Supplementary Table S9 from Clinical Implications and Molecular Features of Extracellular Matrix Networks in Soft Tissue Sarcomas
Valeriya PankovaLukáš KrásnýWilliam KerrisonYuen B. TamMadhumeeta ChadhaJessica BurnsChristopher P. WildingLiang ChenAvirup ChowdhuryEmma PerkinsAlexander T.J. LeeLouise HowellNafia GuljarKaren SisleyCyril FisherPriya ChudasamaKhin ThwayRobin L. JonesPaul H. Huang
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<p>Supplementary Table S9: Summary of multivariable (MVA) Cox regression analyses assessing the association of clinicopathological factors and dedifferentiated liposarcoma (DDLPS) subgroups with local recurrence-free survival (LRFS), overall survival (OS) and metastasis-free survival (MFS).</p>Keywords:
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During the limb preserving procedure for musculoskeletal sarcoma, the course of action that should be taken when a tumor or tumor-cell-contaminated adjacent tissue is violated remains controversial. From January, 1973, to July, 1989, 120 patients with musculoskeletal sarcoma were treated by limb salvage surgery and, in 40 of them, such violations inadvertently occurred during surgery. Follow-up studies on the patients have been conducted for at least one year after the violation. Soft tissue sarcoma was noted in 24 cases (low grade, 4; high grade, 20) and bone sarcoma in 16 (low grade, 6; high grade, 10). To treat the violation, re-excision with a clean margin and copious lavage was generally conducted after careful closure of the violated site. Sixteen cases in the soft tissue sarcoma group and eight in the bone sarcoma group were treated in this way. Local recurrences were found in 13 of the 40 cases (33%), but the percentage was reduced to 13 in cases treated by re-excision with a clean margin. In the present study, there was no significant effect of adjuvant therapy after violation. The survival rate in cases of local recurrence was very low, and not at all improved by adjuvant therapy.
Bone Sarcoma
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There is increasing interest in personalized prediction of disease progression for soft tissue sarcoma patients. Currently, available prediction models are limited to predictions from time of surgery or diagnosis. This study updates predictions of overall survival at different times during follow-up by using the concept of dynamic prediction. Information from 2232 patients with high-grade extremity soft tissue sarcoma, who underwent surgery at 14 specialized sarcoma centers, was used to develop a dynamic prediction model. The model provides updated 5-year survival probabilities from different prediction time points during follow-up. Baseline covariates as well as time-dependent covariates, such as status of local recurrence and distant metastases, were included in the model. In addition, the effect of covariates over time was investigated and modelled accordingly in the prediction model. Surgical margin and tumor histology show a significant time-varying effect on overall survival. The effect of margin is strongest shortly after surgery and diminishes slightly over time. Development of local recurrence and distant metastases during follow-up have a strong effect on overall survival and updated predictions must account for their occurrence. The presence of time-varying effects, as well as the effect of local recurrence and distant metastases on survival, suggest the importance of updating predictions during follow-up. This newly developed dynamic prediction model which updates survival probabilities over time can be used to make better individualized treatment decisions based on a dynamic assessment of a patient's prognosis. • A dynamic prediction model predicts survival at different times during follow-up. • Updated patient information is used for predictions as it becomes available. • Local recurrence and distant metastasis are included in the model. • The effect of surgical margin changes over time.
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Trabectedin is a marine-derived chemotherapy, which has received U.S. Food and Drug Administration approval for use in anthracycline-resistant advanced soft tissue sarcoma (STS), especially liposarcoma and leiomyosarcoma (L-sarcomas).To describe our 10 year real-life experience with trabectedin regarding safety and efficacy in a cohort of 86 patients.In our study cohort, 46.51% were diagnosed with liposarcoma and 43.02% with leiomyosarcoma. A total of 703 cycles of trabectedin were given, with a median of five cycles per patient (range 1-59). Median overall survival was 13.5 months for the whole cohort, 11 months for liposarcoma patients (range 1-63), and 15 months for leiomyosarcoma patients (range 1-35).There was no statistically significant difference in progression free survival when stratified according to previous treatment lines given. Trabectedin exhibited a favorable safety profile, with only 22% requiring dose reductions. Grade 3 and higher toxicity was noted in 25% of the patients, mostly due to myelosuppression. There were no treatment-related deaths.Trabectedin is a safe and effective drug for treating advanced STS. Our results reflect real-life data with patients receiving the drug as a third and even fourth line of treatment, or with a suboptimal performance status, yet achieving impressive clinical benefit rates and survival.
