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Chondrosarcoma of the Proximal Humerus: Does the Margin Affect Survival?

SIMPLE SUMMARY: The aim of this study was to investigate factors that affect the local and systemic prognoses for conventional, central CSs (those that arise from within the medulla of the bone) of the proximal humerus. Our results show that proximal humeral grade 1 CSs behave as a more benign tumou...

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Autores principales: Kask, Gilber, Laitinen, Minna K., Parry, Michael C., Albergo, Jose I., Stevenson, Jonathan D., Farfalli, German, Aponte-Tinao, Luis, Grimer, Robert, Sumathi, Vaiyapuri, Jeys, Lee M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10137324/
https://www.ncbi.nlm.nih.gov/pubmed/37190265
http://dx.doi.org/10.3390/cancers15082337
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author Kask, Gilber
Laitinen, Minna K.
Parry, Michael C.
Albergo, Jose I.
Stevenson, Jonathan D.
Farfalli, German
Aponte-Tinao, Luis
Grimer, Robert
Sumathi, Vaiyapuri
Jeys, Lee M.
author_facet Kask, Gilber
Laitinen, Minna K.
Parry, Michael C.
Albergo, Jose I.
Stevenson, Jonathan D.
Farfalli, German
Aponte-Tinao, Luis
Grimer, Robert
Sumathi, Vaiyapuri
Jeys, Lee M.
author_sort Kask, Gilber
collection PubMed
description SIMPLE SUMMARY: The aim of this study was to investigate factors that affect the local and systemic prognoses for conventional, central CSs (those that arise from within the medulla of the bone) of the proximal humerus. Our results show that proximal humeral grade 1 CSs behave as a more benign tumour, having no cases of LR nor death due to disease. Grade 2 CSs of the proximal humerus act as a low-grade tumour, being locally aggressive with higher rates of LR than grade 1 CSs but still having a low incidence of mortality and high rates of DSS. The LR does not affect the DSS; therefore, the surgical management in proximal humeral grade 2 CSs should have a greater focus on function but still aim for a margin free resection. ABSTRACT: Chondrosarcoma (CS) is the second most common primary malignant bone tumour and, in the absence of reliable chemotherapy and radiotherapy, is effectively a surgical disease. Overall disease specific survival (DSS) is affected by tumour grade, whilst resection margin contributes to local recurrence free survival (LRFS). The aim of this study was to investigate factors that affect the local and systemic prognoses for conventional central CSs arising from the proximal humerus. A multi-centre, retrospective study from three international collaborative sarcoma centres identified 110 patients between 1995 and 2020 undergoing treatment for a conventional central CS of the proximal humerus; 58 patients (53%) had a grade 1 tumour, 36 (33%) had a grade 2 tumour, and 16 patients (13%) had a grade 3 CS. The mean age of patients was 50 years (range 10–85). The incidence of local recurrence (LR) was 9/110 (8.2%), and the disease specific mortality was 6/110 (5.5%). The grade was a statistically significant factor for LRFS (p < 0.001). None of the grade 1 tumours developed LR. The DSS was affected by the grade (p < 0.001) but not by the LR (p = 0.4). Only one patient with a grade 2 tumour died from the disease. The proximal humeral grade 1 CS behaved as a benign tumour, having no cases of LR nor death due to disease. Grade 2 CSs of the proximal humerus behaved in a more indolent way when compared with comparable grade tumours elsewhere in the appendicular skeleton, being locally aggressive with a higher LR rate than grade 1 CSs but still having very low mortality and a high rate of DSS. The LR in grade 2 CSs did not affect the DSS; therefore, surgical management in proximal humeral grade 2 CSs should have a greater emphasis on preserving function whilst maintaining an adequate margin for resection. The proximal humeral grade 3 CS was, as elsewhere in the skeleton, an aggressive, high-grade tumour. Therefore, surgical management should include en bloc resection with clear margins to avoid LR.
