Primary Site and Other Prognostic Factors for Fibrosarcoma: An Analysis of the National Cancer Database.

PURPOSE: Fibrosarcoma (FS) is a rare and malignant tumor that can occur in a variety of anatomic sites. The goal of this study is to use the National Cancer Database (NCDB) to analyze various factors affecting overall survival in FS and to be one of the rare studies to characterize the significance of the primary anatomic sites. METHODS: The study cohort included 2,278 patients diagnosed with fibrosarcoma who received surgery from the NCDB. Kaplan-Meier curves, log-rank tests, and a multivariable Cox proportional hazard model were used to analyze the significance of factors affecting overall survival. RESULTS: The head, face, and neck (HR = 1.44; 95% CI: 1.01-2.05; P = 0.046) and thorax anatomical sites (HR = 1.33; 95% CI: 1.02-1.73; P = 0.035) had a higher increased risk of death in comparison to the lower limb and hip. Compared to patients with private insurance, patients without insurance (HR = 1.99; 95% CI: 1.22 to 3.25; P = 0.006) and patients with Medicaid (HR = 1.99; 95% CI: 1.37 to 2.90; P < 0.001) had decreased overall survival. Patients associated with a zip code-level median household income ≥ $63,000 had a decreased risk of mortality when compared to lower income groups. CONCLUSION: In general, older patients with comorbidities, advanced-stage disease, and larger tumors who did not have private insurance and were from areas associated with lower income levels had poorer overall survival. No significant difference in overall survival was associated with receipt of neoadjuvant chemotherapy or neoadjuvant radiation.

Primary anatomical site as a prognostic factor for pleomorphic liposarcoma.

BACKGROUND: Pleomorphic liposarcomas (PLS) is an aggressive, high-grade subtype of soft tissue sarcoma representing < 15% of liposarcomas. It most commonly arises in the retroperitoneum and proximal upper extremities. Current prognostic factors are centered around staging, which accounts for the grade, size, and location of the tumor in relation to the superficial fascia. METHODS: 750 patients diagnosed with pleomorphic liposarcoma from the National Cancer Database were analyzed. Kaplan-Meier survival tables, log-rank tests, and Cox proportional hazards analysis were utilized to compare survival between groups within variables. RESULTS: The most common primary anatomical site was the lower limb/hip. The head/neck primary anatomical site demonstrated the highest 10-year overall survival probability, while the retroperitoneum/abdomen had the lowest (50% and 18.4%). Compared to the thorax/lung site, the following sites demonstrated a decreased risk of death: lower limb/hip (HR = 0.54; 95% CI: 0.35-0.82, p = 0.004), pelvis (HR = 0.49; 95% CI: 0.28-0.84, p = 0.010), and the retroperitoneum/abdomen (HR = 0.54; 95% CI: 0.33-0.89, p = 0.015). Both adjuvant radiation (HR = 0.64; 95% CI: 0.48-0.85, p = 0.002) and neoadjuvant radiation (HR = 0.70; 95% CI: 0.49-1.00, p = 0.049) provided a survival benefit to patients. There was an increased risk of death for every 10-year increment in age (HR = 1.31; 95% CI: 1.12-1.45, p < 0.001). CONCLUSION: Statistically significant prognostic factors for PLS include primary anatomical site, age, Charlson-Deyo Comorbidity Index Scores and the use of neoadjuvant and adjuvant radiation.

Treatment Facility: An Important Prognostic Factor for Dedifferentiated Liposarcoma Survival.

A National Cancer Database study of on survival outcomes for patients with dedifferentiated liposarcomas found that insurance status, median household income, and treatment facility were associated with differences in median survival and 5- and 10-year survival probabilities.

Primary anatomical site, adjuvant therapy, and other prognostic variables for dedifferentiated liposarcoma.

BACKGROUND: Dedifferentiated liposarcoma (DDLPS) is a high-grade, clinically aggressive tumor associated with low survival probabilities. Prognostic variables for DDLPS have not been previously reported in a large patient population. METHODS: A total of 3573 patients with primary DDLPS were analyzed from the National Cancer Data Base (NCDB). The 5- and 10-year survival probabilities were calculated, and the groups were compared using log-rank comparisons and multivariable Cox hazard regression analysis. Median survival was also calculated. RESULTS: Males comprised 65% of the cohort, the median age at diagnosis was 64 years of age, and 65.4% of the patients were between 51 and 75 years of age. The most common site for primary tumors is the retroperitoneum or abdomen (59.5%). Head or neck tumors had the best 5-year outcomes (86.4%) followed by extremities (67.1%), pelvis (65.8%), thorax or trunk (58.9%), and finally retroperitoneum or abdomen (42.6%). Best outcomes were noted in the 26- to 50-year-old age group (5-year survival:66.8%), < 10 cm size (5-year survival:66.1%), FNCLCC grade 1 (5-year survival:69.2%), and stage II disease (5-year survival:66.7%). Radiation therapy yielded the best 5-year and 10-year survival probabilities of 59% and 39.3%, respectively. Out of all the adjuvant therapies, the use of radiation resulted in the best 5-year survival of 63.4%. CONCLUSION: In the largest and most comprehensive study to date on DDLPS, major findings include primary site as a significant prognostic variable with age at presentation, sex, tumor stage, and type of adjuvant therapy significantly impacting overall survival.

