-Gla protein promotes osteosarcoma lung metastasis and associates with poor prognosis. J Pathol 2016; 239:438-49. [PMID: 27172275 DOI: 10.1002/path.4740] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 04/29/2016] [Accepted: 05/04/2016] [Indexed: 11/11/2022]
Abstract
Osteosarcoma (OS) is the most prevalent osseous tumour in children and adolescents and, within this, lung metastases remain one of the factors associated with a dismal prognosis. At present, the genetic determinants driving pulmonary metastasis are poorly understood. We adopted a novel strategy using robust filtering analysis of transcriptomic profiling in tumour osteoblastic cell populations derived from human chemo-naive primary tumours displaying extreme phenotypes (indolent versus metastatic) to uncover predictors associated with metastasis and poor survival. We identified MGP, encoding matrix-Gla protein (MGP), a non-collagenous matrix protein previously associated with the inhibition of arterial calcification. Using different orthotopic models, we found that ectopic expression of Mgp in murine and human OS cells led to a marked increase in lung metastasis. This effect was independent of the carboxylation of glutamic acid residues required for its physiological role. Abrogation of Mgp prevented lung metastatic activity, an effect that was rescued by forced expression. Mgp levels dramatically altered endothelial adhesion, trans-endothelial migration in vitro and tumour cell extravasation ability in vivo. Furthermore, Mgp modulated metalloproteinase activities and TGFβ-induced Smad2/3 phosphorylation. In the clinical setting, OS patients who developed lung metastases had high serum levels of MGP at diagnosis. Thus, MGP represents a novel adverse prognostic factor and a potential therapeutic target in OS. Microarray datasets may be found at: http://bioinfow.dep.usal.es/osteosarcoma/ Copyright © 2016 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Carolina Zandueta
- Programme in Solid Tumours and Biomarkers, Division of Oncology, Centre for Applied Biomedical Research (CIMA), University of Navarra, Pamplona, Spain
| | - Cristina Ormazábal
- Programme in Solid Tumours and Biomarkers, Division of Oncology, Centre for Applied Biomedical Research (CIMA), University of Navarra, Pamplona, Spain
| | - Naiara Perurena
- Programme in Solid Tumours and Biomarkers, Division of Oncology, Centre for Applied Biomedical Research (CIMA), University of Navarra, Pamplona, Spain
| | - Susana Martínez-Canarias
- Programme in Solid Tumours and Biomarkers, Division of Oncology, Centre for Applied Biomedical Research (CIMA), University of Navarra, Pamplona, Spain
| | - Marta Zalacaín
- Department of Paediatrics, Clínica Universidad de Navarra (CUN), School of Medicine, University of Navarra, Pamplona, Spain
| | - Mikel San Julián
- Department of Orthopaedics, Clínica Universidad de Navarra (CUN), School of Medicine, University of Navarra, Pamplona, Spain
| | - Agamemnon E Grigoriadis
- Department of Craniofacial Development and Stem Cell Biology, Guy's Hospital, King's College, London, UK
| | - Karmele Valencia
- Programme in Solid Tumours and Biomarkers, Division of Oncology, Centre for Applied Biomedical Research (CIMA), University of Navarra, Pamplona, Spain
| | - Francisco J Campos-Laborie
- Bioinformatics and Functional Genomics Research Group, Cancer Research Centre (IBMCC-CIC), CSIC, and University of Salamanca (CSIC/USAL), Salamanca, Spain
| | - Javier De Las Rivas
- Bioinformatics and Functional Genomics Research Group, Cancer Research Centre (IBMCC-CIC), CSIC, and University of Salamanca (CSIC/USAL), Salamanca, Spain
| | - Silvestre Vicent
- Programme in Solid Tumours and Biomarkers, Division of Oncology, Centre for Applied Biomedical Research (CIMA), University of Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Ana Patiño-García
- Department of Paediatrics, Clínica Universidad de Navarra (CUN), School of Medicine, University of Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Fernando Lecanda
- Programme in Solid Tumours and Biomarkers, Division of Oncology, Centre for Applied Biomedical Research (CIMA), University of Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
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Zhang P, Dong L, Long H, Yang TT, Zhou Y, Fan QY, Ma BA. Homologous mesenchymal stem cells promote the emergence and growth of pulmonary metastases of the rat osteosarcoma cell line UMR-106. Oncol Lett 2014; 8:127-132. [PMID: 24959232 PMCID: PMC4063563 DOI: 10.3892/ol.2014.2127] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 03/28/2014] [Indexed: 12/27/2022] Open
Abstract