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spelling pubmed-101373242023-04-28 Chondrosarcoma of the Proximal Humerus: Does the Margin Affect Survival? Kask, Gilber Laitinen, Minna K. Parry, Michael C. Albergo, Jose I. Stevenson, Jonathan D. Farfalli, German Aponte-Tinao, Luis Grimer, Robert Sumathi, Vaiyapuri Jeys, Lee M. Cancers (Basel) Article SIMPLE SUMMARY: The aim of this study was to investigate factors that affect the local and systemic prognoses for conventional, central CSs (those that arise from within the medulla of the bone) of the proximal humerus. Our results show that proximal humeral grade 1 CSs behave as a more benign tumour, having no cases of LR nor death due to disease. Grade 2 CSs of the proximal humerus act as a low-grade tumour, being locally aggressive with higher rates of LR than grade 1 CSs but still having a low incidence of mortality and high rates of DSS. The LR does not affect the DSS; therefore, the surgical management in proximal humeral grade 2 CSs should have a greater focus on function but still aim for a margin free resection. ABSTRACT: Chondrosarcoma (CS) is the second most common primary malignant bone tumour and, in the absence of reliable chemotherapy and radiotherapy, is effectively a surgical disease. Overall disease specific survival (DSS) is affected by tumour grade, whilst resection margin contributes to local recurrence free survival (LRFS). The aim of this study was to investigate factors that affect the local and systemic prognoses for conventional central CSs arising from the proximal humerus. A multi-centre, retrospective study from three international collaborative sarcoma centres identified 110 patients between 1995 and 2020 undergoing treatment for a conventional central CS of the proximal humerus; 58 patients (53%) had a grade 1 tumour, 36 (33%) had a grade 2 tumour, and 16 patients (13%) had a grade 3 CS. The mean age of patients was 50 years (range 10–85). The incidence of local recurrence (LR) was 9/110 (8.2%), and the disease specific mortality was 6/110 (5.5%). The grade was a statistically significant factor for LRFS (p < 0.001). None of the grade 1 tumours developed LR. The DSS was affected by the grade (p < 0.001) but not by the LR (p = 0.4). Only one patient with a grade 2 tumour died from the disease. The proximal humeral grade 1 CS behaved as a benign tumour, having no cases of LR nor death due to disease. Grade 2 CSs of the proximal humerus behaved in a more indolent way when compared with comparable grade tumours elsewhere in the appendicular skeleton, being locally aggressive with a higher LR rate than grade 1 CSs but still having very low mortality and a high rate of DSS. The LR in grade 2 CSs did not affect the DSS; therefore, surgical management in proximal humeral grade 2 CSs should have a greater emphasis on preserving function whilst maintaining an adequate margin for resection. The proximal humeral grade 3 CS was, as elsewhere in the skeleton, an aggressive, high-grade tumour. Therefore, surgical management should include en bloc resection with clear margins to avoid LR. MDPI 2023-04-17 /pmc/articles/PMC10137324/ /pubmed/37190265 http://dx.doi.org/10.3390/cancers15082337 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Kask, Gilber
Laitinen, Minna K.
Parry, Michael C.
Albergo, Jose I.
Stevenson, Jonathan D.
Farfalli, German
Aponte-Tinao, Luis
Grimer, Robert
Sumathi, Vaiyapuri
Jeys, Lee M.
Chondrosarcoma of the Proximal Humerus: Does the Margin Affect Survival?
title Chondrosarcoma of the Proximal Humerus: Does the Margin Affect Survival?
title_full Chondrosarcoma of the Proximal Humerus: Does the Margin Affect Survival?
title_fullStr Chondrosarcoma of the Proximal Humerus: Does the Margin Affect Survival?
title_full_unstemmed Chondrosarcoma of the Proximal Humerus: Does the Margin Affect Survival?
title_short Chondrosarcoma of the Proximal Humerus: Does the Margin Affect Survival?
title_sort chondrosarcoma of the proximal humerus: does the margin affect survival?
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10137324/
https://www.ncbi.nlm.nih.gov/pubmed/37190265
http://dx.doi.org/10.3390/cancers15082337
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