It is important for surgeons performing sarcoma surgery to know that bone resection and tumor prosthesis applications in soft tissue sarcomas(STS)have unique features in terms of indication,surgical approach and follo...It is important for surgeons performing sarcoma surgery to know that bone resection and tumor prosthesis applications in soft tissue sarcomas(STS)have unique features in terms of indication,surgical approach and follow-up,in terms of the management of these cases.Some STS are associated with bone and major neurovascular structures.Bone-associated STS are generally relatively large and relatively deep-seated.Additionally,the tendency for metastasis is high.In some cases,the decision about which structures to resect is difficult.These cases are often accompanied by poor oncological and surgical outcomes.Management of cases should be done by a multidisciplinary team in advanced centers specialized in this field.The surgical team must have sufficient knowledge and experience in the field of limb-sparing surgery.Preoperative evaluation and especially good planning of bone and soft tissue reconstruction are vital.展开更多
BACKGROUND Despite the fact that about one third of patients with primary localized extremity soft tissue sarcoma(e STS)will develop metastatic disease,abdominal metastases(AM)and retroperitoneal metastases(RM)constit...BACKGROUND Despite the fact that about one third of patients with primary localized extremity soft tissue sarcoma(e STS)will develop metastatic disease,abdominal metastases(AM)and retroperitoneal metastases(RM)constitute rare events.There is no clear consensus on how to achieve follow-up on patients with primary localized e STS following curative resection,especially regarding the surveillance of potential AM/RM.AIM To systematically analyse incidence,diagnosis,treatment and outcome of AM/RM in e STS patients.METHODS In this systematic review,899 studies available in Pub Med and published between 2000 and 2018 were screened,identifying 17 original articles focused on AM or RM in e STS.Article selection was based on the PRISMA guidelines,using the search terms(abdominal metastasis AND soft tissue sarcoma)and(soft tissue sarcoma metastasis abdomen).All studies published between January 1,2000 and December 31,2018 were screened.Further articles were identified by crosssearching article references,with the final search date being February 18,2019.Due to limited data and the different reporting techniques used,the present review focused on descriptive analysis of the included studies.RESULTS Of the 17 studies included,six original articles reported on incidence±diagnosis,therapy and outcome in AM and RM,whilst three original and eight case reports focused on diagnostic pathway,therapeutic procedures or outcomes without allowing conclusions regarding incidence of AM and RM.According to the former six studies,incidence of AM ranged from 0.9%-5.6%in patients with miscellaneous histological subtypes,and up to 12.1%in patients with myxoid liposarcoma.The most common histological subtypes that developed AM or RM were(myxoid)liposarcoma and leiomyosarcoma,but also rare subtypes such asepithelioid sarcoma,myxofibrosarcoma,synovial sarcoma,and malignant peripheral nerve sheath tumour had been reported to develop AM/RM.Surgery for AM/RM was performed in five of eight case-reports(62.5%)and in 20.8%-100.0%of original articles.In particular,patients with hepatic metastases undergoing metastasectomy had a survival benefit compared to patients treated with chemotherapy or best supportive care(>3 years vs<6 mo).CONCLUSION Patients with e STS should undergo surveillance with abdominal ultrasonography/computed tomography,or even whole-body-magnetic resonance imaging to detect AM/RM at an early stage.展开更多
In this editorial based on a case report,we delve into a seldom-seen occurrence of clear cell sarcoma featuring pancreatic metastasis in a 47-year-old male patient.Recognized for its typical tendency to metastasize to...In this editorial based on a case report,we delve into a seldom-seen occurrence of clear cell sarcoma featuring pancreatic metastasis in a 47-year-old male patient.Recognized for its typical tendency to metastasize to the lungs,bones,and brain,clear cell sarcoma rarely extends its reach to the pancreas.Despite the initial absence of discernible abnormalities during the patient's physical examination,the manifestation of abdominal pain prompted further investigation.Subsequent abdominal computed tomography brought to light the presence of a pancreatic tumor,culminating in the definitive diagnosis of clear cell sarcoma with pancreatic metastasis.The successful management of this atypical presentation involved a series of surgical interventions,including distal pancreatectomy and splenectomy.This report not only sheds light on the infrequent manifestation of clear cell sarcoma within the pancreas but also underscores the pivotal role of vigilant postoperative follow-up in addressing this rare sarcoma.The emphasis on postoperative care serves as a crucial aspect of the broader narrative,acknowledging the need for ongoing monitoring and management to ensure a comprehensive and successful treatment trajectory for patients with this unique presentation of clear cell sarcoma.展开更多
骨与软组织肉瘤是一组异质性肿瘤,起源于骨骼或软组织中的不同细胞类型,根据国际肿瘤分类学委员会(International Classification of Disease for Oncology Third Edition, ICD-O3)的分类,骨与软组织肉瘤可以分为50余种亚型,其中骨肉瘤...骨与软组织肉瘤是一组异质性肿瘤,起源于骨骼或软组织中的不同细胞类型,根据国际肿瘤分类学委员会(International Classification of Disease for Oncology Third Edition, ICD-O3)的分类,骨与软组织肉瘤可以分为50余种亚型,其中骨肉瘤、软骨肉瘤和尤文肉瘤是最常见的3种原发性恶性骨肿瘤。由于骨与软组织肉瘤具有侵袭性、易转移和发展快的特点,传统治疗手段虽然可以控制疾病进展,但对于晚期或复发性患者的生存率提升仍然有限。免疫治疗以激活患者自身免疫系统为核心,通过调节免疫反应,实现对肿瘤的有针对性攻击,从而在最大程度上减少对正常组织的损害,这一治疗策略的独特性和高效性使其成为当前癌症治疗领域备受瞩目的研究热点。基于此,本综述将系统性地回顾并总结骨与软组织肉瘤免疫治疗的最新研究进展,重点关注已经在临床试验中取得成功的免疫治疗手段,并探讨其在改善患者预后、减轻治疗不良反应以及提高生存质量方面的潜在作用,以期为进一步探索免疫治疗在骨与软组织肉瘤中的应用提供参考和启示。展开更多