Osteosarcoma (OS) is the most frequent primary bone sarcoma and tends to develop pulmonary metastasis. Studies have shown that mesenchymal stem cells (MSCs) are involved in OS growth and metastasis, but the mechanism remains unclear. The aim of the present study was to identify whether homologous MSCs could promote the growth and metastasis of OS in rats with a normal immune system. The OS cell line, UMR-106, which originally derives from a Sprague-Dawley (SD) rat-transplantable osteogenic sarcoma with an osteoblastic phenotype, has a strong carcinogenic capability and a high lung metastasis. Xenotransplanted models of UMR-106 with or without MSCs injected through the tibia (IT) or caudal vein (IV) were established. SD rats were randomly divided into six groups: Control, UMR-106 (IT), MSCs (IV), UMR-106 (IT) + MSCs (IV), UMR-106 (IV) and UMR-106 (IV) + MSCs (IV). Following injection, all rats were sacrificed at week 5, and the volume and quantity of metastatic sarcoma and the serum alkaline phosphatase levels were measured. There was no metastatic sarcoma in the liver, spleen and kidney in all groups. The rats in the MSCs (IV) + UMR-106 (IV) group showed a significantly higher volume and number of pulmonary metastatic tumors than those of the UMR-106 (IV) group. In pulmonary metastatic tissues, MSCs were found in the MSCs (IV) + UMR-106 (IV) group, but not in the UMR-106 (IT) + MSCs (IV) group. Notably, the expression of vascular endothelial growth factor (VEGF) was increased in the MSCs + UMR-106 cells co-culture system. The present study indicated that MSCs can significantly promote the pulmonary metastasis of the rat OS cell line, UMR-106, with a normal immune system, and VEGF was involved in MSC-promoted UMR-106 emergence and growth of pulmonary metastasis.
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Affiliation(s)
- Peng Zhang
- Department of Orthopedic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China ; Department of Orthopedic Surgery, Urumqi General Hospital, Urumqi, Xinjiang 830000, P.R. China
| | - Ling Dong
- Department of Physiology, Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Hua Long
- Department of Orthopedic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Tong-Tao Yang
- Department of Orthopedic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Yong Zhou
- Department of Orthopedic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Qing-Yu Fan
- Department of Orthopedic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Bao-An Ma
- Department of Orthopedic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
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Zils K, Wirth T, Loff S, Biskup S, von Kalle T, Bielack S. Multiple metachronous osteosarcomas in a patient with Li-Fraumeni syndrome. Pediatr Hematol Oncol 2014; 31:359-61. [PMID: 24274641 DOI: 10.3109/08880018.2013.848388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Katja Zils
- 1 Pediatrics 5 (Oncology, Hematology, Immunology; Gastroenterology, Rheumatology, General Pediatrics), Klinikum Stuttgart -Olgahospital, Germany
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Three Metachronous Osteosarcomas within 22 Years without Pulmonary Metastases: A Case Report and Review of the Literature. Case Rep Orthop 2014; 2013:197287. [PMID: 24455368 PMCID: PMC3886224 DOI: 10.1155/2013/197287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 11/21/2013] [Indexed: 11/21/2022] Open
Abstract
Introduction. We present the extremely rare case of a patient with three metachronous osteosarcomas within 22 years without evident pulmonary manifestation of disease 30 years after first diagnosis. Case Presentation. In 1983, a high-grade osteosarcoma of the left distal femur was diagnosed in an 18-year-old Caucasian male. He received rotationplasty accompanied by pre- and postoperative chemotherapy. Ten years later, an osteoblastic osteosarcoma occurred in TH12. En bloc resection and pre- and postoperative chemotherapy followed. In 2005, the patient developed another high-grade osteosarcoma in his right distal femur. Treatment included a wide resection and reconstruction with a tumour endoprosthesis as well as (neo)adjuvant chemotherapy. After the third tumour occurrence, cytogenetic and molecular genetic examinations (p53, rb1) were performed, showing a normal genetic pattern. Screening for metastases never showed clinical evidence of extraskeletal tumour manifestation. Discussion. In patients presenting metachronous osteosarcoma, identification of their lesions clonality (second primary tumour or metastases) could lead to a better understanding of tumour development and help to filter patients who need extended long-term followup due to a higher risk of late occurring sarcoma recurrence.
