scholarly journals Clinical Outcomes of Atypical Lipomatous Tumor/Well-Differentiated Liposarcoma of the Extremities: Analysis of Recurrence Factors

2021 ◽  
Author(s):  
Toshiki Zeniya ◽  
Makoto Emori ◽  
Hiroyuki Tsuchie ◽  
Hiroyuki Nagasawa ◽  
Kousuke Iba ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Clinical Outcomes ◽  
Rank Test ◽  
Low Grade ◽  
Tumor Diameter ◽  
Exact Test ◽  
Time To Recurrence ◽  
Average Maximum ◽  
Maximum Tumor Diameter ◽  
Well Differentiated

Abstract Background: Atypical lipomatous tumors/well-differentiated liposarcomas (ALT/WDLPS) are low-grade, slow-growing, and locally aggressive tumors. We investigated clinical outcomes and recurrence factors for ALT/WDLPS of the extremities.Patients and Methods: The variables were evaluated as potential recurrence factor using Fisher’s exact test. The 5-year recurrence-free survival (RFS) rate was calculated using the Kaplan-Meier method, and differences in survival were assessed using a log-rank test in univariate analyses. Results: Sixty-two patients were identified, including 29 men and 33 women. The median age was 63.7 years (range, 34–82 years). The average maximum tumor diameter was 15.9 cm (range, 5–28 cm). The maximum tumor diameter (≥20 cm) was significantly associated with local recurrence (p=0.049). Ten patients (16.1%) developed local recurrence, and the mean time to recurrence was 48.4 months (range, 5–161 months).Conclusions: Tumor diameter ≥20 cm was identified as a risk factor for recurrence.

scholarly journals Impact of Pathological Stratification on the Clinical Outcomes of Advanced Well-Differentiated/Dedifferentiated Liposarcoma Treated with Trabectedin

Cancers ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1453
Author(s):  
Chiara Fabbroni ◽  
Giovanni Fucà ◽  
Francesca Ligorio ◽  
Elena Fumagalli ◽  
Marta Barisella ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Proportional Hazards ◽  
Case Series ◽  
Progression Free Survival ◽  
Cox Proportional Hazards ◽  
Low Grade ◽  
High Grade ◽  
Retrospective Case ◽  
Well Differentiated ◽  
The Impact

Background. We previously showed that grading can prognosticate the outcome of retroperitoneal liposarcoma (LPS). In the present study, we aimed to explore the impact of pathological stratification using grading on the clinical outcomes of patients with advanced well-differentiated LPS (WDLPS) and dedifferentiated LPS (DDLPS) treated with trabectedin. Patients: We included patients with advanced WDLPS and DDLPS treated with trabectedin at the Fondazione IRCCS Istituto Nazionale dei Tumori between April 2003 and November 2019. Tumors were categorized in WDLPS, low-grade DDLPS, and high-grade DDLPS according to the 2020 WHO classification. Patients were divided in two cohorts: Low-grade (WDLPS/low-grade DDLPS) and high-grade (high-grade DDLPS). Results: A total of 49 patients were included: 17 (35%) in the low-grade cohort and 32 (65%) in the high-grade cohort. Response rate was 47% in the low-grade cohort versus 9.4% in the high-grade cohort (logistic regression p = 0.006). Median progression-free survival (PFS) was 13.7 months in the low-grade cohort and 3.2 months in the high-grade cohort. Grading was confirmed as an independent predictor of PFS in the Cox proportional-hazards regression multivariable model (adjusted hazard ratio low-grade vs. high-grade: 0.45, 95% confidence interval: 0.22–0.94; adjusted p = 0.035). Conclusions: In this retrospective case series, sensitivity to trabectedin was higher in WDLPS/low-grade DDLPS than in high-grade DDLPS. If confirmed in larger series, grading could represent an effective tool to personalize the treatment with trabectedin in patients with advanced LPS.

