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Lim Z, Gu TY, Tai BC, Puhaindran ME. Survival outcomes of malignant peripheral nerve sheath tumors (MPNSTs) with and without neurofibromatosis type I (NF1): a meta-analysis. World J Surg Oncol 2024; 22:14. [PMID: 38191386 PMCID: PMC10775467 DOI: 10.1186/s12957-023-03296-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 12/26/2023] [Indexed: 01/10/2024] Open
Abstract
INTRODUCTION Malignant peripheral nerve sheath tumors (MPNSTs) are malignancies that demonstrate nerve sheath differentiation in the peripheral nervous system. They can occur sporadically or be associated with neurofibromatosis type 1 (NF1), an autosomal dominant neurocutaneous disorder, with up to 13% of patients developing MPNSTs in their lifetimes. Previous studies have suggested conflicting findings regarding the prognosis of NF1 for patients with MPNSTs. The elucidation of NF1 as an independent prognostic factor on mortality has implications for clinical management. We aim to investigate the role of NF1 status as an independent prognostic factor of overall survival (OS) and disease-specific survival (DSS) in MPNSTs. METHODS An electronic literature search of PubMed and MEDLINE was performed on studies reporting OS or DSS outcomes of MPNSTs with and without NF1. A grey literature search by reviewing bibliographies of included studies and review articles was performed to find pertinent studies. Data was extracted and assessed in accordance with the PRISMA guidelines. A meta-analysis was performed to calculate hazard ratios (HRs) using a random-effects model. The primary and secondary outcomes were all-cause and disease-specific mortality, respectively, with NF1 as an independent prognostic factor of interest. RESULTS A total of 59 retrospective studies involving 3602 patients fulfilled the inclusion criteria for OS analysis, and 23 studies involving 704 MPNST patients were included to evaluate DSS outcomes. There was a significant increase in the hazard of all-cause mortality (HR 1.63, 95% CI 1.45 to 1.84) and disease-specific mortality (HR 1.52, 95% CI 1.24 to 1.88) among NF1 as compared to sporadic cases. Subgroup analyses and meta-regression showed that this result was consistent regardless of the quality of the study and year of publication. CONCLUSION NF1 is associated with a substantially higher risk of all-cause and disease-specific mortality. This finding suggests that closer surveillance is required for NF1 patients at risk of developing MPNSTs.
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Affiliation(s)
- Zhixue Lim
- Department of Hand & Reconstructive Microsurgery, University Orthopaedic, Hand & Reconstructive Microsurgical Cluster, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore.
| | - Tian Yuan Gu
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive, #10-01, Singapore, 117549, Singapore
| | - Bee Choo Tai
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive, #10-01, Singapore, 117549, Singapore.
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Mark Edward Puhaindran
- Department of Hand & Reconstructive Microsurgery, University Orthopaedic, Hand & Reconstructive Microsurgical Cluster, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore
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Würtemberger J, Ripperger T, Vokuhl C, Bauer S, Teichert-von Lüttichau I, Wardelmann E, Niemeyer CM, Kratz CP, Schlegelberger B, Hettmer S. Genetic susceptibility in children, adolescents, and young adults diagnosed with soft-tissue sarcomas. Eur J Med Genet 2023; 66:104718. [PMID: 36764384 DOI: 10.1016/j.ejmg.2023.104718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 10/30/2022] [Accepted: 01/29/2023] [Indexed: 02/11/2023]
Abstract
Soft tissue sarcomas (STS) may arise as a consequence of germline variants in cancer predisposition genes (CPGs). We believe that elucidating germline sarcoma predisposition is critical for understanding disease biology and therapeutic requirements. Participation in surveillance programs may allow for early tumor detection, early initiation of therapy and, ultimately, better outcomes. Among children, adolescents, and adults diagnosed with soft-tissue sarcomas and examined as part of published germline sequencing studies, pathogenic/likely pathogenic (P/LP) variants in CPGs were reported in 7-33% of patients. P/LP germline variants were detected most frequently in TP53, NF1 and BRCA1/2. In this review, we describe reported associations between soft tissue sarcomas and germline variants in CPGs, with mentioning of locally aggressive and benign soft tissue tumors that have important associations with cancer predisposition syndromes. We also discuss recommendations for diagnostic germline genetic testing. Testing for sarcoma-predisposing germline variants should be considered as part of the routine clinical workup and care of any child, adolescent, or adult diagnosed with STS and take into account consequences for the whole family.