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Errani C, Longhi A, Rossi G, Rimondi E, Biazzo A, Toscano A, Alì N, Ruggieri P, Alberghini M, Picci P, Bacci G, Mercuri M. Palliative therapy for osteosarcoma. Expert Rev Anticancer Ther 2014; 11:217-27. [DOI: 10.1586/era.10.172] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Comparison of (18)F-FDG PET/CT and (99 m)Tc-MDP bone scintigraphy for detection of bone metastasis in osteosarcoma. Skeletal Radiol 2013; 42:1673-81. [PMID: 23995264 DOI: 10.1007/s00256-013-1714-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Revised: 07/10/2013] [Accepted: 08/08/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We compared the diagnostic performance of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) and (99 m)Tc-methylene diphosphonate bone scintigraphy (BS) for the detection of bone metastasis in osteosarcoma. MATERIALS AND METHODS We retrospectively reviewed 206 patients with stage II-IV osteosarcoma treated with surgery and chemotherapy as well as at least one paired PET/CT and BS scan (defined as an examination). PET/CT and BS images were interpreted separately. When analyzing the diagnostic yield of a combination of PET/CT and BS (PET/CT+BS), an examination was considered positive if either PET/CT or BS scored positive. The final diagnosis was obtained from histological findings or clinical follow-up with imaging studies for at least 6 months. Diagnostic performances of PET/CT, BS, and their combinations were calculated. RESULTS Out of 833 examinations in 206 patients, 55 with 101 lesions in 38 patients were confirmed as bone metastases. The sensitivity, specificity, and diagnostic accuracy were 95, 98, and 98%, respectively, for PET/CT; 76, 97, and 96%, respectively, for BS; and 100, 96, and 97%, respectively, for PET/CT+BS in an examination-based analysis. Lesion-based analysis demonstrated that the sensitivity of PET/CT+BS (100%) was significantly higher than that of PET/CT (92%) or BS (74%) alone. BS detected significantly less bone metastases in the growth plate region than outside the growth plate region (22 vs. 77%). CONCLUSIONS PET/CT is more sensitive and accurate than BS for diagnosing bone metastases in osteosarcoma. The combined use of PET/CT and BS improves sensitivity.
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Vijayamurugan N, Bakhshi S. Review of management issues in relapsed osteosarcoma. Expert Rev Anticancer Ther 2013; 14:151-61. [PMID: 24308680 DOI: 10.1586/14737140.2014.863453] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Osteosarcoma is the most common primary malignant bone tumor in children and adolescents. With combined modality treatment long-term survival rate for localized disease is near 70%. Thirty percent of patients relapse with lung as the commonest site. Surgery is the treatment of choice for relapsed patients whenever possible. Addition of chemotherapy to surgery provides survival benefit in patients not achieving second surgical remission. Even patients with multiple lung recurrences can be cured with repeated thoracotomies. Disease-free interval and complete surgical resection are the main prognostic factor for post-relapse survival.
