OBJECTIVE To emphasize the importance of reconstruction and repair after resection of soft tissue sarcoma. METHODS From November 1990 to November 1996, in 107 cases of soft tissue sarcoma 32 cases had received various reconstructive or reparative operations. Among the 32 cases, 4 cases were primary sarcomas and 28 cases were recurrent sarcomas. In surgical grading, 3 cases were of I B, 3 cases of II A and 26 cases of II B. Radical resection was performed in 13 cases, widen local resection in 17 cases and local excision in 2 cases. After operation, 13 cases received chemotherapy and 7 cases received radiotherapy. Reconstruction of blood vessels was performed in 3 cases, reconstruction of kinetic function in 16 cases, and repair of defect was carried out in 23 cases. RESULTS Thirty patients were followed up for 4 months to 6 years and 6 months. The clinical results showed that the local control rate of sarcoma was 80%, limb-salvage rate after reconstruction of blood vessels was 100%, the excellent and good rate after reconstruction of kinetic function was 87.5%, and the survival rate of the tissue flap of transplantation and transposition was 96%. CONCLUSION It was concluded that the reconstruction and repair after resection of soft tissue sarcoma was the extension of operative treatment, and was very important in lowering the recurrence rate and improving the life quality of the sufferings.
Objective To assess effectiveness of chemotherapy versus non-chemotherapy in the treatment of soft tissue sarcoma. Methods We searched MEDLINE (1966 to Dec. 2008), EMBASE (1984 to Dec. 2008), OVID (1980 to Dec. 2008), CBMdisc (1980 to Dec. 2008), and the Cochrane Central Register of Controlled Trials. We also handsearched Journal of Chinese Oncology, Journal of Chinese Clinical Oncology, and Tumor (from inception to Dec. 2008). The quality of the included studies was evaluated by two reviewers independently and meta-analysis was performed for results of the homogenous studies. Results Six studies involving 836 participants related to primary, high grade, nonmetastatic soft tissue sarcoma were included. All included studies were unclear in reporting randomization and blinding; all studies reported the number and the reason of withdraw; and baseline conditions of all studies were compared. The results of meta-analyses showed that there were no significant differences in 5-year overal survival (RR=0.90, 95%CI0.76 to 1.06), local recurrence (OR=0.69, 95%CI 0.36 to 1.32), distant recurrence (OR=0.83, 95%CI 0.62 to 1.11), and overall recurrence (RR=0.91, 95%CI 0.78 to 1.06) between the chemotherapy group and the control group. But as to 5-year disease-free survival, the chemotherapy group was better than the control group (RR=0.73, 95%CI 0.63 to 0.86). Conclusion There is no advantage for the chemotherapy group over the control group in 5-year overal survival, local recurrence, distant recurrence and overall recurrence. Due to the risk of selection bias, performance bias and published bias, the evidence is not b enough to judge whether chemotherapy is better than control in treating soft tissue sarcoma. Our conclusion suggests that larger-scale randomized trials should be performed in future.
As the most common primary malignant bone tumor in children and adolescents, osteosarcoma has the characteristics of high malignancy, easy metastasis and poor prognosis. The recurrence, metastasis and multi-drug resistance of osteosarcoma are the main problems that limit the therapeutic effect and survival rate of osteosarcoma. Among them, lung metastasis is often the main target organ for distant metastasis of osteosarcoma. In recent years, people have paid attention to the signaling pathway of the occurrence and development of osteosarcoma and made in-depth studies on its mechanism. A variety of relevant signaling pathways have been constantly clarified. At present, there is still a lack of systematic and multi-directional exploration and summary on the signaling pathway related to the pulmonary metastasis of osteosarcoma. This paper explores the new direction of targeted therapy for osteosarcoma by elucidating the relationship between the signaling pathway associated with osteosarcoma and the pulmonary metastasis of osteosarcoma.
目的 總結小細胞性骨肉瘤的臨床特征及診治情況。 方法 回顧性分析1995年12月－2012年6月收治的12例小細胞性骨肉瘤患者的臨床資料。結合文獻分析該病的診治特點。 結果 全組患者手術11例，化學治療（化療）8例，術后輔助放射治療（放療）2例。隨訪截止時，全組患者總生存4～55個月。文獻回顧方面，通過檢索策略獲得探討相關治療方案的文獻8篇，涉及小細胞性骨肉瘤患者79例。治療方式以手術+輔助化療為主。 結論 小細胞性骨肉瘤發病率低，預后較普通骨肉瘤更差。手術為主要治療方式，新輔助化療及輔助化療可能使患者進一步受益，放療的治療效果目前還不明確。
Objective To investigate the effect of ursolic acid on the proliferation and apoptosis of human osteosarcoma cell line U2-OS and analyze its mechanism. Methods Human osteosarcoma cell line U2-OS was divided into 4 groups, which was cultured with ursolic acid of 0, 10, 20, and 40 μmol/L, respectively. At 0, 24, 48, and 72 hours after being cultured, the cell proliferation ability was detected by cell counting kit 8 (CCK-8). At 48 hours, the effects of ursolic acid on cell cycle and apoptosis of U2-OS cells were measured by flow cytometry. Besides, the expressions of cyclin D1 and Caspase-3 were detected by real-time fluorescent quantitative PCR and Western blot. Results CCK-8 tests showed that the absorbance (A) value of each group was not significant at 0 and 24 hours (P>0.05); but the differences between groups were significant at 48 and 72 hours (P<0.05). Flow cytometry results showed that, with the ursolic acid concentration increasing, the G1 phase of U2-OS cells increased, the S phase and G2/M phase decreased, and cell apoptosis rate increased gradually. There were significant differences between groups (P<0.05). Compared with the 0 μmol/L group, the relative expressions of cyclin D1 mRNA and protein in 10, 20, and 40 μmol/L groups significantly decreased (P<0.05); whereas, there was no significant difference in relative expression of Caspase-3 mRNA between groups (P>0.05). However, with the ursolic acid concentration increasing, the relative expressions of pro-Caspase-3 protein decreased and the relative expressions of activated Caspase-3 increased; there were significant differences between groups (P<0.05). Conclusion Ursolic acid can effectively inhibit the proliferation of osteosarcoma cell line U2-OS, induce the down-regulation of cyclin D1 expression leading to G0/G1 phase arrest, increase the activation of Caspase-3 and promote cell apoptosis.
