PLOS ONE / Oncological and surgical outcome after treatment of pelvic sarcomas

Background and objectives Treatment of pelvic tumors remains challenging due to complex anatomy, poor oncological outcome and high complication rates. We sought to investigate the long-term oncological and surgical outcome of these patients. Methods Between 1980 and 2012, 147 patients underwent surgical treatment for pelvic sarcoma. Histological diagnosis was Chondrosarcoma in 54, Ewings Sarcoma/PNET in 37, Osterosarcoma in 32 and others in 24 patients. Statistical analysis for the evaluation of oncological and surgical outcome was performed by applying Cox proportional hazards regression and Fine-Gray regression models for competing risk (CR) endpoints. Results The estimated overall survival (OS) to death was 80%, 45% and 37% at 1, 5 and 10 years, respectively. Univariate analyses revealed a statistically significant unadjusted influence of age age (p = 0.038; HR = 1.01), margin (p = 0.043; HR = 0.51) and grade (p = 0.001; HR = 2.27) on OS. Considering the multivariable model, grade (p = 0.005; HR = 3.04) and tumor volume (p = 0.014; HR = 1.18) presented themselves as independent prognostic factors on OS. CR analysis showed a cumulative incidence for major complication of 31% at 5 years. Endoprosthetic reconstruction had a higher risk for experiencing a major complication (p<0.0001) and infection (p = 0.001). Conclusions Pelvic resections are still associated with a high incidence of complications. Patients with pelvic reconstruction and high volume tumors are especially at risk. Consequently, a cautious decision-making process is necessary when indicating pelvic reconstruction, although a restrictive approach to pelvic reconstruction is not necessarily reasonable when the other option is major amputation.(VLID)486947

Data from: Oncological and surgical outcome after treatment of pelvic sarcomas

Background and Objectives. Treatment of pelvic tumors remains challenging due to complex anatomy, poor oncological outcome and high complication rates. We sought to investigate the long-term oncological and surgical outcome of these patients. Methods. Between 1980 and 2012, 147 patients underwent surgical treatment for pelvic sarcoma. Histological diagnosis was Chondrosarcoma in 54, Ewing's Sarcoma/PNET in 37, Osterosarcoma in 32 and others in 24 patients. Statistical analysis for the evaluation of oncological and surgical outcome was performed by applying Cox proportional hazards regression and Fine-Gray regression models for competing risk (CR) endpoints. Results. The estimated overall survival (OS) to death was 80%, 45% and 37% at 1, 5 and 10 years, respectively. Univariate analyses revealed a statistically significant unadjusted influence of age age (p=0.038; HR=1.01), margin (p=0.043; HR=0.51) and grade (p=0.001; HR=2.27) on OS. Considering the multivariable model, grade (p=0.005; HR=3.04) and tumor volume (p=0.014; HR=1.18) presented themselves as independent prognostic factors on OS. CR analysis showed a cumulative incidence for major complication of 31% at 5 years. Endoprosthetic reconstruction had a higher risk for experiencing a major complication (p<0.0001) and infection (p=0.001). Conclusions. Pelvic resections are still associated with a high incidence of complications. Patients with pelvic reconstruction and high volume tumors are especially at risk. Consequently, a cautious decision-making process is necessary when indicating pelvic reconstruction, although a restrictive approach to pelvic reconstruction is not necessarily reasonable when the other option is major amputation

Baseline characteristics and operative data.

<p>Baseline characteristics and operative data.</p

Cumulative incidence of first major complication, infection and neurovascular complication was assessed by CR analysis.

<p>Cumulative incidence of first major complication, infection and neurovascular complication was assessed by CR analysis.</p

Cumulative incidence of first major complication for patients with and without endoprosthetic reconstruction was assessed by CR analysis (p<0.0001; HR = 4.93).

<p>Cumulative incidence of first major complication for patients with and without endoprosthetic reconstruction was assessed by CR analysis (p<0.0001; HR = 4.93).</p

Univariate and multivariable Cox regression models for overall survival to death.

<p>Univariate and multivariable Cox regression models for overall survival to death.</p

Overall survival of all patients as assessed by KM analysis.

<p>Overall survival of all patients as assessed by KM analysis.</p

Cumulative incidence of infection for patients with and without endoprosthetic reconstruction was assessed by CR analysis (p = 0.0017; HR = 4.11).

<p>Cumulative incidence of infection for patients with and without endoprosthetic reconstruction was assessed by CR analysis (p = 0.0017; HR = 4.11).</p

Overall survival of patients with grade 2 and grade 3 as assessed by KM analysis (p = 0.005; HR = 3.04).

<p>Overall survival of patients with grade 2 and grade 3 as assessed by KM analysis (p = 0.005; HR = 3.04).</p

C-reactive protein : an independent predictor for dedifferentiated chondrosarcoma

Dedifferentiated chondrosarcoma is a rare primary bone malignancy with a very poor prognosis. The aim of the study was to identify pretreatment serum markers as prognostic factors for the overall survival (OS) of patients with dedifferentiated chondrosarcoma. We retrospectively reviewed 33 patients with histologically confirmed dedifferentiated chondrosarcoma treated at our department from 1977 to 2015. KaplanMeier estimation, uni and multivariable Cox proportional hazard model were performed to evaluate the association between serum markers such as the Creactive protein and OS. In univariable analysis, CRP was strongly associated with OS (HR 1.35; 95%CI 1.131.61; p=0.001). This association prevailed after adjustment for AJCC tumor stage (HR 1.31; 95%CI 1.021.57; p=0.031) in multivariable analysis. In conclusion, our data gave evidence that baseline CRP is an independent predictor for OS in patients with dedifferentiated chondrosarcoma. CRP could be exploited for the clinical prediction of this disease in the future. © 2018 The Authors. Journal of Orthopaedic Research® Published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 36:27972801, 2018.(VLID)339634