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Affiliation(s)
- Nataraj Vijayamurugan
- Departments of Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi-110029, India
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Maheshwari AV, Jelinek JS, Seibel NL, Meloni-Ehrig AM, Kumar D, Henshaw RM. Bilateral synchronous tibial periosteal osteosarcoma with familial incidence. Skeletal Radiol 2012; 41:1005-9. [PMID: 22349598 DOI: 10.1007/s00256-012-1376-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2011] [Revised: 01/23/2012] [Accepted: 01/29/2012] [Indexed: 02/02/2023]
Abstract
Multifocal or multicentric osteosarcoma (OS) has been described as tumor occurrence at two or more sites in a patient without visceral metastasis. These may be synchronous (more than one lesion at presentation) or metachronous (new tumor developing after the initial treatment). The incidence of multifocal OS has ranged from 1.5 to 5.4% in large series, with the synchronous type being rarer. Similarly, periosteal OS is another rare subtype of surface OS and constitutes less than 2% of all OS. An 11-year-old female was diagnosed with bilateral synchronous tibial periosteal OS, which were confirmed by CT-guided biopsies. After neoadjuvant chemotherapy, the patient underwent a staged wide local resection of the tumors. The defect was reconstructed with a proximal tibial replacement on the left side and autologous bone grafting on the right side. The patient did well after surgery and is free of disease at 5.5 years of follow-up. However, her brother also developed a right tibial periosteal osteosarcoma 4 years after her index surgery. Genetic analysis of blood sample from both patients showed a similar missense mutation in at least one allele of TP53 gene (exon 8). To the best of our knowledge, a case of bilateral 'synchronous' periosteal OS with a familial incidence has not been reported before.
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Affiliation(s)
- Aditya V Maheshwari
- Department of Orthopaedics, SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203, USA.
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Berger M, Grignani G, Giostra A, Ferrari S, Ferraresi V, Tamburini A, Cefalo G, Carnevale-Schianca F, Vassallo E, Picci P, Pagano M, Aglietta M, Pellerito R, Fagioli F. 153Samarium-EDTMP administration followed by hematopoietic stem cell support for bone metastases in osteosarcoma patients. Ann Oncol 2012; 23:1899-905. [DOI: 10.1093/annonc/mdr542] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Franke M, Hardes J, Helmke K, Jundt G, Jürgens H, Kempf-Bielack B, Kevric M, Tunn PU, Werner M, Bielack S. Solitary skeletal osteosarcoma recurrence. Findings from the Cooperative Osteosarcoma Study Group. Pediatr Blood Cancer 2011; 56:771-6. [PMID: 21370409 DOI: 10.1002/pbc.22864] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Accepted: 09/14/2010] [Indexed: 11/08/2022]
Abstract
BACKGROUND Solitary skeletal osteosarcoma (OS) manifestations distant from the site of the primary tumor rarely arise as only sign of disease recurrence. METHODS This report reviews 38 patients with high-grade central OS of the limbs or axial skeleton and initial complete surgical remission (CR) who developed first recurrences as solitary osseous lesions distant from the primary tumor. The Cooperative Osteosarcoma Study Group (COSS) database was used to evaluate patient-, tumor-, and treatment-related variables and outcomes. RESULTS Thirty-eight patients (27 males and 11 females; 36 limb and 2 axial primaries) developed solitary osseous recurrences a median of 2.1 years (range: 0.5-14.3) from primary diagnosis. Relapses involved axial (24), extremity (10), or craniofacial bones (4). Treatment for recurrence included surgery (28), radiotherapy (10), and chemotherapy (27). After a median follow-up of 1.9 years (range: 0.1-21.2) from first recurrence for all 38 patients and 5.5 years (0.3-21.2) for 16 survivors (10 in continuous second CR), 2- and 5-year overall and event-free survival (EFS) probabilities were 55% and 34% and 34% and 27%, respectively. A long interval to recurrence (>1.5 years) predicted for better overall (P < 0.001) and EFS (P = 0.005). For 21 patients achieving a second CR, 2- and 5-year overall and EFS probabilities were 81% and 61% and 52% and 49%, respectively, while only 1/17 others survived beyond 5 years (P < 0.001). Survivors (14/16) had also received second-line chemotherapy. CONCLUSION First solitary skeletal recurrences of OS should be treated with curative intent. Some presumed bone metastases may represent second primary OSs.