Resection Status Does Not Impact Recurrence in Well-Differentiated Liposarcoma of the Extremity

2021 ◽  
pp. 000313482110545
Author(s):  
Chelsea R. Olson ◽  
Lorena P. Suarez-Kelly ◽  
Cecilia G. Ethun ◽  
Rita D. Shelby ◽  
Peter Y. Yu ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Resection Margins ◽  
R0 Resection ◽  
Low Grade ◽  
Incomplete Resection ◽  
R1 Resection ◽  
Increased Risk ◽  
Clinicopathologic Factors ◽  
Resection Margin Status ◽  
Well Differentiated

Background Well-differentiated liposarcoma (WDLPS) is a low-grade soft tissue sarcoma with a propensity for local recurrence. The necessity of obtaining microscopically free surgical margins (R0) to minimize local recurrence is not clear. This study evaluates recurrence-free survival (RFS) of extremity WDLPS in relation to resection margin status. Methods A retrospective review of adult patients with primary extremity WDLPS at seven US institutions from 2000 to 2016 was performed. Patients with recurrent tumors or incomplete resection (R2) were excluded. Clinicopathologic factors were analyzed to assess impact on local RFS. Results 97 patients with primary extremity WDLPS were identified. The majority of patients had deep, lower extremity tumors. Mean tumor size was 18.2±8.9cm. Patients were treated with either radical (76.3%) or excisional (23.7%) resections; 64% had R0 and 36% had microscopically positive (R1) resection margins. Ten patients received radiation therapy with no difference in receipt of radiation between R0 vs R1 groups. Thirteen patients (13%) developed a local recurrence with no difference in RFS between R0 vs R1 resection. Five-year RFS was 59.5% for R0 vs 85.2% for R1. Only one patient died of disease after developing dedifferentiation and distant metastasis despite originally having an R0 resection. Discussion In this large multi-institutional study of surgical resection of extremity WDLPS, microscopically positive margins were not associated with an increased risk of recurrence. Positive microscopic margin resection for extremity WDLPS may yield similar rates of local control while avoiding a radical approach to obtain microscopically negative margins.

Association of the neutrophil to eosinophil ratio with response to immunotherapy-based combinations in metastatic renal cell carcinoma.

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 341-341
Author(s):  
Matthew D Tucker ◽  
Katy Beckermann ◽  
Kristin Kathleen Ancell ◽  
Kerry Schaffer ◽  
Renee McAlister ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Clinical Outcomes ◽  
Metastatic Renal Cell Carcinoma ◽  
Renal Cell ◽  
Objective Response ◽  
Progression Free Survival ◽  
Rank Test ◽  
Cancer Center ◽  
Exact Test

341 Background: Neutrophilia is known to be associated with worse prognosis in metastatic renal cell carcinoma (mRCC); however, less is known about the role of eosinophils in the response to immunotherapy (IO). We investigated the association of the baseline neutrophil to eosinophil ratio (NER) with outcomes to IO-based combination treatment in mRCC. Methods: Patients with mRCC treated with ipilimumab plus nivolumab, pembrolizumab plus axitinib, or avelumab plus axitinib at the Vanderbilt-Ingram Cancer Center were retrospectively identified. Patients on >10mg prednisone and patients with prior IO were excluded. Baseline NER (at time of first IO) and association with progression free survival (PFS), overall survival (OS), and objective response rate (ORR) were investigated. Data cutoff was 9/1/2020. Analysis for PFS and OS was performed using the log-rank test and Mantel-Haenszel method, and analysis of the odds ratio for ORR was performed using Fischer’s exact test. Results: Sixty-one patients were identified: 89% clear cell histology, 74% prior nephrectomy, 69% IMDC intermediate risk, and 72% treatment-naïve. Patients with baseline NER < median (N=31) had improved clinical outcomes compared to patients with baseline NER > median (N=30) (Table). Improvement in PFS by NER was maintained when stratified by anti-PD-1/CTLA-4 and anti-PD(L)-1/VEGF (p= 0.0062 and p= 0.049); however, differences in OS and ORR were no longer significant. The median baseline NER among patients with partial response (PR) was significantly lower at 22.7 (95% CI 18.9-31.1) vs. 51.6 (95% CI 39.5-93.1) among those with progressive disease (PD) (p= 0.0054). For comparison, the median neutrophil to lymphocyte ratio was not significantly different between PR (2.60) and PD (3.84, p= 0.056). Conclusions: Patients with a low baseline NER treated with IO-based combinations had improved clinical outcomes compared to patients with a high baseline NER. Additional investigation of this parameter in larger cohorts is warranted. [Table: see text]

Retrospective study of non-mucinous appendiceal adenocarcinomas: Role of systemic chemotherapy and cytoreductive surgery.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 263-263
Author(s):  
Marc Isamu Uemura ◽  
Wei Qiao ◽  
Keith F. Fournier ◽  
Jeffrey Morris ◽  
Paul F. Mansfield ◽  
...  
Keyword(s):  
Cytoreductive Surgery ◽  
Systemic Chemotherapy ◽  
Stage Iv ◽  
Stage Ii ◽  
Stage Iii ◽  
Rank Test ◽  
Low Grade ◽  
Histologic Subtype ◽  
Well Differentiated ◽  
Quantitative Response