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Affiliation(s)
- Julia Würtemberger
- Division of Pediatric Hematology and Oncology, Department of Pediatric and Adolescent Medicine, University Medical Center Freiburg, University of Freiburg, Germany
| | - Tim Ripperger
- Department of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Christian Vokuhl
- Institute of Pathology, University Hospital Bonn, 53127, Bonn, Germany
| | - Sebastian Bauer
- Department of Oncology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Irene Teichert-von Lüttichau
- Technical University of Munich, School of Medicine, Department of Pediatrics and Children's Cancer Research Center, Kinderklinik München Schwabing, Munich, Germany
| | - Eva Wardelmann
- Gerhard Domagk Institute of Pathology, University Hospital Muenster, Muenster, Germany
| | - Charlotte M Niemeyer
- Division of Pediatric Hematology and Oncology, Department of Pediatric and Adolescent Medicine, University Medical Center Freiburg, University of Freiburg, Germany
| | - Christian P Kratz
- Department of Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
| | | | - Simone Hettmer
- Division of Pediatric Hematology and Oncology, Department of Pediatric and Adolescent Medicine, University Medical Center Freiburg, University of Freiburg, Germany.
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Petković S, Petković S, Tadić-Latinović L, Berendika J, Tubić B, Jungić S. A case report of malignant peripheral nerve sheath tumour of the left thigh and popliteal fossa with lungs, spleen, and brain dissemination related to neurofibromatosis type 1. SCRIPTA MEDICA 2022. [DOI: 10.5937/scriptamed53-32417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
A malignant peripheral nerve sheath tumour (MPNST) is a highly aggressive sarcoma. This disease develops in a number of people with neurofibromatosis type 1 (NF1), which is a common genetic disease. The paper presents a patient with typical manifestations of a malignant tumour of the peripheral nerve sheath, in the form of a large tumour of primary localisation in the distal part of the left thigh and left popliteal fossa and with significant dissemination into the lung parenchyma, which was accompanied by respiratory risk. The first operation of the tumour was done four years earlier, after which the patient did not come for regular check-ups. Nine cycles of chemotherapy were performed by Doxorubicin / Ifosfamide / Mesna protocol with clinical improvement and stabilisation, but without a significant impact on the dynamics of the disease and the overall survival was 14 months. It is of utmost importance to early recognise clinical presentation of the malignant form of this tumour and active supervision of a patient with a benign form by experts. In this way, it is possible to apply the optimal treatment modality in a timely manner.
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Griffin S, Witt MC, El Tecle N, Prim M, Hockman J, Schwetye KE, Pierson MJ. Intracranial metastasis from a malignant peripheral nerve sheath tumor in a patient with neurofibromatosis type 1: A case study and literature review. Clin Neurol Neurosurg 2021; 203:106540. [PMID: 33607580 DOI: 10.1016/j.clineuro.2021.106540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 01/25/2021] [Accepted: 01/28/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Malignant Peripheral Nerve Sheath Tumors (MPNSTs) are a rare type of soft tissue sarcoma. While these tumors often metastasize, intracranial metastases of MPNSTs have only been rarely noted. METHODS Using Pubmed, Google Scholar, and Science Direct we conducted a systematic review of the literature to identify all reported cases of MPNSTs with metastases to the brain since the inception of these databases through January 2020. Data were extracted and data analysis was completed using python statistical packages. RESULTS Only 26 cases (including present study) of MPNSTs resulting in intracranial metastases have been reported in the literature. Eight of these 26 cases occurred in patients who were previously diagnosed with Neurofibromatosis Type 1 (NF1). Additionally, one patient had been previously diagnosed with Neurofibromatosis Type 2 (NF2). The average reported time from diagnosis of a MPNST to the time of diagnosis with intracranial metastasis was 36 months, with a median time of 14 months. The average reported survival time for patients after being diagnosed with intracranial metastasis was 5.9 months. The cases that utilized a combination of therapeutic intervention including surgical resection, radiotherapy and chemotherapy saw the greatest improvement of survival times. CONCLUSION MPNSTs with brain metastases are extremely rare and have a poor prognosis with a 6 months median survival after metastasis. While combination therapy is indicated, further studies on treatment are needed to determine survival benefits. Early and effective initial diagnosis of MPNST before brain metastases occurs is likely to give the best chance of increased overall survival.