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Affiliation(s)
- Markus Franke
- Klinikum Stuttgart-Olgahospital, Department of Pediatric Surgery, Stuttgart, Germany
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21
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Bousdras V, Flanagan A, Bousdras K, Vourvachis M, Newman L, Kalavrezos N. Multiple-site osteosarcomas of the jaw in a single patient. A true case of a metachronous lesion? Int J Oral Maxillofac Surg 2010; 39:733-6. [DOI: 10.1016/j.ijom.2010.02.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2009] [Revised: 08/04/2009] [Accepted: 02/09/2010] [Indexed: 10/19/2022]
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Brandal P, Bjerkehagen B, Bruland OS, Skjeldal S, Bogsrud TV, Hall KS. Synchronous and metachronous skeletal osteosarcomas: the Norwegian Radium Hospital experience. Acta Oncol 2009; 48:1165-72. [PMID: 19863225 DOI: 10.3109/02841860903032809] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background. The purpose of this work was to study clinical and histopathological tumor characteristics of patients treated for synchronous or metachronous skeletal osteosarcoma at The Norwegian Radium Hospital from January 1, 1980 to January 1, 2008. Patients and methods. The hospital sarcoma database and patient records were reviewed to identify cases with synchronous or metachronous skeletal osteosarcoma. Patients with more than one skeletal lesion in the absence of pulmonary or other soft tissue tumor manifestations were included in the study, and histopathological slides from these tumors were reviewed. Results. Among a total of 297 registered osteosarcoma patients, six with synchronous (2.0%) and 10 with metachronous (3.4%) skeletal osteosarcomas were identified. All tumors were of high-grade malignancy. Treatment at the time of the first osteosarcoma diagnosis was in most cases wide resections and multi-agent chemotherapy according to international protocols, whereas the treatment for metachronous tumors was individualized and in general much less intensive. One patient was diagnosed with Li-Fraumeni syndrome, two other individuals may be suspected to have the same syndrome, and yet another patient had previously been treated for a bilateral retinoblastoma. Thirteen patients are dead, 11 from metastatic osteosarcoma, one from myelodysplastic syndrome, and one from wound infection and methotrexate-related nephrotoxicity; whereas three patients are still alive with no evidence of osteosarcoma. Conclusions. The prognosis for patients with synchronous and metachronous skeletal osteosarcoma is poor. However, because long-term survival is seen, aggressive treatment to selected cases, e.g., patients with an osteosarcoma predisposing syndrome and/or late occurring metachronous tumours, is justified. Revealing a possible clonal relationship between these tumors, e.g., by karyotyping, may be of interest for estimating prognosis and guide therapy intensiveness.
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Affiliation(s)
- Petter Brandal
- Department of Oncology, Division of Cancer Medicine and Radiotherapy, The Norwegian Radium Hospital, Montebello, Oslo, Norway.
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Arkader A, Huvos AG, Healey JH. Multifocal synchronous low-grade intramedullary and juxtacortical osteogenic sarcoma. Clin Orthop Relat Res 2007; 465:265-70. [PMID: 17906589 DOI: 10.1097/blo.0b013e318159a2e6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We report the case of a 41-year-old woman who presented with ipsilateral synchronous low-grade juxtacortical osteogenic sarcoma of the distal femur and low-grade intramedullary osteogenic sarcoma of the proximal tibia. The diagnosis and treatment and a review of the literature also are provided.