263 Background: The majority of studies evaluating appendiceal epithelial neoplasms have focused on those with mucinous histology. Few studies have reported on non-mucinous appendiceal adenocarcinomas. We performed the largest single-center study to investigate this histologic subtype, in order to describe the natural history and impact of both cytoreductive surgery (CRS) and systemic chemotherapy. Methods: We retrospectively reviewed 172 pts with non-mucinous appendiceal adenocarcinoma evaluated at the UT-MD Anderson Cancer Center between 1990 and 2015. Patient demographics, tumor characteristics, therapy received, and outcomes were recorded. Response assessment was semi-quantitative (response vs. no response) according to the treating physician. Overall survival (OS) and time to progression (TTP) were calculated using Kaplan Meier product-limit method and survival rates compared using the log rank test. Results: Median age at diagnosis was 52.9 yrs (M:F 1:1). Most pts presented with advanced stage: stage I (1.7%), stage II (32.5%), stage III (14.5%), and stage IV (51.2%). No patient had well-differentiated histology. 56% had moderate and 44% poor histology. Median OS by stage was 90.9m [95% CI: 70.8 to 172.9] for stage II, 52.1m [95% CI: 28.9 to NA] for stage III and 28.3m [95% CI: 22.9 to 31.9] for stage IV, (p < 0.0001). In pts with metastatic disease (n = 128) CRS was attempted in 20 (15.6%) and was complete (CCS 0/1) in 12. The median OS for pts achieving complete CRS was 48.6m. Systemic chemotherapy was administered to 92% (118/128) of metastatic pts. The median TTP was 9.4m [95% CI: 8.0 to 11.5] and semi-quantitative response rate was 54%. The majority of pts received either oxaliplatin-based, 57%, or irinotecan-based, 23%, first-line chemotherapy regimens. No statistical difference in TTP (p = 0.9) or OS (p = 0.07) between different chemotherapies was seen. Conclusions: In contrast to mucinous appendiceal neoplasms, non-mucinous appendiceal adenocarcinomas rarely present with low-grade (well-differentiated) histology. Treatment approaches appear more akin to colorectal cancer with most metastatic pts undergoing systemic chemotherapy and a minority undergoing CRS.

Preoperative prognostic classification system for hemispheric low-grade gliomas in adults

2008 ◽  
Vol 109 (5) ◽  
pp. 817-824 ◽  
Author(s):  
Edward F. Chang ◽  
Justin S. Smith ◽  
Susan M. Chang ◽  
Kathleen R. Lamborn ◽  
Michael D. Prados ◽  
...  
Keyword(s):  
Scoring System ◽  
Clinical Decision Making ◽  
Cox Proportional Hazards ◽  
World Health ◽  
Rank Test ◽  
Karnofsky Performance Scale ◽  
Low Grade ◽  
Tumor Diameter ◽  
Low Grade Gliomas

Object Hemispheric low-grade gliomas (LGGs) have an unpredictable progression and overall survival (OS) profile. As a result, the objective in the present study was to design a preoperative scoring system to prognosticate long-term outcomes in patients with LGGs. Methods The authors conducted a retrospective review with long-term follow-up of 281 adults harboring hemispheric LGGs (World Health Organization Grade II lesions). Clinical and radiographic data were collected and analyzed to identify preoperative predictors of OS, progression-free survival (PFS), and extent of resection (EOR). These variables were used to devise a prognostic scoring system. Results The 5-year estimated survival probability was 0.86. Multivariate Cox proportional hazards modeling demonstrated that 4 factors were associated with lower OS: presumed eloquent location (hazard ratio [HR] 4.12, 95% confidence interval [CI] 1.71–10.42), Karnofsky Performance Scale score ≤ 80 (HR 3.53, 95% CI 1.56–8.00), patient age > 50 years (HR 1.96, 95% CI 1.47–3.77), and tumor diameter > 4 cm (HR 3.43, 95% CI 1.43–8.06). A scoring system calculated from the sum of these factors (range 0–4) demonstrated risk stratification across study groups, with the following 5-year cumulative survival estimates: Scores 0–1, OS = 0.97, PFS = 0.76; Score 2, OS = 0.81, PFS = 0.49; and Scores 3–4, OS = 0.56, PFS = 0.18 (p < 0.001 for both OS and PFS, log-rank test). This proposed scoring system demonstrated a high degree of interscorer reliability (kappa = 0.86). Four illustrative cases are described. Conclusions The authors propose a simple and reliable scoring system that can be used to preoperatively prognosticate the degree of lesion resectability, PFS, and OS in patients with LGGs. The application of a standardized scoring system for LGGs should improve clinical decision-making and allow physicians to reliably predict patient outcome at the time of the original imaging-based diagnosis.