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Affiliation(s)
- Samuel Griffin
- Saint Louis University School of Medicine, 1402 S Grand Blvd, Saint Louis, MO 63104, United States.
| | - M Cassandra Witt
- Saint Louis University School of Medicine, 1402 S Grand Blvd, Saint Louis, MO 63104, United States.
| | - Najib El Tecle
- Saint Louis University Department of Neurological Surgery, 1008 S Spring Ave, 3rd Floor, Saint Louis, MO 63110, United States.
| | - Michael Prim
- Saint Louis University Department of Neurological Surgery, 1008 S Spring Ave, 3rd Floor, Saint Louis, MO 63110, United States.
| | - Jakob Hockman
- Saint Louis University Department of Pathology, 1402 S Grand Blvd, Saint Louis, MO 63104, United States.
| | - Katherine E Schwetye
- Saint Louis University Department of Pathology, 1402 S Grand Blvd, Saint Louis, MO 63104, United States.
| | - Matthew J Pierson
- Midwest Neurosurgery Associates, 2330 E Meyer Blvd, Ste 411, Kansas City, MO 64132, United States.
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Cai Z, Tang X, Liang H, Yang R, Yan T, Guo W. Prognosis and risk factors for malignant peripheral nerve sheath tumor: a systematic review and meta-analysis. World J Surg Oncol 2020; 18:257. [PMID: 32998743 PMCID: PMC7528472 DOI: 10.1186/s12957-020-02036-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 09/22/2020] [Indexed: 12/14/2022] Open
Abstract
Background No available meta-analysis was printed to systematically introduce the MPNST clinic outcome and risk factors based on largely pooled data. This systematic review and meta-analysis aimed to investigate 5-year OS rate, 5-year EFS rate, and LR rate for MPNST, and to assess potential risk factors for prognosis. Methods Electronic articles published between January 1, 1966 and February 29, 2020 were searched and critically evaluated. The authors independently reviewed the abstracts and extracted data for 5-year OS rate, 5-year EFS rate, LR rate, and potential risk factors for prognosis. Results Twenty-eight literatures were finally included for meta-analysis. The pooled 5-year OS rate, 5-year EFS rate, and LR rate were 49%, 37%, and 38%, respectively. The significant prognostic factors for survival were NF1 status, tumor size, depth, location, malignant grade, margin status, chemotherapy, and radiotherapy. Age and sex were not associated with survival. Conclusion Survival and local recurrence of MPNST are poor. Worse prognosis is mainly associated with NF 1, large size, deep to fascia, high grade, metastases, and location (trunk and head and neck). Complete resection with adequate surgical margins is the mainstay protective factor of MPNST patients, following necessary adjuvant therapies.
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Affiliation(s)
- Zhenyu Cai
- 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
| | - Haijie Liang
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Rongli Yang
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Taiqiang Yan
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Wei Guo
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China.