Introduction:Patients with soft tissue sarcoma(STS)that present with metastasis at diagnosis have a dire prognosis.Within this patient population,we sought to assess:(1)demographic and clinical characteristics,(2)meta...Introduction:Patients with soft tissue sarcoma(STS)that present with metastasis at diagnosis have a dire prognosis.Within this patient population,we sought to assess:(1)demographic and clinical characteristics,(2)metastatic patterns,(3)treatment strategies,and(4)disease-specific survival(DSS).Materials and Methods:The SEER database was queried to identify patients with histologically confirmed STS of the pelvis or extremity.Univariate and multivariate analysis was performed using the Cox proportional hazards model.Disease-specific survival(DSS)was analyzed using the Kaplan-Meier method.Results:A total of 22,683 patients were retrieved,out of which 2,553(11.3%)had metastasis at diagnosis.Leiomyosarcoma,undifferentiated pleomorphic sarcoma(UPS),liposarcoma,synovial sarcoma,spindle cell sarcoma,and alveolar rhabdomyosarcoma(A-RMS)were the six most common STS presenting with metastasis.Among patients with metastasis,53.7%and 33.2%of patients had primary tumors located in the lower limb and pelvis,respectively.Lung was the most common site of metastasis in all subtypes except A-RMS,in which bone metastases and lymph node(LN)predominated(85.2%and 62.1%,respectively).Chemotherapy and radiotherapy were associated with higher DSS(HR=0.788 and HR=0.755,respectively).Five-year DSS was below 20%in all tumor histologies.Two-year DSS for patients with synchronous lung and liver metastases was 28%.Conclusion:Although the lung was the most common site of metastasis,metastatic patterns are highly variable depending on tumor histology.Metastatic A-RMS is most commonly presented with regional LN and bone involvement.Disease-specific survival remained poor for patients with metastatic disease at presentation regardless of(neo)-adjuvant radiotherapy or chemotherapy.展开更多
文摘It is important for surgeons performing sarcoma surgery to know that bone resection and tumor prosthesis applications in soft tissue sarcomas(STS)have unique features in terms of indication,surgical approach and follow-up,in terms of the management of these cases.Some STS are associated with bone and major neurovascular structures.Bone-associated STS are generally relatively large and relatively deep-seated.Additionally,the tendency for metastasis is high.In some cases,the decision about which structures to resect is difficult.These cases are often accompanied by poor oncological and surgical outcomes.Management of cases should be done by a multidisciplinary team in advanced centers specialized in this field.The surgical team must have sufficient knowledge and experience in the field of limb-sparing surgery.Preoperative evaluation and especially good planning of bone and soft tissue reconstruction are vital.
文摘BACKGROUND Despite the fact that about one third of patients with primary localized extremity soft tissue sarcoma(e STS)will develop metastatic disease,abdominal metastases(AM)and retroperitoneal metastases(RM)constitute rare events.There is no clear consensus on how to achieve follow-up on patients with primary localized e STS following curative resection,especially regarding the surveillance of potential AM/RM.AIM To systematically analyse incidence,diagnosis,treatment and outcome of AM/RM in e STS patients.METHODS In this systematic review,899 studies available in Pub Med and published between 2000 and 2018 were screened,identifying 17 original articles focused on AM or RM in e STS.Article selection was based on the PRISMA guidelines,using the search terms(abdominal metastasis AND soft tissue sarcoma)and(soft tissue sarcoma metastasis abdomen).All studies published between January 1,2000 and December 31,2018 were screened.Further articles were identified by crosssearching article references,with the final search date being February 18,2019.Due to limited data and the different reporting techniques used,the present review focused on descriptive analysis of the included studies.RESULTS Of the 17 studies included,six original articles reported on incidence±diagnosis,therapy and outcome in AM and RM,whilst three original and eight case reports focused on diagnostic pathway,therapeutic procedures or outcomes without allowing conclusions regarding incidence of AM and RM.According to the former six studies,incidence of AM ranged from 0.9%-5.6%in patients with miscellaneous histological subtypes,and up to 12.1%in patients with myxoid liposarcoma.The most common histological subtypes that developed AM or RM were(myxoid)liposarcoma and leiomyosarcoma,but also rare subtypes such asepithelioid sarcoma,myxofibrosarcoma,synovial sarcoma,and malignant peripheral nerve sheath tumour had been reported to develop AM/RM.Surgery for AM/RM was performed in five of eight case-reports(62.5%)and in 20.8%-100.0%of original articles.In particular,patients with hepatic metastases undergoing metastasectomy had a survival benefit compared to patients treated with chemotherapy or best supportive care(>3 years vs<6 mo).CONCLUSION Patients with e STS should undergo surveillance with abdominal ultrasonography/computed tomography,or even whole-body-magnetic resonance imaging to detect AM/RM at an early stage.