ObjectiveTo systematically review the predictive value of ezrin expression in bone and soft tissue sarcomas.MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 2, 2016), CNKI, CBM, VIP, and WanFang Data were searched to collect cohort studies about the prognostic value of ezrin expression in bone and soft tissue sarcomas from inception to May 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed by using RevMan 5.3 software.ResultsFinally, a total of 17 cohort studies, involving 1 460 patients were included. The results of meta-analysis showed that: the overall survival (HR=1.90, 95%CI 1.70 to 2.13, P<0.000 01), event-free survival (HR=2.42, 95%CI 1.53 to 3.84, P=0.0002), metastasis-free survival (HR=2.09, 95%CI 1.10 to 3.97, P=0.02) in the bone and soft tissue sarcomas patients with ezrin high expression were lower than patients with lower expression. The same results were also observed in subgroup analysis according to histologica type and ethnicity in overall survival.ConclusionEzrin high expression may be used as a predictive maker for poor prognosis in bone and soft tissue sarcomas. For the quantity and quality limitation of the included studies, this conclusion still needs to be further proved by performing more high quality studies.
Objective To investigate the application and clinical efficacy of orthotopic autologous renal transplantation combined with inferior vena cava (IVC) resection and reconstruction in retroperitoneal tumor. Methods The clinical data of a patient with complex retroperitoneal tumor was analyzed retrospectively. Abdominal CT examination showed that the tumor originated from IVC and invaded the retrohepatic IVC and bilateral renal vein trunks. Intraoperative ultrasound exploration revealed mechanized thrombosis in the IVC and bilateral renal vein trunks. After blocking the left renal vein, no significant hemodynamic changes were seen before and after intraoperative ultrasound exploration and contrast-enhanced ultrasound. Results After complete removal of the left renal vein and suture of the severed end, the right renal vein was successfully reconstructed with an orthotopic autologous right kidney graft combined with IVC resection after removal of the mechanized thrombus. The patient recovered well after surgery, and a repeat CT showed that the reconstructed artificial IVC was patent, and the color Doppler ultrasonography of both kidneys showed good perfusion and no obstruction of return. The patient was given oral rivaroxaban anticoagulant therapy after operation, and discharged at 19 days after operation. The postoperative pathological findings suggested inferior vena cava smooth muscle sarcoma. Conclusion Orthotopic autologous renal transplantation combined with IVC resection and reconstruction for complex retroperitoneal tumor is safe and feasible, and the left renal vein can be ligated and dissected intraoperatively, but a comprehensive evaluation with intraoperative ultrasound (imaging) is required.
ObjectiveTo investigate the feasibility and effectiveness of proximal tibial hemiprosthesis replacement in the first stage and prosthesis revision in the second stage in reducing the risk of length discrepancy of limbs in children with proximal tibial osteosarcoma.MethodsBetween 2009 and 2013, 3 children with conventional osteosarcoma at the proximal tibia (stage ⅡB) were treated. There were 2 boys and 1 girl. They were 12, 13, and 13 years old, respectively. After 4 courses of preoperative chemotherapy, the proximal tumor segmental resection and proximal tibial hemiprosthesis replacement were performed. Then the patients underwent prosthetic revision in the second stage when they were 20, 17, and 17 years old, respectively.ResultsAll patients successfully completed two stages of operations. The length discrepancy of lower limb after the second stage operation were 19, 7, and 21 mm, respectively. Three patients were followed up 13, 3, and 27 months after the second stage operation, and the lower extremities functions were satisfactory. The Musculoskeletal Tumor Society (MSTS) score was 26, 27, and 25, respectively.ConclusionThe proximal tibial hemiprosthesis replacement in the first stage combined with prosthesis revision in the second stage for treating the proximal tibia osteosarcoma in children can keep the distal femur growth ability, reduce the length discreapancy of lower limb, and obtain satisfactory stability and good function.