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Sobczuk P, Teterycz P, Czarnecka AM, Świtaj T, Koseła-Paterczyk H, Kozak K, Falkowski S, Goryń T, Zdzienicki M, Morysiński T, Rutkowski P. Malignant peripheral nerve sheath tumors - Outcomes and prognostic factors based on the reference center experience. Surg Oncol 2020; 35:276-284. [PMID: 32949967 DOI: 10.1016/j.suronc.2020.09.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 07/08/2020] [Accepted: 09/07/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Malignant peripheral nerve sheath tumor (MPNST) accounts for about 5% of soft tissue sarcomas. It can occur as sporadic diseases or can be associated with type 1 neurofibromatosis. MPNST is usually associated with poor prognosis, mostly due to their aggressive behavior, high metastatic potential, and resistance to chemotherapy. Our study aimed to determine treatment outcomes and associated prognostic factors in a large cohort of patients with MPNSTs treated at the reference sarcoma center. METHODS 239 consecutive patients (114 women and 125 men) diagnosed with MPNST between March 1998 and March 2018 who were treated with surgery with curative intent in the reference sarcoma center were included in the retrospective analysis. RESULTS The mean age at diagnosis was 51 years (range 15-86). 28 (11.7%) patients had neurofibromatosis type 1 associated tumors (NF1 positive). Median OS was 126.5 months and 5-year survival rate was 61.9% in the group treated with curative intent. Median DFS, LRFS and DMFS were 91.6, 126.5 and 126.5 months, respectively. We identified tumor size, high tumor grade and positive surgical margins as independent negative predictors of DFS, LRFS, DMFS and OS. CONCLUSIONS High-quality surgery remains a gold standard of MPNST treatment. High grade, size and quality of surgery are significant independent prognostic factors for overall survival. There is an unmet need for improvement, especially regarding the perioperative treatment and treatment of metastatic disease. Future studies on the biology of MPNST would lead to the development of novel treatment options and improvement of treatment outcomes.
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Affiliation(s)
- Paweł Sobczuk
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland; Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Warsaw, Poland.
| | - Paweł Teterycz
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Anna M Czarnecka
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland; Department of Experimental Pharmacology, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
| | - Tomasz Świtaj
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Hanna Koseła-Paterczyk
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Katarzyna Kozak
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Sławomir Falkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Tomasz Goryń
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Marcin Zdzienicki
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Tadeusz Morysiński
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
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Martínez F, Domínguez-Páez M, Cuadros-Romero M, Moragues R, Segura-Fernández Nogueras M, Casales N, de Armas R, Arraez-Sánchez MÁ. Peripheral nerve tumours: A 66-case retrospective study. Neurocirugia (Astur) 2019; 31:105-111. [PMID: 31679909 DOI: 10.1016/j.neucir.2019.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 08/31/2019] [Accepted: 09/03/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND/OBJECTIVES Peripheral nerve tumours (PNT) are rare lesions that are generally categorised as soft tissue tumours, so they are usually managed by a range of surgical disciplines such as plastic, orthopaedic and trauma surgery, dermatology, general surgery and neurosurgery. Appropriate knowledge of the therapeutic indication and surgical management are essential in order to avoid neurological deficit. MATERIALS AND METHODS This is a retrospective study of 66 tumour lesions in 64 patients, acquired from the joint experience of 2surgical teams specialised in peripheral nerve surgery. RESULTS The most common location was the lower limb and upper limb with 48 tumour lesions. The most common pathological diagnosis was Schwannoma, accounting for 51.5%. Complete tumour resection was achieved in 81.8% of the lesions and always with neurophysiological stimulation and/or monitoring. The most common postsurgical complication was neuropathic pain and/or a transient sensory disorder in 15% of surgeries, with only one persistent motor deficit appearing in 2cases that required nerve graft reconstruction. CONCLUSIONS Although the therapeutic management of benign tumours such as Schwannomas can be considered to be relatively simple thanks to the application of the basic concepts of peripheral nerve microsurgery, malignant tumors, despite being very rare, require multidisciplinary management. The option of pre-surgical biopsy remains a controversial issue and no consensus has been reached among the different authors. In our opinion, percutaneous biopsy is not necessary in most cases.
