Treatment and analysis of prognostic factors of stage Ⅱ and Ⅲ undifferentiated high-grade pleomorphic sarcoma in extremities and trunk / 中华肿瘤杂志

Objective@#To evaluate the efficacy and prognostic factors of comprehensive treatment of undifferentiated high grade pleomorphic sarcoma (UHGPS) in extremities and trunk, including surgery, radiotherapy and chemotherapy.@*Methods@#A retrospective analysis and follow-up of 131 UHGPS cases with clinical stage Ⅱ or Ⅲ in extremities and trunk soft tissue was performed to analyze the prognostic factors. Survival data were collected through follow-up. The survival rate was calculated with life table method and Kaplan-Meier survival curves were drawn. Survival rate between the two groups was compared using Log rank test. The multivariate analysis was performed using Cox regression model.@*Results@#The median survival time of 131 patients was 41.6 months. The 1-year, 3-year and 5-year survival rates were 95.0%, 82.0%, and 77.0%, respectively. The 5-year recurrence-free survival rate was 81.0%, and the 5-year metastasis-free survival rate was 72.0%. Univariate analysis showed that the tumor size, initial or recurrence, surgical margin, AJCC stage, and with/without standard treatment were associated with overall survival (all P<0.05). Stratification analysis according to the American Joint Committee of Cancer (AJCC) stage showed that 5-year survival rate of stage Ⅱ patients with radiotherapy was 100.0%, which was higher than that of patients without radiotherapy (79.6%) and the difference was statistically significant (P=0.010); but no statistical significance of radiotherapy for stage Ⅲ and chemotherapy for stage Ⅱ or Ⅲ patients (all P>0.05). The multivariate analysis showed surgical margin (HR=4.220, P=0.002), with/without standard treatment (HR=4.040, P=0.030) were independent risk factors associated with prognosis of UHGPS patients.@*Conclusions@#For UHGPS with stage Ⅱ or stage Ⅲ in extremities and trunk soft tissue, patients with complete resection and standard treatment have improved prognosis. Therefore, standard treatment, including extensive resection for the first surgery, should be performed according to expert consensus in order to increase the long-term survival rate. Adjuvant radiotherapy should be performed for stage Ⅱ patients.

The role of preoperative 18F-FDG PET-CT in lymphatic metastasis diagnosis of cutaneous malignant melanoma on extremities and trunk / 中华肿瘤杂志

Objective@#To evaluate the clinical value of preoperative 18F-Fludeoxyglucose (18F-FDG PET-CT) in lymphatic metastasis diagnosis of cutaneous melanoma on extremities and trunk.@*Methods@#112 patients with cutaneous melanoma pathologically of extremities and trunk from January 2006 to December 2016, who received 18F-FDG PET-CT examination preoperatively, were retrospectively reviewed. The correlations between the maximal diameters of lymph nodes, the maximal standard uptake value (SUV) and the diagnostic impression grades of PET-CT examination, and the final pathological diagnosis were analyzed. The correlations between Breslow thickness of primary lesions and the diagnostic impression of PET-CT examination were also analyzed. All the above were analyzed with Receiver Operating Characteristic (ROC) curve to get the cut-off value. Based on the final results of pathological diagnosis of lymph nodes as the golden standard, the statistically significant indicators of ROC curve analysis were used to evaluate the diagnostic effect, as well as to calculate the sensitivity, specificity and accuracy. With gender, age, maximal diameter of lymph nodes, maximal SUV, diagnosis impressions, and Breslow thickness as the independent variables and pathological diagnosis results of lymph nodes as the dependent variable, two-class stepwise Logistic regression analysis was used to determine the independence of diagnostic indicators. ROC curve analysis and log rank test were used to analyze the relationship between Breslow thickness and patient survival.@*Results@#To evaluate melanoma patients′ lymph node status, the results of ROC curve analysis showed that the area under the curve of lymph node maximal diameter, maximal SUV, diagnosis impression of PET-CT examinations were 0.789, 0.786 and 0.816, respectively (all P<0.05). The cut-off values were 0.85 cm, 1.45 and 2.5, respectively. The sensitivity of the cut-off values to determine the status of lymph nodes in melanoma patients were 71.4%, 64.9% and 72.1% respectively, and the specificities were 85.2%, 88.7% and 87.0% respectively. Multivariate Logistic regression analysis showed that PET-CT diagnosis impressions had independent diagnostic significance for the lymph node status of melanoma patients (OR=11.296, 95%CI: 2.550~50.033). The area under the curve of Breslow thickness evaluating PET-CT diagnostic impression is 0.664 (P=0.042) and the cut-off value was 4.25 mm. The survival rate of the patients with Breslow thickness ≥ 4.25 mm was lower than that in the group <4.25 mm (P=0.006).@*Conclusions@#18F-FDG PET-CT can help to evaluate metastases and make treatment decisions for cutaneous melanoma of extremities and trunk, especially for patients whose primary lesion′s Breslow thickness has reached more than 4.25 mm. For the patients whose maximal SUV of regional lymph node is higher than 1.45 and short diameter of the largest lymph node is larger than 0.85cm, the possibility of metastases should be considered.