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Affiliation(s)
- Alexandre Arkader
- Orthopedic Surgery Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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Gassiamis A, Tsakonas G, Soukouli G, Mylonakis N, Karabelis A, Kosmas C. Diffuse calcification of metastases after intensive multiagent chemotherapy in widespread osteosarcoma leading to death in a 18-year-old male: report of a case and literature review. Med Oncol 2007; 23:455-62. [PMID: 17303903 DOI: 10.1385/mo:23:4:455] [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: 03/04/2006] [Revised: 11/30/1999] [Accepted: 06/22/2006] [Indexed: 11/11/2022]
Abstract
Multifocal osteosarcoma represents a rare and aggressive type of osteosarcoma in which multiple bone lesions are detected simultaneously in the absence of pulmonary or any other visceral organ involvement. Despite a multidisciplinary approach, overall survival remains poor and disease progresses, leading to death within 1 yr of diagnosis. Here we report a case of an 18-yr-old patient with extensively metastatic osteosarcoma developing diffuse calcification in lung, pleural, diaphragm, pericardial, subcutaneous metastases, and mediastinal lymph nodes after intensive multiagent chemotherapy. We provide an extensive review of the literature together with presentation of different aspects regarding the debate on the multicentric versus metastatic hypotheses for multifocal osteosarcoma. An update on the current understanding of the molecular features of this disease is also included.
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Affiliation(s)
- Argyris Gassiamis
- Department of Medicine, 2nd Division of Medical Oncology, Metaxa Cancer Hospital, Pireaus, Greece
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Hicks MJ, Roth JR, Kozinetz CA, Wang LL. Clinicopathologic Features of Osteosarcoma in Patients With Rothmund-Thomson Syndrome. J Clin Oncol 2007; 25:370-5. [PMID: 17264332 DOI: 10.1200/jco.2006.08.4558] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Patients with Rothmund-Thomson syndrome (RTS) and RECQL4 gene mutations have an increased risk of developing osteosarcoma (OS). Because RTS is considered a genomic instability syndrome, patients may experience increased toxicity with chemotherapy. The purpose of this study was to summarize the clinical features and response to therapy of OS in patients with RTS. The results of this analysis will help to define treatment guidelines for this complex and rare condition. Patients and Methods An international cohort of patients with RTS and OS was enrolled in an institutional review board–approved study at Baylor College of Medicine (Houston, TX). Medical records were reviewed, and the following information was extracted: clinical features, treatment, pathologic findings, and clinical outcome. Results The median age at diagnosis of OS for the 12 patients was 10 years. The most common primary tumor sites were the long bones (femur, tibia); the most frequent histologic subtype was conventional OS. Histologic response to chemotherapy and outcome were similar to other published large series of sporadic OS. Eight patients are alive and disease free; four died as a result of cancer. Five patients required chemotherapy dose modifications, most commonly due to mucositis from doxorubicin. Conclusion Our results indicate that patients with RTS and OS are younger, but that their clinical behavior is similar to patients with sporadic OS. Our report suggests that these patients should initially be treated with conventional doses of chemotherapy as prescribed by current protocols; however, cautious and careful clinical observation is warranted to monitor for enhanced doxorubicin sensitivity in patients with RTS.
