Risk factors for 30-day soft tissue complications after pelvic sarcoma surgery:A National Surgical Quality Improvement Program study

Introduction: Soft tissue (ST) complications after resection of bone and ST sarcomas of the pelvis occur more frequently than in appendicular tumors. We sought to identify risk factors for complications within 30 days of surgery. Methods: The National Surgical Quality Improvement Program database was used for this study. Patients with sarcomas of bone and ST of the pelvis were retrieved using Current Procedural Terminology and International Classification of Diseases codes. Outcomes assessed were ST complications, overall complication rates, 30-day reoperation, and mortality. Results: A total of 770 patients with pelvic bone and ST sarcoma were included. The ST complication rate was 12.6%, including 4.9% superficial and 4.7% deep surgical site infections. Higher ST complication rates were seen in patients &gt;30 years, with partially dependent health status, hematocrit &lt;30%, bone tumors, tumor &gt;5 cm, amputation procedures, and longer operative times. ST complication rates were 1.5 and 3 times higher in pelvic sarcoma surgeries than in the lower and upper extremities, respectively. Age &gt;30 years (odds ratio [OR] = 5.07), hematocrit &lt;30% (OR = 1.84), operative time 1–3 h (OR = 2.97), and &gt;3 h (OR = 4.89) were risk factors for ST complications. Conclusion: One in nine patients with pelvic sarcoma surgery will develop ST complications within 30 days. Risk factors for ST complications were age &gt;30, hematocrit &lt;30%, and longer operative time.</p

Metastatic appendicular soft tissue sarcoma:treatment and survival outcomes of 2,553 patients from the SEER database

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.</p

Metastatic appendicular soft tissue sarcoma:treatment and survival outcomes of 2,553 patients from the SEER database

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.</p

Metastatic appendicular soft tissue sarcoma:treatment and survival outcomes of 2,553 patients from the SEER database

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.</p

Metastatic appendicular soft tissue sarcoma:treatment and survival outcomes of 2,553 patients from the SEER database

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.</p

The Discrepancy between Patient and Clinician Reported Function in Extremity Bone Metastases

Background:. The Musculoskeletal Tumor Society (MSTS) scoring system measures function and is commonly used but criticized because it was developed to be completed by the clinician and not by the patient. We therefore evaluated if there is a difference between patient and clinician reported function using the MSTS score. Methods. 128 patients with bone metastasis of the lower (n = 100) and upper (n = 28) extremity completed the MSTS score. The MSTS score consists of six domains, scored on a 0 to 5 scale and transformed into an overall score ranging from 0 to 100% with a higher score indicating better function. The MSTS score was also derived from clinicians' reports in the medical record. Results. The median age was 63 years (interquartile range [IQR]: 55–71) and the study included 74 (58%) women. We found that the clinicians' MSTS score (median: 65, IQR: 49–83) overestimated the function as compared to the patient perceived score (median: 57, IQR: 40–70) by 8 points (p < 0.001). Conclusion. Clinician reports overestimate function as compared to the patient perceived score. This is important for acknowledging when informing patients about the expected outcome of treatment and for understanding patients' perceptions

Metastatic appendicular soft tissue sarcoma:treatment and survival outcomes of 2,553 patients from the SEER database

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.</p

Metastatic appendicular soft tissue sarcoma:treatment and survival outcomes of 2,553 patients from the SEER database

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.</p

Lower Extremity Megaprostheses in Orthopaedic Oncology

The megaprosthesis is designed to reproduce the form and function of a removed or lost large segment of bone and accompanying soft tissues. Slow but substantial improvements in the design and surgical implementation of these devices have advanced the capacity to restore patients' functional abilities. The essential challenges include identifying the ideal materials, bonding these materials to bone and soft tissues, reproducing functional anatomy, and adapting to the growing skeleton. Failure of these devices can result from soft-tissue insufficiency, aseptic loosening, structural failures, infection, and tumor recurrence. The history of the use of megaprostheses in the pelvis, proximal femur, distal femur, total femur, and proximal tibia has shown that each anatomic area presents unique challenges. Improvements that have been made over the years will guide the development of the next generation of devices. Despite early high complication rates, these devices are a reasonable choice in the right patient

Giant cell-rich osteosarcoma:A match pair analysis of 11 new cases and literature review of 56 patients

Background: Limited remains known on giant cell-rich osteosarcoma (GCRO) with current studies being case reports or smaller series. This investigation compared GCRO and conventional osteoblastic osteosarcoma (OOS) with regard to demographics and survival. Methods: An institutional tumor registry was used to identify 11 patients (six males) treated for GCRO. Mean age was 43 years. Staging showed American Joint Committee on Cancer (AJCC) stages IIA in four and IIB in seven patients. Mean follow-up was 14 years. Study initiatives were: (1) Comparison of demographics between GCRO and 167 OOS from our institutional registry, (2) Differences in survival between GCRO and 33 OOS case controls (based on sex and AJCC stage), as well as 10 OOS using an age-based propensity match, and (3) Summary of all GCRO cases reported in the literature. Results: (1) Sex (p = 0.53), grading (p = 0.56), AJCC stage (p = 0.42), and chemotherapeutic response rate (p = 0.67) did not differ between groups. Age was significantly increased in GCRO (p = 0.001). (2) Case–control and propensity-matched groups revealed no difference in disease-free survival, local recurrence, and distant disease-free survival at 2 years (p &gt; 0.05). (3) Mean age of 56 patients (50% males) reported in the literature was 26 years. After merging with our 11 cases, the 2-year disease-free survival was 66%. Conclusions: GCRO remains a rare disease with high short-term mortality. Although affecting older patients more than conventional osteosarcoma, GCRO should not be viewed as a predictor of survival compared to OOS.</p