Malignant Peripheral Nerve Sheath Tumors of the Head and Neck: Analysis of Prognostic Factors

2000 ◽  
Vol 122 (5) ◽  
pp. 667-672 ◽  
Author(s):  
Thom R. Loree ◽  
James H. North ◽  
Bruce A. Werness ◽  
Rina Nangia ◽  
Alan P. Mullins ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Peripheral Nerve ◽  
Head And Neck ◽  
Adjuvant Radiotherapy ◽  
Rank Test ◽  
Etiologic Factor ◽  
Low Grade ◽  
Nerve Sheath Tumors ◽  
Peripheral Nerve Sheath Tumors ◽  
Nerve Sheath

Malignant peripheral nerve sheath tumors of the head and neck region are uncommon and may be associated with neurofibromatosis or occur in a sporadic manner. This is a retrospective review of 17 patients with these tumors who were treated at a single institution. Analysis of clinical and pathologic factors that influenced outcome was performed. There were 9 men and 8 women. Seven patients had a history of neurofibromatosis. Radiotherapy was implicated as a possible etiologic factor in 4 patients. The neck was the most frequently involved site. Overall survival at 5 years was 52%. Survival was improved for women and for patients with low-grade tumors. Age, tumor site, and size had no impact on survival. Survival was worse for patients with neurofibromatosis than for those with the sporadic form of the disease ( P = 0.02). Survival was calculated by the method of Kaplan and Meier. The significance of such results was based on results of the log rank test. Local recurrence correlated with tumor size and resection margin status. No local recurrences occurred in those patients who had negative margins of resection and received adjuvant radiotherapy. Tumor grade was predictive of the development of distant metastases. Negative margins of resection are essential for obtaining local control, and the addition of adjuvant radiotherapy may be beneficial in this group. Salvage surgery for local recurrence is possible in some patients.

Treatment experience of large intraventricular central neurocytoma: a retrospective cohort study

2020 ◽  
Author(s):  
Chaocai Zhang ◽  
Lanbing Yu ◽  
Shuyu Hao ◽  
Yehong Fang ◽  
Heyuan Jia ◽  
...  
Keyword(s):  
Retrospective Cohort ◽  
Age Of Onset ◽  
Tumor Resection ◽  
Central Neurocytoma ◽  
Intracranial Tumor ◽  
Maximum Diameter ◽  
Tumor Diameter ◽  
Average Maximum ◽  
Maximum Tumor Diameter ◽  
Treatment Plans

Abstract Background: Central neurocytoma is a rare intracranial tumor. Due to the limited number of reported cases, the treatment strategy for central neurocytomas, especially large central neurocytomas, remains controversial. This paper discusses our clinical experience in the treatment of large central neurocytomas.Methods: A retrospective analysis of 29 patients with intraventricular central neurocytomas diagnosed and treated by the same surgeon between April 2012 and September 2019 at the Neurosurgery Departments of Beijing Tiantan Hospital and Hainan General Hospital was performed. The clinical characteristics, treatment plans and prognoses of these patients were reviewed.Results: Among the 29 patients, the average age of onset was 31.93 (17-61) years, and the average maximum tumor diameter was 54.17 ± 15.62 mm. Twenty-three patients (79.3%) had an average maximum diameter greater than 50 mm. Twenty-seven patients (93.1%) underwent transcortical tumor resection. Twenty-seven patients (93.1%) underwent gross total tumor resection. Five patients (17.2%) received radiotherapy after the first operation, and 3 patients (10.3%) had tumor recurrence. None of the patients died.Conclusions: Surgical resection via transcortical fistulotomy is a reliable approach for removal of large central neurocytomas in the ventricle. Patients should be closely observed postoperatively, and MRI of the head should be performed regularly. If a tumor shows progression, then radiotherapy should be considered.

scholarly journals Renal Cell Carcinoma: Comparison of RENAL Nephrometry and PADUA Scores with Maximum Tumor Diameter for Prediction of Local Recurrence after Thermal Ablation