文摘In this editorial based on a case report,we delve into a seldom-seen occurrence of clear cell sarcoma featuring pancreatic metastasis in a 47-year-old male patient.Recognized for its typical tendency to metastasize to the lungs,bones,and brain,clear cell sarcoma rarely extends its reach to the pancreas.Despite the initial absence of discernible abnormalities during the patient's physical examination,the manifestation of abdominal pain prompted further investigation.Subsequent abdominal computed tomography brought to light the presence of a pancreatic tumor,culminating in the definitive diagnosis of clear cell sarcoma with pancreatic metastasis.The successful management of this atypical presentation involved a series of surgical interventions,including distal pancreatectomy and splenectomy.This report not only sheds light on the infrequent manifestation of clear cell sarcoma within the pancreas but also underscores the pivotal role of vigilant postoperative follow-up in addressing this rare sarcoma.The emphasis on postoperative care serves as a crucial aspect of the broader narrative,acknowledging the need for ongoing monitoring and management to ensure a comprehensive and successful treatment trajectory for patients with this unique presentation of clear cell sarcoma.
文摘骨与软组织肉瘤是一组异质性肿瘤,起源于骨骼或软组织中的不同细胞类型,根据国际肿瘤分类学委员会(International Classification of Disease for Oncology Third Edition, ICD-O3)的分类,骨与软组织肉瘤可以分为50余种亚型,其中骨肉瘤、软骨肉瘤和尤文肉瘤是最常见的3种原发性恶性骨肿瘤。由于骨与软组织肉瘤具有侵袭性、易转移和发展快的特点,传统治疗手段虽然可以控制疾病进展,但对于晚期或复发性患者的生存率提升仍然有限。免疫治疗以激活患者自身免疫系统为核心,通过调节免疫反应,实现对肿瘤的有针对性攻击,从而在最大程度上减少对正常组织的损害,这一治疗策略的独特性和高效性使其成为当前癌症治疗领域备受瞩目的研究热点。基于此,本综述将系统性地回顾并总结骨与软组织肉瘤免疫治疗的最新研究进展,重点关注已经在临床试验中取得成功的免疫治疗手段,并探讨其在改善患者预后、减轻治疗不良反应以及提高生存质量方面的潜在作用,以期为进一步探索免疫治疗在骨与软组织肉瘤中的应用提供参考和启示。
文摘Introduction:Patients with soft tissue sarcoma(STS)that present with metastasis at diagnosis have a dire prognosis.Within this patient population,we sought to assess:(1)demographic and clinical characteristics,(2)metastatic patterns,(3)treatment strategies,and(4)disease-specific survival(DSS).Materials and Methods:The SEER database was queried to identify patients with histologically confirmed STS of the pelvis or extremity.Univariate and multivariate analysis was performed using the Cox proportional hazards model.Disease-specific survival(DSS)was analyzed using the Kaplan-Meier method.Results:A total of 22,683 patients were retrieved,out of which 2,553(11.3%)had metastasis at diagnosis.Leiomyosarcoma,undifferentiated pleomorphic sarcoma(UPS),liposarcoma,synovial sarcoma,spindle cell sarcoma,and alveolar rhabdomyosarcoma(A-RMS)were the six most common STS presenting with metastasis.Among patients with metastasis,53.7%and 33.2%of patients had primary tumors located in the lower limb and pelvis,respectively.Lung was the most common site of metastasis in all subtypes except A-RMS,in which bone metastases and lymph node(LN)predominated(85.2%and 62.1%,respectively).Chemotherapy and radiotherapy were associated with higher DSS(HR=0.788 and HR=0.755,respectively).Five-year DSS was below 20%in all tumor histologies.Two-year DSS for patients with synchronous lung and liver metastases was 28%.Conclusion:Although the lung was the most common site of metastasis,metastatic patterns are highly variable depending on tumor histology.Metastatic A-RMS is most commonly presented with regional LN and bone involvement.Disease-specific survival remained poor for patients with metastatic disease at presentation regardless of(neo)-adjuvant radiotherapy or chemotherapy.