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Affiliation(s)
| | - Miguel Domínguez-Páez
- Servicio de Neurocirugía, Hospital Regional Universitario de Málaga, Málaga, España.
| | - Miguel Cuadros-Romero
- Servicio de Cirugía Ortopédica y Traumatológica, Hospital Parque San Antonio, Málaga, España
| | - Rodrigo Moragues
- Servicio de Neurocirugía, Hospital de Clínicas, Montevideo, Uruguay
| | | | - Nicolás Casales
- Unidad de Patología Osteo Músculo Esquelética (UPOME), Instituto Nacional de Ortopedia y Traumatología, Montevideo, Uruguay
| | - Rafael de Armas
- Servicio de Anatomía Patológica, Hospital de Clínicas, Montevideo, Uruguay
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Tora MS, Xenos D, Texakalidis P, Boulis NM. Treatment of neurofibromatosis 1-associated malignant peripheral nerve sheath tumors: a systematic review. Neurosurg Rev 2019; 43:1039-1046. [PMID: 31209658 DOI: 10.1007/s10143-019-01135-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 05/07/2019] [Accepted: 06/10/2019] [Indexed: 12/24/2022]
Abstract
Malignant peripheral nerve sheath tumors (MPNST) are a rare and aggressive group of tumors that are challenging to treat. Neurofibromatosis type 1 (NF-1)-associated MPNSTs have been associated with poorer clinical outcomes. The treatment options for NF-1-associated MPNSTs broadly include surgery (SG), chemotherapy (CT), and adjuvant radiotherapy (RT). Overall, the role and efficacy of CT and RT are unclear. Examination of existing literature for studies reporting on NF-1-associated MPNSTs and respective treatment-related outcomes was conducted. We conducted a systematic review according to PRISMA guidelines in PubMed/Medline and Cochrane databases of studies which reported treatment-specific outcomes in NF-1-associated MPNSTs. The literature search found 444 records after removal of duplicates. The present study included 50 patients across 12 observational studies. All of the included studies reported data on overall survival (OS 52%, n = 26/50) but mean follow-up in months among the studies and among patients varied widely, between 10.85 (SD, ± 10.38) and 192 (SD, ± 98.22). From the included studies, patients underwent either SG alone (n = 21), SG + CT (n = 10), SG + RT (n = 7), or SG + CT + RT (n = 12). The quality of evidence in the literature regarding optimal treatment options for NF-1-associated MPNSTs remains tenuous. Future retrospective and prospective comparative trials should consider adherence to a set of reporting guidelines to improve the quality of evidence in the literature with respect to individual treatment-related outcomes. The need for prospective multi-institutional efforts cannot be overstated.
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Affiliation(s)
- Muhibullah S Tora
- Department of Neurosurgery, School of Medicine, Emory University Hospital, 101 Woodruff Circle, Suite 6204, Atlanta, GA, 30322, USA.
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA.
| | - Dimitrios Xenos
- Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Pavlos Texakalidis
- Department of Neurosurgery, School of Medicine, Emory University Hospital, 101 Woodruff Circle, Suite 6204, Atlanta, GA, 30322, USA
| | - Nicholas M Boulis
- Department of Neurosurgery, School of Medicine, Emory University Hospital, 101 Woodruff Circle, Suite 6204, Atlanta, GA, 30322, USA
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
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Miao R, Wang H, Jacobson A, Lietz AP, Choy E, Raskin KA, Schwab JH, Deshpande V, Nielsen GP, DeLaney TF, Cote GM, Hornicek FJ, Chen YLE. Radiation-induced and neurofibromatosis-associated malignant peripheral nerve sheath tumors (MPNST) have worse outcomes than sporadic MPNST. Radiother Oncol 2019; 137:61-70. [PMID: 31078939 DOI: 10.1016/j.radonc.2019.03.015] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 03/06/2019] [Accepted: 03/18/2019] [Indexed: 01/30/2023]
Abstract
BACKGROUND Malignant peripheral nerve sheath tumors (MPNST) may be sporadic or associated with neurofibromatosis or prior radiation. MPNST may behave aggressively with a high rate of local recurrence and distant metastasis. METHODS In an IRB approved protocol, we reviewed the clinical characteristics, treatment, and outcomes of 280 patients treated for MPNST at Massachusetts General Hospital (MGH) between 1960 and 2016. RESULTS There were 138 men and 142 women with a median age of 41 (range: 3-95) years. Tumors were classified as neurofibromatosis-associated (nfMPNST, n = 77), radiation-induced (rMPNST, n = 21), or sporadic (sMPNST, n = 182) MPNST. The median time to development of rMPNST from prior radiation was 15 years. With a median follow-up of 43.1 months, the median overall survival (OS) was 65.3 months. Older age, nfMPNST, rMPNST, increased tumor size, lymph node involvement, metastatic disease, intermediate to high grade, radiotherapy alone, and R2 resection were related to worse OS, whereas surgery with radiotherapy was associated with improved OS. Among the 251 patients without metastasis, nfMPNST, rMPNST, and increased tumor size were correlated with worse metastasis-free survival; nfMPNST, radiotherapy alone, and R1/R2 resection were associated with local recurrence, whereas surgery with adjuvant radiotherapy was related to improved local control in patients with R1/R2 resection. CONCLUSIONS Both radiation-induced and neurofibromatosis-associated MPNSTs have poorer prognosis than sporadic MPNSTs. Complete resection of the tumor is a significant prognostic factor for MPNST. The addition of radiotherapy after surgery should be considered especially when the surgical margins are positive.