Radiology ◽  
2017 ◽  
Vol 283 (2) ◽  
pp. 590-597 ◽  
Author(s):  
Aaron W. P. Maxwell ◽  
Grayson L. Baird ◽  
Jason D. Iannuccilli ◽  
William W. Mayo-Smith ◽  
Damian E. Dupuy
Keyword(s):  
Renal Cell Carcinoma ◽  
Local Recurrence ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Thermal Ablation ◽  
Tumor Diameter ◽  
Maximum Tumor Diameter

scholarly journals Transhyoid approach in surgical treatment of oropharyngeal carcinoma

2021 ◽  
Vol 10 (4) ◽  
pp. 32-43
Author(s):  
A. V. Karpenko ◽  
R. R. Sibgatullin ◽  
А. А. Boyko ◽  
М. G. Kostova
Keyword(s):  
Surgical Treatment ◽  
Local Recurrence ◽  
Univariate Analysis ◽  
Tube Feeding ◽  
Rank Test ◽  
Oropharyngeal Carcinoma ◽  
Depth Of Invasion ◽  
Study Objective ◽  
Exact Test ◽  
Oncologic Results

The study objective is to assess functional and oncologic results of transhyoid approach used for surgical treatment of oropharyngeal carcinoma.Materials and methods. Operative records, hospital charts and data from out-patient department of 55 patients (T1 – 6, T2 – 16, T3 – 19, T4 – 14) with oropharyngeal carcinoma operated via a transhyoid approach were reviewed. Postoperative period was reviewed for complications. All oncologic adverse events were registered with special emphasis on the rate of local recurrence. A univariate analysis with chisquare and Fisher’s exact test was used to check the correlation between tumor factors and surgical variables (complications, mode of reconstruction). The influence of tumor- and treatment-related variables (T stage, differentiation, perineural invasion, p16 status, depth of invasion, extension to the oral cavity, adjuvant treatment) on the rate of local recurrence was studied in the same way. The log-rank test was used to assess differences in survival curves. The data was compared with other series of patients treated with the same technique.Results. Seventeen (30,9 %) patients developed 29 complications. There was 1 postoperative death. Five (9,1 %) patients required repeated operation. The mode of reconstruction (primary closure vs flaps) was a major factor influencing the rate of complications. Fifty (92,6 %) patients were able to resume oral diet with a duration of nasogastric tube feeding of 7–35 days. Three-year overall/disease-specific survival for the whole cohort were 47 and 51,1 %, for p16-positive (22 %) cohort – 65,6 and 87,5 %, for p16-negative (78 %) cohort – 40,6 and 46,8 %. Thirteen (24 %) patients developed a local recurrence. The rate of local recurrence was negatively affected by p16 negativity (p = 0,048), depth of invasion >10 mm (p = 0,044) and depth of invasion >15 mm (p = 0,003).Conclusion. Transhyoid approach may be considered as a surgical option for treatment of oropharyngeal carcinoma with acceptable rate of complications.

scholarly journals Angioleiomyoma of the hand with nerve compression

2020 ◽  
Vol 48 (6) ◽  
pp. 030006052092868
Author(s):  
Qianjun Jin ◽  
Hui Lu
Keyword(s):  
Contrast Material ◽  
Case Series ◽  
Surgical Excision ◽  
Nerve Compression ◽  
Tumor Diameter ◽  
Average Maximum ◽  
Maximum Tumor Diameter ◽  
Preoperative Magnetic Resonance ◽  
Medical Histories

Objective This study was performed to analyze the clinical, radiographic, and pathological features of hand angioleiomyoma causing nerve compression and assess the outcomes of surgical excision. Methods This case series included three men and one woman (mean age, 53.3 years; range, 49–56 years). The patients’ chief complaint was numbness of the fingers. The patients’ medical histories were reviewed, and the diagnosis of angioleiomyoma with nerve compression was confirmed by means of imaging examination and pathological analysis. Results Three tumors occurred in the palm and one in the finger, and the average maximum tumor diameter was 1.8 cm (range, 0.8–2.6 cm). Preoperative magnetic resonance imaging demonstrated well-defined masses with isointense signals on T1 sequences, hyperintense signals on T2 sequences, and strong heterogeneous enhancement after injection of contrast material. All tumors were located near nerves, leading to nerve compression. The diagnosis of angioleiomyoma was confirmed by postoperative pathology. Finger sensation recovered and no recurrence was found during an average follow-up of 37 months (range, 25–59 months). Conclusions Angioleiomyoma should be considered among the differential diagnoses of hand tumors and timely resection should be performed, particularly if the mass is causing numbness and/or pain with positive Tinel’s sign and/or tenderness.

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