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Evidence-based Tumor Staging of Skeletal Chondrosarcoma.


  • 影响因子:6.06
  • DOI:10.1097/PAS.0000000000001397
  • 作者列表:"Compton ML","Cates JMM
  • 发表时间:2020-01-01

:The eighth edition of the American Joint Committee on Cancer (AJCC) staging system has introduced major changes for the staging of skeletal sarcomas. However, it is unclear if these changes improve the predictive value for chondrosarcomas of the nonpelvic appendicular and nonspinal axial skeleton. Specifically, there is no clear evidence that supports the use of the proposed binary size cutoff of 8 cm for risk stratification, nor is a rationale provided for the categorization of grade 2 chondrosarcomas as high grade. The prognostic value of various anatomic and pathologic factors including tumor size, histologic grade, site of metastasis, and local tumor extent was evaluated using a cohort of patients derived from the National Cancer Database (N=3946). A simplified evidence-based staging system for chondrosarcoma (the Vanderbilt Staging System) was developed based on histologic subtype, histologic grade, and presence of metastatic disease. The predictive accuracy for 5-year overall survival was evaluated for the AJCC 8th edition, Musculoskeletal Tumor Society, and Vanderbilt Staging Systems by comparing areas under receiver operating characteristic curves generated from logistic regression analysis. Three different concordance indices and Bayesian information criterion were also calculated for model comparisons. The Vanderbilt Staging System showed significantly improved predictive accuracy for 5-year survival (82±2%) compared with the AJCC (79±2%; P=0.0075) and Musculoskeletal Tumor Society systems (76±2%; P<0.00005) in a separate validation cohort. Furthermore, the Vanderbilt Staging System showed significantly higher concordance with clinical outcomes for 2 of 3 examined indices and significantly greater extent of explained variation compared with the other 2 staging systems.


: 第八版美国癌症联合委员会 (AJCC) 分期系统对骨骼肌肉瘤的分期进行了重大变革。然而,尚不清楚这些变化是否能提高非骨盆附件和非脊柱中轴骨骼软骨肉瘤的预测价值。具体而言,没有明确的证据支持使用建议的二进制大小截断值 8 cm进行风险分层,也没有为 2 级软骨肉瘤的分类提供理由。各种解剖和病理因素的预后价值,包括肿瘤大小,组织学分级,转移部位,使用来自国家癌症数据库的患者队列 (N = 3946) 评估局部肿瘤范围。基于组织学亚型、组织学分级和转移性疾病的存在,开发了一个简化的软骨肉瘤循证分期系统 (Vanderbilt分期系统)。通过比较logistic回归分析生成的受试者工作特征曲线下面积,评价AJCC第 8 版、肌肉骨骼肿瘤学会和Vanderbilt分期系统 5 年总生存期的预测准确性。还计算了三种不同的一致性指数和贝叶斯信息准则进行模型比较。与AJCC (79 ± 2%; P = 2%) 相比,Vanderbilt分期系统显示 5 年生存率的预测准确性显著提高 (82 ± 0.0075) 和肌肉骨骼肿瘤学会系统 (76 ± 2%; P<0.00005) 在单独的验证队列中。此外,与其他 2 个分期系统相比,Vanderbilt分期系统显示出 3 个检查指标中 2 个与临床结局的一致性显著较高,解释的变异程度显著较大。



作者列表:["Tran S","Puric E","Walser M","Poel R","Datta NR","Heuberger J","Pica A","Marder D","Lomax N","Bolsi A","Morach P","Bachtiary B","Seddon BM","Schneider R","Bodis S","Weber DC"]