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Affiliation(s)
- Ruoyu Miao
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, USA.
| | - Haotong Wang
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, USA.
| | - Alex Jacobson
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, USA
| | - Anna P Lietz
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, USA.
| | - Edwin Choy
- Department of Medical Oncology, Massachusetts General Hospital, Boston, USA; Harvard Medical School, Boston, USA.
| | - Kevin A Raskin
- Department of Orthopedic Oncology, Massachusetts General Hospital, Boston, USA; Harvard Medical School, Boston, USA.
| | - Joseph H Schwab
- Department of Orthopedic Oncology, Massachusetts General Hospital, Boston, USA; Harvard Medical School, Boston, USA.
| | - Vikram Deshpande
- Department of Pathology, Massachusetts General Hospital, Boston, USA; Harvard Medical School, Boston, USA.
| | - G Petur Nielsen
- Department of Pathology, Massachusetts General Hospital, Boston, USA; Harvard Medical School, Boston, USA.
| | - Thomas F DeLaney
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, USA; Harvard Medical School, Boston, USA.
| | - Gregory M Cote
- Department of Medical Oncology, Massachusetts General Hospital, Boston, USA; Harvard Medical School, Boston, USA.
| | - Francis J Hornicek
- Department of Orthopedic Oncology, Massachusetts General Hospital, Boston, USA; Harvard Medical School, Boston, USA; Department of Orthopedic Surgery, University of California Los Angeles, USA.
| | - Yen-Lin E Chen
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, USA; Harvard Medical School, Boston, USA.
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Peltonen S, Kallionpää RA, Rantanen M, Uusitalo E, Lähteenmäki PM, Pöyhönen M, Pitkäniemi J, Peltonen J. Pediatric malignancies in neurofibromatosis type 1: A population-based cohort study. Int J Cancer 2019; 145:2926-2932. [PMID: 30724342 PMCID: PMC6849871 DOI: 10.1002/ijc.32187] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 01/08/2019] [Accepted: 01/22/2019] [Indexed: 12/18/2022]
Abstract
Neurofibromatosis type 1 (NF1) is a cancer predisposition syndrome with an incidence of 1:2,000. Patients with NF1 have an increased cancer risk and mortality, but there are no population‐based cohort studies specifically investigating the risk of childhood malignancies. We used the Finnish NF1 cohort to analyze the incidence, risk and prognosis of malignancies in NF1 patients <20 years of age. Persons born in 1987–2011 were included, and 524 persons were followed through the files of the Finnish Cancer Registry from birth up to age 20 years. This amounted to 8,376 person years. Fifty‐three patients had cancer <20 years of age, yielding a standardized incidence ratio (SIR) of 35.6. The most frequent location of pediatric cancers was the central nervous system (CNS); there were 45 cases and the SIR was 115.7. Exclusion of 22 optic pathway gliomas (OPGs) gave an SIR of 59.1 for the CNS and 21.6 for all cancers. There were nine malignant peripheral nerve sheath tumors (MPNSTs); their cumulative risk was 2.7% by age 20. No cases of leukemia were observed. NF1 patients showed considerable excess mortality with a standardized mortality ratio (SMR) of 73.1. The survival of NF1 patients with CNS tumors other than OPGs did not differ from that of non‐NF1 controls (HR 0.64, 95% CI 0.23 to 1.76). In conclusion, brain tumors in childhood and MPNSTs in adolescence are malignancies of major concern in patients with NF1. The risk for myeloid malignancies may not be as high as suggested in the literature. What's new? Patients with neurofibromatosis type 1 (NF1) are known to have a high risk of various cancers. What has not been well‐studied, however, are the types of cancers that are most common among children with NF1, and how those cancers impact mortality. In this cohort study, the authors found that malignancies do cause increased mortality in patients under age 20. Brain tumors in childhood and malignant peripheral nerve sheath tumors (MPNSTs) in adolescence are of particular concern. On the other hand, the risk of myeloid malignancies may be lower than previously assumed.