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Affiliation(s)
- M John Hicks
- Baylor College of Medicine, Houston, TX 77030, USA
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Bacci G, Longhi A, Bertoni F, Briccoli A, Versari M, Pignotti E, Picci P. Bone metastases in osteosarcoma patients treated with neoadjuvant or adjuvant chemotherapy: the Rizzoli experience in 52 patients. Acta Orthop 2006; 77:938-43. [PMID: 17260205 DOI: 10.1080/17453670610013268] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION There have been no large-scale studies reporting the outcome of patients with osteosarcoma who first relapse with bone metastases, but there have been several case reports describing a much poorer prognosis for these patients than for those who relapse with lung metastases. METHODS We compared 52 patients with skeletal metastases as first relapse after neoadjuvant or adjuvant treatment for osteosarcoma of the extremity given at our institution between 1972 and 1999 with 371 contemporary patients treated with the same chemotherapy protocols, who first relapsed with lung metastases. RESULTS We found that the 52 patients with bone metastases had a higher rate of local recurrences (36% vs. 6%), a lower rate of remission (35% vs. 77%), and lower rates of 5-year event-free survival (11% vs. 27%) and overall survival (13% vs. 31%) (p < 0.01 for all comparisons). INTERPRETATION The prognosis of patients who relapse with bone metastases--unless they have a single late-appearing metastasis--is worse than the prognosis of patients who first relapse with lung metastases. There was no difference in outcome between patients with single, resectable and late-appearing skeletal metastases and patients relapsing in the lung.
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Affiliation(s)
- Gaetano Bacci
- Section of Chemotherapy, Department of Musculoskeletal Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy.
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Longhi A, Errani C, De Paolis M, Mercuri M, Bacci G. Primary bone osteosarcoma in the pediatric age: State of the art. Cancer Treat Rev 2006; 32:423-36. [PMID: 16860938 DOI: 10.1016/j.ctrv.2006.05.005] [Citation(s) in RCA: 447] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2005] [Revised: 05/30/2006] [Accepted: 05/31/2006] [Indexed: 01/11/2023]
Abstract
The current combination treatment, chemotherapy and surgery, has significantly improved the cure rate and the survival rate of primary bone osteosarcoma. The 5-year survival rate has increased in the last 30 years from 10% to 70%. Even in patients with poor prognosis, such as those with metastases at diagnosis, the 5-year survival rate has reached 20-30% due to chemotherapy and the surgical removal of metastases and primary tumor. However, the most effective drugs are still the same as those employed over the last 20 years as front line neoadjuvant or adjuvant chemotherapy: Doxorubicin, Cisplatin, Methotrexate, Ifosfamide. No standard, second line therapy exists for those who relapse. At relapse, due to the lack of new non-cross-resistant drugs, surgery is still the main option when feasible. Other drugs have been employed in relapsed patients with poor results. This article reviews the state of the art of treatment for bone osteosarcoma in the pediatric age.
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Affiliation(s)
- Alessandra Longhi
- Chemotherapy Surgery of the Musculoskeletal, Oncology Department at Rizzoli Orthopaedic Institute, Bologna, Italy.
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Kempf-Bielack B, Bielack SS, Jürgens H, Branscheid D, Berdel WE, Exner GU, Göbel U, Helmke K, Jundt G, Kabisch H, Kevric M, Klingebiel T, Kotz R, Maas R, Schwarz R, Semik M, Treuner J, Zoubek A, Winkler K. Osteosarcoma relapse after combined modality therapy: an analysis of unselected patients in the Cooperative Osteosarcoma Study Group (COSS). J Clin Oncol 2005; 23:559-68. [PMID: 15659502 DOI: 10.1200/jco.2005.04.063] [Citation(s) in RCA: 464] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To evaluate the impact of patient, tumor, and treatment-related factors on outcome in unselected patients with recurrent osteosarcoma. PATIENTS AND METHODS Five hundred seventy-six consecutive patients who had achieved a first complete surgical remission (CR) during combined-modality therapy on neoadjuvant Cooperative Osteosarcoma Study Group (COSS) protocols and then developed recurrent osteosarcoma were analyzed (median time from biopsy to relapse, 1.6 years; range, 0.1 to 14.3 years). There were 501 patients with metastases, 44 with local recurrences, and 31 with both. Metastases involved lungs (469 patients), bones (90 patients), and/or other sites (54 patients). RESULTS After a median follow-up of 1.2 years for all patients and 4.2 years for survivors, actuarial overall survival (OS) rates at 2, 5, and 10 years were 0.38, 0.23, and 0.18, respectively. Five-year OS was 0.39 for 339 patients with and 0.00 for 229 patients without a second surgical CR (P < .0001). A long time to relapse, a solitary lesion, and, in the case of pulmonary metastases, unilateral disease and the absence of pleural disruption, were of positive prognostic value in uni- and multivariate analyses, as were a second surgical CR and the use of second-line chemotherapy. Radiotherapy was associated with moderately prolonged survival in patients without a second CR. The very limited prognostic differences associated with the use of second-line chemotherapy appeared to be more pronounced with polychemotherapy. CONCLUSION Time to relapse and tumor burden correlate with postrelapse outcome in osteosarcoma. Complete surgery is an essential component of curative second-line therapy. Chemotherapy, particularly chemotherapy with more than one agent, may contribute to limited improvements in outcome.