METHODS:OBJECTIVE:Large inoperable sacral chordomas show unsatisfactory local control rates even when treated with high dose proton therapy (PT). The aim of this study is assessing feasibility and reporting early results of patients treated with PT and concomitant hyperthermia (HT). METHODS: :Patients had histologically proven unresectable sacral chordomas and received 70 Gy (relative biological effectiveness) in 2.5 Gy fractions with concomitant weekly HT. Toxicity was assessed according to CTCAE_v4. A volumetric tumor response analysis was performed. RESULTS: :Five patients were treated with the combined approach. Median baseline tumor volume was 735 cc (range, 369-1142). All patients completed PT and received a median of 5 HT sessions (range, 2-6). Median follow-up was 18 months (range, 9-26). The volumetric analysis showed an objective response of all tumors (median shrinkage 46%; range, 9-72). All patients experienced acute Grade 2-3 local pain. One patient presented with a late Grade 3 iliac fracture. CONCLUSION:Combining PT and HT in large inoperable sacral chordomas is feasible and causes acceptable toxicity. Volumetric analysis shows promising early results, warranting confirmation in the framework of a prospective trial. ADVANCES IN KNOWLEDGE: :This is an encouraging first report of the feasibility and early results of concomitant HT and PT in treating inoperable sacral chordoma.

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作者列表:["Gyori DJ","Bullington SM","Crawford BS","Vernon VP"]

METHODS:BACKGROUND:National guidelines recommend screening and treatment for cancer-related bone disease and continued monitoring of bone-modifying agents. It is unclear whether a standardized screening tool is utilized to identify eligible patients and ensure appropriate supportive care is implemented. The purpose of this study was to evaluate current prescribing practices and optimize management of bone-modifying agents. METHODS:A retrospective chart review was performed to identify patients who received hormone deprivation therapy or had bone metastases through Hematology/Oncology or Urology clinics from 1 November 2016 to 31 October 2017. The primary endpoints of this study were the incidence of completed baseline dual-energy X-ray absorptiometry (DEXA) scan for patients on hormone deprivation therapy and percent of patients started on a bone-modifying agent for the prevention of skeletal-related events secondary to bone metastasis. Secondary endpoints included percent of patients with dental examinations prior to initiation, adequate calcium and vitamin D supplementation, incidence of osteonecrosis of the jaw or flu-like symptoms and education, and percent of bisphosphonate doses appropriately adjusted based on renal function. RESULTS:A total of 375 patients were assessed for baseline DEXA scans and bone-modifying therapy. Of the 226 patients on hormone deprivation therapy, 111 (49%) patients were appropriately screened with a DEXA scan prior to initiation of hormone deprivation therapy. Among the 149 patients with bone metastases, only 94 (63.1%) patients were started on a bone-modifying agent. CONCLUSIONS:Opportunities have been identified to optimize management of patients with cancer-related bone disease. Implementation of standardized tools may increase the rate of appropriate screening and initiation of bone-modifying therapy when warranted.

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作者列表:["Dohzono S","Sasaoka R","Takamatsu K","Hoshino M","Nakamura H"]

METHODS:PURPOSE:Low skeletal muscle mass has been associated with poor prognosis in patients with advanced lung cancer. However, little is known about the relationship between skeletal muscle mass and overall survival in patients with bone metastases from lung cancer. The objective of the present study was to evaluate the prognostic value of low trunk muscle mass in predicting overall survival in these patients. METHODS:The data from 198 patients who were diagnosed with bone metastases from lung cancer from April 2009 to May 2017 were retrospectively reviewed. The areas of the psoas and paravertebral muscles were measured at the level of the third lumbar vertebra on computed tomography scans taken at the time nearest to the diagnosis of bone metastasis. Muscle area was evaluated for male and female cohorts separately using different cutoff points. Cox proportional hazards analysis was performed to evaluate the factors independently associated with overall survival. RESULTS:The overall survival of patients in the lowest quartile for psoas muscle area or paravertebral muscle area was significantly shorter than that of patients above the 25th percentile for muscle area (p < 0.001). Multivariate analyses showed that paravertebral muscle mass (hazard ratio, 1.73; 95% confidence interval, 1.17-2.56; p = 0.006), epidermal growth factor receptor-targeted therapy, and performance status were independent prognostic factors. CONCLUSIONS:Low paravertebral muscle mass was associated with shorter survival, independently of known prognostic factors.

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