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Affiliation(s)
- Sirkku Peltonen
- Department of Dermatology, University of Turku, Turku, Finland.,Department of Dermatology, Turku University Hospital, Turku, Finland
| | | | - Matti Rantanen
- Finnish Cancer Registry - Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - Elina Uusitalo
- Institute of Biomedicine, University of Turku, Turku, Finland
| | - Päivi M Lähteenmäki
- Department of Pediatric and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Minna Pöyhönen
- Department of Clinical Genetics, HUSLAB, Helsinki University Central Hospital, Helsinki, Finland.,Department of Medical Genetics, University of Helsinki, Helsinki, Finland
| | - Janne Pitkäniemi
- Finnish Cancer Registry - Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland.,Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Juha Peltonen
- Institute of Biomedicine, University of Turku, Turku, Finland
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11
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Vasconcelos RATD, Guimarães Coscarelli P, Vieira TM, Noguera WS, Rapozo DCM, Acioly MA. Prognostic significance of mast cell and microvascular densities in malignant peripheral nerve sheath tumor with and without neurofibromatosis type 1. Cancer Med 2019; 8:972-981. [PMID: 30735009 PMCID: PMC6434338 DOI: 10.1002/cam4.1977] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 12/21/2018] [Accepted: 12/27/2018] [Indexed: 12/12/2022] Open
Abstract
Malignant peripheral nerve sheath tumors (MPNSTs) are rare and aggressive soft tissue sarcomas with a significant susceptibility to metastasize early in their course. Pathogenesis is yet to be fully elucidated. Recently, the essential role of mast cells in the tumor onset of neurofibromatosis type 1 (NF1)‐associated neurofibromas and MPNSTs was confirmed in both experimental and human studies. In this study, we investigate mast cell density (MCD), microvascular density (MVD), and proliferation index (Ki‐67) in MPNST. A secondary aim was to correlate histological staining to clinical data and survival in patients with and without NF1. In total, 34 formalin‐fixed paraffin‐embedded MPNST tissues from 29 patients were eligible. MCD, MVD, and Ki‐67 labeling index (LI) were analyzed in all stained tissues by a computer‐based quantitative algorithm (Aperio ImageScope). In addition, chart review was performed for clinical data and survival analysis. Overall, MCD, MVD, and Ki‐67 LI were evenly distributed throughout tumor tissue. There was a negative correlation of NF1 status (affected, P = 0.037), tumor size (>10 cm, P = 0.023), and MVD in the tumor periphery (higher tercile, P = 0.002) to survival. Multivariate analysis confirmed the association of MVD in the tumor periphery (higher tercile, P = 0.019) with a decreased overall survival. Diverse mast cell and microvascular distributions suggest that angiogenesis in MPNST occurs independently. The role of mast cells in tumor progression is unclear and lacks prognostic value. Higher MVD has prognostic significance with possible therapeutic implications in MPNST.