Electrospun PCL, gold nanoparticles, and soy lecithin composite material for tissue engineering applications.

Soy lecithin has been shown to play a critical role in cell signaling and cellular membrane structure. In addition, it has been shown to increase biocompatibility, hydrophilicity, and decrease cytotoxicity. Gold nanoparticles have also shown to improve cellularity. Lecithin, gold nanoparticles, and polycaprolactone (PCL) solutions were electrospun in order to develop unique mesh materials for the treatment of osteoarthritis. The electrospinning parameters were optimized to achieve different solution ratios for fiber optimization. The amount of lecithin mixed with PCL varied from 30 wt.% to 50 wt.% . Gold nanoparticles (1% to 10% concentrations) were also added to lecithin-PCL mixture. The mechanical and chemical properties of the fiber mesh were analyzed via contact angle test, tensile mechanical tests, Fourier transform infrared spectroscopy (FTIR), and differential scanning calorimetry (DSC). Cell viability was measured using a WST-1 Assay. Scanning electron microscopy confirmed the successful formation of fiber mesh. The compositions of 40% soy lecithin with PCL in 40% solvent (40:40) resulted in the most well-formed fiber mesh. DSC melt temperatures were statically insignificant; uniaxial stresses and the moduli resulted in no significant difference between the test composition and pristine PCL compositions. WST-1 assay revealed all compositions were non-cytotoxic. Overall, the addition of lecithin increased hydrophilicity while maintaining cell viability and the mechanical and chemical properties of PCL. This study demonstrated that it is possible to successfully electrospin a lecithin, gold nanoparticle, and polycaprolactone scaffold for tissue engineering applications.

The epidemiology and survivorship of clear cell sarcoma: a National Cancer Database (NCDB) review.

PURPOSE: Clear cell sarcoma (CCS) is a rare soft tissue tumor thought to originate from tendons and aponeuroses. This is the largest and most comprehensive study of CCS to the best of our knowledge. In addition, this is the first study to determine the estimated 10-year overall survival, specific treatment modalities including neoadjuvant and adjuvant combinations, and sites of distant metastasis in CCS utilizing a national database. METHODS: The National Cancer Database (NCDB) was used to study 489 patients diagnosed with CCS from 2004 to 2014. Kaplan-Meier methods were used to estimate 5- and 10-year overall survival, and log-rank tests were used to compare survival amongst stage. RESULTS: Median age at diagnosis was 39 years. Males and females were equally affected. Race distribution was 78% Caucasian and 15% Black. Most common primary site was lower limb or hip (53%). Percentage of patients with distant organ metastases was 15%, with lung being the most common site (4%). Median overall survival was 57.2 months. Overall estimated 5- and 10-year survival was approximately 50 and 38%, respectively. Approximate 5-year survival for Stages I-IV was 75, 65, 35, and 15%, respectively. Stages at disease presentation were 34% at Stage I, 13% at Stage II, 16% at Stage III, and 38% at Stage IV. Surgery was the most common form of treatment (83%); 34% received radiation and 20% received chemotherapy. CONCLUSION: The 5-year overall survival for CCS in Stages III and IV was much worse than Stages I and II. Overall estimated 5- and 10-year survival was approximately 50 and 38%, respectively. Men and women were equally affected and had a median age at diagnosis of 39 years. The most common tumor location was lower limb and hip and the most common site of metastases was the lung.

Gold Nanoparticle-Collagen Gels for Soft Tissue Augmentation.

Collagen soft tissue fillers suffer from fast reabsorption, which minimizes their use as a tissue-engineered construct. Extensive cross-linking can be utilized to extend longevity, but changes in microstructure and biomechanics can have deleterious effects. To enhance longevity while still achieving a natural microstructure, gold nanoparticles (AuNPs) were conjugated to fibrilized collagen and homogenized into an injectable form for use as a soft tissue filler. A long-term animal study in Yucatan swine was conducted to assess biocompatibility and longevity. Two formulations of the AuNP-collagen were compared to porcine cross-linked collagen and commercially available hyaluronic acid (HA). The results of the study demonstrated that the AuNPs may provide enhanced longevity over 6 months compared to HA and cross-linked collagen. Irritation scores indicated that the AuNP-collagen construct (AuNP-CC) demonstrated low irritation compared to the cross-linked collagen and HA while histology scores demonstrated good biocompatibility. Overall, it may be possible to utilize AuNPs to stabilize and increase the longevity of CC while still achieving biocompatibility.