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Affiliation(s)
- Beate Kempf-Bielack
- Cooperative Osteosarkomstudiengruppe (COSS), Universitätsklinikum Münster, Klinik und Poliklinik für Kinder- und Jugendmedizin, Pädiatrische Hämatologie und Onkologie, Albert-Schweitzer-Strasse 33, D-48149 Münster, Germany.
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Jaffe N, Pearson P, Yasko AW, Lin P, Herzog C, Raymond K. Single and multiple metachronous osteosarcoma tumors after therapy. Cancer 2003; 98:2457-66. [PMID: 14635081 DOI: 10.1002/cncr.11800] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The objective of the current study was to determine the incidence, clinical and pathologic characteristics, and outcome of patients with conventional osteosarcoma who developed metachronous tumors after treatment for the primary tumor and prevention of pulmonary metastases. METHODS The medical records of 270 pediatric patients (younger than age 18 years) were reviewed. The prevention and absence of pulmonary metastases was confirmed by chest radiographs and computerized scans of the lungs. Radionuclide bone scans were used to confirm the absence of skeletal metastases. RESULTS Eleven patients with metachronous tumors were identified. Index primary tumors involved the femur (n = 8), the tibia (n = 2), and the radius (n = 1). Single metachronous tumors developed in the femur (n = 6), in the humerus (n = 1), and multifocal in multiple bones (n = 4). Two patients later developed second metachronous tumors. The interval between identification of the primary tumor to development of the single metachronous tumors varied from 11 months to 78 months and from 12 months to 42 months for synchronous multifocal tumors. Metachronous tumors were treated with single-agent cisplatin or ifosfamide. Only 1 patient experienced > 90% tumor necrosis. Pulmonary metastases were not detected in 10 of 11 patients at the time metachronous tumors were discovered. In the 11th patient, synchronous pulmonary metastasis with the metachronous tumor was noted. Three patients had a prior history of bilateral retinoblastoma. The Li-Fraumeni syndrome may have been present in another patient. Six patients died. Five patients have survived for 20+ to 50+ months after the appearance, treatment, and resection of metachronous tumors. CONCLUSIONS With improvement in the cure rate, metachronous osteosarcoma should be recognized as an important sequela in long-term survivors. The etiology of this disease is unknown. Speculation rests on a skeletal multicentric origin, which includes an inherited predisposition to develop osteosarcoma in retinoblastoma and in the Li-Fraumeni syndrome. Meticulous follow-up is required to permit early detection and successful therapeutic intervention.
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Affiliation(s)
- Norman Jaffe
- Division of Pediatrics, University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
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Abstract
Skip metastasis is rare in high-grade osteosarcoma and indicates a very poor prognosis. The authors describe two patients who had high-grade osteosarcoma and skip metastasis. MRI detected the skip lesion in both patients, and both lesions were confirmed by histology. The patients were treated with adjuvant chemotherapy and radical surgical resection. Both are alive and free of disease 3 and 6 years from diagnosis.
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Affiliation(s)
- Patrick J Leavey
- Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, TX 75390-9063, USA.
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