Analysis of clinicopathological characteristics and prognostic factors of foot and ankle soft tissue and bone tumors / 中华肿瘤杂志

Objective@#To evaluate the clinicopathological characteristics of foot and ankle soft tissue and bone tumor, and to analyze the prognosis and the related factors of malignant tumors in this site.@*Methods@#74 patients with soft tissue and bone tumors of foot and ankle from January 2006 to February 2017 were retrospectively analyzed. The clinicopathological characteristics, the treatment and survival status of malignant tumors were followed up, and the clinical and therapeutic factors related to prognosis were analyzed.@*Results@#Of the 74 patients, 34 were males and 40 were females. The male to female ratio was 1∶1.18; the age ranged from 12 to 64 years and the median age was 42 years. Tumors located in forefoot of 22 cases, 22 in midfoot, 10 in hind foot, 14 in ankle joint and 6 in multiple sites. 14 cases were bone tumors, including 7 benign and 7 malignant, and 60 cases were soft tissue tumors, including 14 benign and 46 malignant. The most common malignant soft tissue tumors were synovial sarcomas (13 cases), and the most common benign soft tissue tumors were hemangiomas (4 cases). 44 cases of malignant tumors underwent surgery were followed up, of which were 7 bone and 37 soft tissue malignant tumors. Limb salvage surgeries were performed in 33 cases and amputation in 11 cases. The median follow-up time was 69.8 months, and the median survival time was 40.7 months. The 1-year, 3-year and 5-year survival rate of soft tissue malignant tumors was 88.0%, 73.0%, and 63.0%, respectively. The 1-year, 3-year and 5-year survival rate of bone malignant tumors was 86.0%, 57.0% and 57.0%, respectively. Univariate analysis showed that the prognostic factors affecting 5-year survival rate were tumor size and adjuvant therapy (P<0.05). Patient′s gender, age, tumor location, histological type and surgical procedure had no effect on overall survival(P>0.05). Multivariate analysis showed that tumor size was an independent prognostic factor (RR=7.262, P=0.005).@*Conclusions@#Forefoot and midfoot are more common in foot and ankle soft tissue and bone tumors. Synovial sarcoma is the most common diagnosis in malignant soft tissue tumors, and hemangioma is the most common diagnosis in benign soft tissue tumors. The prognostic factor of malignant soft tissue and bone tumors in foot and ankle is tumor size. Patients with the tumor size of 5 cm or more have a worse prognosis.

Clinicopathological features and prognosis of malignant peripheral nerve sheath tumor: a retrospective study of 140 cases / 中华肿瘤杂志

Objective@#To investigate the clinicopathological features and prognosis of malignant peripheral nerve sheath tumors (MPNST).@*Methods@#We retrospectively reviewed the clinical data of MPNST patients who were treated at Cancer Institute & Hospital, Chinese Academy of Medical Science from January 1999 to January 2016. A total of 140 patients with 66 male and 74 female with MPNST were enrolled in the study. The median age was 40 at the time of diagnosis. Survival analysis were estimated by Kaplan-Meier method and Log rank test. Multivariate analysis were estimated by Cox proportional hazards regression model.@*Results@#The median follow-up time was 43.0 months. The 3- and 5-year overall survival (OS) rates were 56.4% and 48.6%, respectively. The 3-year local recurrence (LR) rate and distant metastasis (DM) rates were 42.9% and 49.3%, respectively. Univariate analysis showed that the tumor location, AJCC stage, S-100, radiotherapy and margin status affected 5-year OS rate (all P<0.05). The tumor location, AJCC stage, S-100, Ki-67 staining, margin status, radiotherapy and chemotherapy affected 3-year LR rate (all P<0.05). The tumor location, AJCC stage, S-100, Ki-67 staining and margin status affected 3-year DM rate (all P<0.05). Multivariate analysis showed that the tumor location, AJCC stage, S-100 were independent factors for 5-year OS rate (all P<0.05). The tumor location, Ki-67 staining and chemotherapy were independent factors for LR (all P<0.05) while the AJCC stage, margin status and Ki-67 staining were independent factors for DM (all P<0.05).@*Conclusions@#MPSNT is an aggressive tumor with poor prognosis. Multiple factors were identified in this study. Patients with the tumor located at head and neck, advanced AJCC stage and negative S-100 usually have a low 5-year overall survival rate. Patients with the tumor located at head and neck, Ki-67 staining ≥ 20% and without chemotherapy had a higher tendency of local recurrence. Poor prognosis factors for DM were advanced AJCC stage, positive margin and Ki-67 staining ≥ 20%.

