Transcript 皮下発生軟部腫瘍の診断治療の現状に

Tail-like pattern of myxofibrosarcoma
October, 15-18th, 2014 InterContinental Berlin Hotel Berlin, Germany
An Analysis of Clinicopathological Factors
Related to the Tail-like Pattern of
Myxofibrosarcoma on MRI
Kazutaka Kikuta1, 2, 3, Daisuke Kubota1,
Akihiko Yoshida3, Hideo Morioka2,
Yoshiaki Toyama2, Hirokazu Chuman1, Akira Kawai1
1, Divison of Orthopedic Surgery, National Cancer Center Hospital
2, Department of Orthopedic Surgery, Keio University School of Medicine
3, Division of Diagnostic Pathology, National Cancer Center Hospital
Musculoskeletal Oncology Service, National Cancer Center Hospital
Musculoskeletal Oncology Service, Keio University Hospital
Tail-like pattern of myxofibrosarcoma
October, 15-18th, 2014 InterContinental Berlin Hotel Berlin, Germany
Superficial location is significantly correlated
to the tail-like pattern on MRI
Tail–like pattern
Gd MRI
Superficial layer
Musculoskeletal Oncology Service, National Cancer Center Hospital
Musculoskeletal Oncology Service, Keio University Hospital
Tail-like pattern of myxofibrosarcoma
October, 15-18th, 2014 InterContinental Berlin Hotel Berlin, Germany
The 2014 CTOS Annual Meeting
Conflict of Interest (COI)
Presentator: Kazutaka Kikuta
The authors have no conflict of interest to
disclose with respect to this presentation
Musculoskeletal Oncology Service, National Cancer Center Hospital
Musculoskeletal Oncology Service, Keio University Hospital
Tail-like pattern of myxofibrosarcoma
October, 15-18th, 2014 InterContinental Berlin Hotel Berlin, Germany
Backgrounds
Musculoskeletal Oncology Service, National Cancer Center Hospital
Musculoskeletal Oncology Service, Keio University Hospital
Tail-like pattern of myxofibrosarcoma
October, 15-18th, 2014 InterContinental Berlin Hotel Berlin, Germany
Myxofibrosarcoma (MFS)
►Most often affects the extremities of
the elderly
►The number of patients will increase
due to the aging society
►High recurrence rate even after wide
resection: 50-60 %
Musculoskeletal Oncology Service, National Cancer Center Hospital
Musculoskeletal Oncology Service, Keio University Hospital
Tail-like pattern of myxofibrosarcoma
October, 15-18th, 2014 InterContinental Berlin Hotel Berlin, Germany
If It Recurs…
Amputation or death due to metastasis
Musculoskeletal Oncology Service, National Cancer Center Hospital
Musculoskeletal Oncology Service, Keio University Hospital
Tail-like pattern of myxofibrosarcoma
October, 15-18th, 2014 InterContinental Berlin Hotel Berlin, Germany
Tail-like Pattern
Tail (+)
Gd MRI
Tail (+)
What is the relationship between the tail-like
pattern and clinical factors?
Musculoskeletal Oncology Service, National Cancer Center Hospital
Musculoskeletal Oncology Service, Keio University Hospital
Tail-like pattern of myxofibrosarcoma
October, 15-18th, 2014 InterContinental Berlin Hotel Berlin, Germany
Purpose of This Study
To identify clinical factors
related to the tail-like pattern on MRI
Musculoskeletal Oncology Service, National Cancer Center Hospital
Musculoskeletal Oncology Service, Keio University Hospital
Tail-like pattern of myxofibrosarcoma
October, 15-18th, 2014 InterContinental Berlin Hotel Berlin, Germany
Materials and Methods
Musculoskeletal Oncology Service, National Cancer Center Hospital
Musculoskeletal Oncology Service, Keio University Hospital
Tail-like pattern of myxofibrosarcoma
October, 15-18th, 2014 InterContinental Berlin Hotel Berlin, Germany
Materials
50 patients (1999-2008, National Cancer Center)
►Confirmed as MFS by a certified pathologist
►MRI reviewed by a certified radiologist
Musculoskeletal Oncology Service, National Cancer Center Hospital
Musculoskeletal Oncology Service, Keio University Hospital