Trabectedin
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Liposarcomas are rare tumors arising from adipocytic tissue and accounting for approximately 15–20% of all soft tissue sarcomas. Liposarcoma can be further classified into histopathological subtypes with variable chemosensitivity according to subtype. Decisions regarding management should be made on an individual basis, but surgery for localized disease and systemic chemotherapy remain the mainstay of treatment. Currently, only doxorubicin and trabectedin have robust Phase III data to support their use in the management of advanced liposarcoma. However, in the subgroup analysis of a Phase III trial comparing eribulin with dacarbazine, there was a greater than 7-month improvement in median overall survival in those treated with eribulin. There are also promising results from emerging studies in novel and targeted agents for the treatment of liposarcoma.
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Objective
To investigate the effect of the first surgical treatment on progression-free survival (PFS)time of retroperitoneal liposarcoma and the prognosis.
Methods
We analyzed the clinical data of 74 cases of retroperitoneal liposarcoma from 1998 to 2016 in He′nan Cancer Hospital (Zhengzhou University Affiliated Tumor Hospital Department of General Surgery) .
Results
The results demonstrated that progression-free survival time of the first surgical resection of retroperitoneal liposarcoma in patients related with tumor necrosis (P 0.05) .The rate of 1-year , 3-year, 5-year survival time attached to PFS≤24 m and PFS>24 m were 93.7% vs. 94.7, 90.5% vs. 80.9%, 58.4% vs. 74.8%(P=0.111).
Conclusion
The first attempt of radical resection determines progression-free survival of retroperitoneal liposarcoma, however, patients′ PFS was not related with their overall survival.
Key words:
Liposarcoma; Disease-free survival; Prognosis; Surgical procedures , operative
Progression-free survival
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The Australia and New Zealand Sarcoma Association established the Sarcoma Guidelines Working Party to develop national guidelines for the management of Sarcoma. We asked whether surgery at a specialised centre improves outcomes. A systematic review was performed of all available evidence pertaining to paediatric or adult patients treated for bone or soft tissue sarcoma at a specialised centre compared with non-specialised centres. Outcomes assessed included local control, limb salvage rate, 30-day and 90-day surgical mortality, and overall survival. Definitive surgical management at a specialised sarcoma centre improves local control as defined by margin negative surgery, local or locoregional recurrence, and local recurrence free survival. Limb conservation rates are higher at specialised centres, due in part to the depth of surgical experience and immediate availability of multidisciplinary and multimodal therapy. A statistically significant correlation did not exist for 30-day and 90-day mortality between specialised centres and non-specialised centres. The literature is consistent with improved survival when definitive surgical treatment is performed at a specialised sarcoma centre. Evidence-based recommendation: Patients with suspected sarcoma to be referred to a specialised sarcoma centre for surgical management to reduce the risk of local recurrence, surgical complication, and to improve limb conservation and survival. Practice point: Patients with suspected sarcoma should be referred to a specialised sarcoma centre early for management including planned biopsy.
Bone Sarcoma
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Eribulin
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Abstract New evidence and systemic therapies demand an updated analysis of chemotherapy for soft tissue sarcoma. We completed a meta‐analysis of chemotherapy in localized STS, assessing OS, PFS, and local and distant recurrence (local recurrence‐free survival [LRFS] and distant recurrence‐free survival [DRFS]). Ten studies, totaling 3157 patients, were included. A pooled analysis for 5‐year OS, progression‐free survival, LRFS, and DRFS showed no benefit of chemotherapy over locoregional therapy alone for all‐comers or site‐specific STS. We make recommendations to improve outcome reporting and quality indices.
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Abstract The clinical characteristics of 240 patients with sarcoma as a second metachronous primary neoplasm (SPN) were compared with those of 8,815 patients with sarcoma as a single tumor. The data were obtained from patients registered during the period 1973–1986 in the Surveillance, Epidemiology and End Results (SEER) Program in the United States. Seventy‐four of the 240 SPN patients had postirradiation sarcoma (PIS) while the other 153 patients developed the sarcoma as a second tumor in an area which was not exposed to prior radiotherapy (non‐PIS). The stage of disease at diagnosis was more advanced in patients with PIS than in those with single sarcomas but the difference did not reach statistical significance. Overall, in comparable clinical stage localized and regional disease there was no statistically significant difference in survival between PIS and non‐PIS sarcoma patients after adjusting for age. The survival of patients with localized or regionally advanced sarcoma as a second tumor was significantly worse than of those with single sarcomas with the same stage. There was no difference in survival between first or second sarcomas with metastatic disease. © 1992 Wiley‐Liss, Inc.
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