Role and significance of sentinel lymph node biopsy for the treatment of melanoma of the extremities / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the role of sentinel lymph node biopsy (SLNB) for the treatment of melanoma of the extremities.</p><p><b>METHODS</b>From April 2007 to August 2013, forty-eight (25 men and 23 women) cases of melanoma of the extremities underwent sentinel lymph node biopsy. All the cases had sentinel lymph node biopsy and surgery. Among them 37 cases underwent limb salvage surgery, while 11 cases underwent amputation. Of the cases with limb salvage, 28 cases underwent free skin grafting or local flap grafting reconstruction after wide resection. Of the surgical margin, wide resection was performed in 37 patients, and radical resection was performed in 11 cases. There were 39 cases in stage I or II, and 9 cases in stage III. After the surgery, adjuvant chemotherapy was performed in 9 cases, and adjuvant biotherapy of interferon and interleukin was performed in 26 cases. Except for 2 cases, 46 cases were followed up with a mean follow-up period of 20.1 months (range from 2 to 60 months).</p><p><b>RESULTS</b>39 (81.3%) cases had negative SLNB, while 9 (18.8%) cases had positive SLNB. Recurrence or metastasis was more common in those with positive SLNB (3 of 9 cases, 33.3%) compared with those with negative SLNB (4 of 39 cases, 10.3%). The median disease-free survival of patients with negative results was 19.5 months, significantly longer than that of the positive cases (9.5 months, P = 0.03). Otherwise, sex and age showed no significant difference in the disease free survivals.</p><p><b>CONCLUSIONS</b>Sentinel lymph node biopsy enables us to have a better understanding of regional lymph node status through lymphoscintigraphy. It improves the accuracy of staging and provides valuable prognostic information to guide subsequent treatment decisions.</p>

Soft tissue leiomyosarcoma of the trunk and extremities:a retrospective analysis of 18 cases / 中国综合临床

Objective To explore the clinical feature,suitable treatment and prognosis of soft tissue leiomyosarcoma of the trunk and extremities.Methods Clinical data of 18 cases of pathologically confirmed soft tissue leiomyosarcoma of the trunk and extremities from January 1999 to December 2012 were analyzed retrospectively.Primary tumors in 7 cases were marginally excised before admitted to our hospital,2 had open biopsy before admission to our hospital,and 8 cases had local relapse at admission; Only one patient took our institute as the first visit.Seventeen cases were performed extended excision of tumors and 1 case underwent marginal resection.All the patients were followed up and the follow-up period was from 16 to 158 months.Results During follow-up period,9 patients developed lung metastasis,and local recurrence occurred in 5 patients.Ten patients died and 8 survived.Of the ten dead cases,seven died of tumor progression and 3 died from non-tumor factors.In the 8 patients survived,2 survived with tumor.The 5-year overall survival rate was 59.2％.Conclusion Soft tissue leiomyosarcoma of the trunk and extremities are rare malignant tumors,mostly occurred in elder patients and presenting soft tissue mass.Local recurrence and distant metastasis are common and associated with a poor prognosis.Surgical excision combined with adjuvant radiation is the common treatment strategy.

Safty and acute toxicities of intraoperative electron radiotherapy for patients with abdominal tumors / 中华放射肿瘤学杂志

Objective To investigate the safety and acute toxicities of intraoperative electron radiotherapy for patients with abdominal tumors.Methods From May 2008 to August 2009, 52 patients with abdominal tumors were treated with intraoperative electron radiotherapy,including 14 patients with breast cancer,19 with pancreatic cancer,3 with cervical cancer, 4 with ovarian cancer, 6 with sarcoma, and 6 with other tumors.Fifteen patients were with recurrent tumors.The intraoperative radiotherapy was performed using Mobetron mobile electron accelerator, with total dose of 9 - 18 Gy.In all, 29, 4 and 19 patients received complete resection, palliative resection and surgical exploration, respectively.The complications during the operations and within 6 months after operations were graded according to Common Terminology Criteria for Adverse Events v3.0 (CTC 3.0).Results The median duration of surgery was 190 minutes.Intraoperative complications were observed in 5 patients, including 3 with hemorrhage, 1 with hypotension,and 1 with hypoxemia, all of which were treated conservatively.The median hospitalization time and time to take out stitches was 12 and 13 days, respectively.And the in-hospital mortality was 4% (2/52).Twentyfour patients suffered post-operative adverse events, including 3 postoperative infections.With a median follow-up time of 183 days, 20% of patients sufferred from grade 3 to 5 adverse events, with hematological toxicities being the most common complication, followed by bellyache.Grade 1 and 2 toxicities which were definitely associated with intraoperative radiotherapy was 28% and 4%, respectively.None of grade 3 to 5 complications were proved to be caused by intraoperative radiotherapy.Conclusions Intraoperative electron radiotherapy is well tolerable and could be widely used for patients with abdominal tumors, with a little longer time to take out stitches but without more morbidities and toxicities compared surgery alone.