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Affiliation(s)
- Roberto André Torres de Vasconcelos
- Division of Bone and Connective Tissue, Department of Surgical Oncology, National Cancer Institute, Rio de Janeiro, Brazil.,Postgraduation Program in Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | | | | | - Marcus André Acioly
- Postgraduation Program in Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil.,Division of Neurosurgery, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Division of Neurosurgery, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
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12
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Peckham-Gregory EC, Montenegro RE, Stevenson DA, Viskochil DH, Scheurer ME, Lupo PJ, Schiffman JD. Racial/ethnic disparities and incidence of malignant peripheral nerve sheath tumors: results from the Surveillance, Epidemiology, and End Results Program, 2000-2014. J Neurooncol 2018; 139:69-75. [PMID: 29663170 DOI: 10.1007/s11060-018-2842-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 03/17/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND Malignant peripheral nerve sheath tumors (MPNSTs) are rare tumors, generally high-grade, and comprise ~ 5-10% of soft tissue sarcomas. Over two-thirds of MPNSTs metastasize, and upwards of 40% clinically recur. Etiologic risk factors for MPNSTs are historically understudied. There is evidence to suggest MPNST incidence differs across racial/ethnic groups in pediatric populations. Therefore, we sought to estimate differences in MPNST incidence by race/ethnicity among all ages in the United States. METHODS Incidence data were obtained from the Surveillance, Epidemiology, and End Results (SEER-18) Program, 2000-2014. Race/ethnicity was categorized as: White; Black; Asian; Other; and Latino/a ("Spanish-Hispanic-Latino"). Latino/a included all races, while all other categories excluded those identified as Latino/a. Age-adjusted incidence rate ratios (IRR) and 95% confidence intervals (CIs) were generated in SEER-STAT (v8.3.4). We estimated incidence rates among all ages, and among those diagnosed < 25 and ≥ 25 years. RESULTS MPNST cases were abstracted from SEER-18 (n = 1047). Among all age groups, Blacks experienced an elevated incidence of MPNSTs compared to Whites (IRRBlacks = 1.26, 95% CI 1.04-1.50). Asian and Latinos/as experienced lower incidences compared to Whites (IRRAsians = 0.78, 95% CI 0.61-0.99; IRRLatinos/as = 0.84, 95% CI 0.69-1.02). In subgroup analyses, no statistically significant associations with MPNSTs were identified among cases diagnosed < 25 years of age, whereas the associations observed among all age groups were prominent among those diagnosed ≥ 25 years of age. CONCLUSIONS Incidence rates of MPNSTs were highest in Blacks compared to Whites and other minority groups. This study suggests specific patterns exist in terms of race/ethnicity and age at diagnosis of MPNSTs.
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Affiliation(s)
- Erin C Peckham-Gregory
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, One Baylor Plaza, MS: BCM305, Houston, TX, 77030, USA
- Texas Children's Cancer Center, Texas Children's Hospital, Feigin Center, 1102 Bates St, Houston, TX, 77030, USA
| | - Roberto E Montenegro
- Department of Psychiatry and Behavioral Medicine, The University of Washington School of Medicine, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - David A Stevenson
- Division of Medical Genetics, Stanford University, 300 Pasteur Drive, Boswell Building A097, Stanford, CA, 94304, USA
| | - David H Viskochil
- Division of Medical Genetics, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - Michael E Scheurer
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, One Baylor Plaza, MS: BCM305, Houston, TX, 77030, USA
- Texas Children's Cancer Center, Texas Children's Hospital, Feigin Center, 1102 Bates St, Houston, TX, 77030, USA
| | - Philip J Lupo
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, One Baylor Plaza, MS: BCM305, Houston, TX, 77030, USA
- Texas Children's Cancer Center, Texas Children's Hospital, Feigin Center, 1102 Bates St, Houston, TX, 77030, USA
| | - Joshua D Schiffman
- Department of Pediatrics and Department of Oncological Sciences, Huntsman Cancer Institute, University of Utah School of Medicine, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA.
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13
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Renne SL, Iwenofu OH. Pathology of retroperitoneal sarcomas: A brief review. J Surg Oncol 2017; 117:12-24. [PMID: 29230829 DOI: 10.1002/jso.24928] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 11/01/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Salvatore L. Renne
- Sarcoma and Pediatric Pathology Unit, Department of Diagnostic Pathology and Laboratory Medicine; Fondazione IRCCS Istutito Nazionale dei Tumori; Milano Italy
| | - O. Hans Iwenofu
- Department of Pathology & Laboratory Medicine; Wexner Medical Center at The Ohio State University; Columbus Ohio
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