Tail-like pattern of myxofibrosarcoma
October, 15-18th, 2014 InterContinental Berlin Hotel Berlin, Germany
Clinical Variables
►Tail-like pattern (+) or (-)
►Age at surgery (60≦or 60>)
►Gender
►Size (5cm ≦or 5cm>)
►Site (Extremity or Trunk)
Chi-square test
P<0.01
►Location (Subcutaneous or deep)
►Histological grade (G1 or G2+G3)
►5-year recurrence free survival (5-year RFS) Log-rank test
P<0.01
►5-year disease free survival (5-year DFS)
Musculoskeletal Oncology Service, National Cancer Center Hospital
Musculoskeletal Oncology Service, Keio University Hospital
Tail-like pattern of myxofibrosarcoma
October, 15-18th, 2014 InterContinental Berlin Hotel Berlin, Germany
Different Patterns on Gd MRI
Tail-like pattern
Tail (+)
Solid pattern
Tail (-)
(Kikuta K, et al. 2014)
Musculoskeletal Oncology Service, National Cancer Center Hospital
Musculoskeletal Oncology Service, Keio University Hospital
Tail-like pattern of myxofibrosarcoma
October, 15-18th, 2014 InterContinental Berlin Hotel Berlin, Germany
Results
Musculoskeletal Oncology Service, National Cancer Center Hospital
Musculoskeletal Oncology Service, Keio University Hospital
Tail-like pattern of myxofibrosarcoma
October, 15-18th, 2014 InterContinental Berlin Hotel Berlin, Germany
Analysis of Clinical Data
Nu mbe rs
Variable s
Follow-up period: 1-154 months
(Median: 62 m, Mean: 56.4 m)
Average age: 64.1y (23 – 97y)
Recurrence: 9/ 50 patients
Oncological outcome
CDF :
31 patients
NED :
11 patients
AWD :
4 patients
DOD :
4 patients
Metastasis: 6 patients
MRI statu s
Tail- like patte rn
Solid patte rn
32
18
6 0≦
60>
38
12
Male
Fe male
32
18
Extre mity
Tru n k
35
15
Su pe rfic ial
De e p
24
26
5 c m≦
5 c m>
40
10
G1
G2 + G3
29
13
Age at su rge ry
Ge n de r
Site
Loc ation
Size
Histologic al grade
Musculoskeletal Oncology Service, National Cancer Center Hospital
Musculoskeletal Oncology Service, Keio University Hospital
Tail-like pattern of myxofibrosarcoma
October, 15-18th, 2014 InterContinental Berlin Hotel Berlin, Germany
The 5-Year RFS and DFS of All 50 Patients
5-year RFS
5-year DFS
80 %
68.9 %
(Kikuta K, et al. 2014)
Musculoskeletal Oncology Service, National Cancer Center Hospital
Musculoskeletal Oncology Service, Keio University Hospital
Tail-like pattern of myxofibrosarcoma
October, 15-18th, 2014 InterContinental Berlin Hotel Berlin, Germany
Superficial location was significantly
correlated to the tail-like pattern
Variables
Age at surgery
Solid pattern Tail - like pattern
<60
60 ≦
4
14
χ2
0.049
8
24
Gender
0.102
M
F
11
7
IIHC
Size Protein X 200x
21
11
0.008
5cm>
5cm≦
0
18
10
22
Depth
0.0009
Subcutaneous
Deep
3
15
21
11
Site
0.068
Extremity
Trunk
13
5
22
10
Grade
0.319
G1
G2+G3
7
4
22
9
Musculoskeletal Oncology Service, National Cancer Center Hospital
Musculoskeletal Oncology Service, Keio University Hospital
Tail-like pattern of myxofibrosarcoma
October, 15-18th, 2014 InterContinental Berlin Hotel Berlin, Germany
MFS with the tail-like pattern
Poorer prognosis
5-year RFS
5-year DFS
(Kikuta K, et al. 2014)
Musculoskeletal Oncology Service, National Cancer Center Hospital
Musculoskeletal Oncology Service, Keio University Hospital
Tail-like pattern of myxofibrosarcoma
October, 15-18th, 2014 InterContinental Berlin Hotel Berlin, Germany
Discussion
Musculoskeletal Oncology Service, National Cancer Center Hospital
Musculoskeletal Oncology Service, Keio University Hospital
Tail-like pattern of myxofibrosarcoma
October, 15-18th, 2014 InterContinental Berlin Hotel Berlin, Germany
Tail-like pattern is most obvious on Gd MRI
Tail (+)
Gd MRI
Tail (+)
(Kaya M, et al. 2008)
No research regarding the relationship
between the tail-like pattern and clinical factors
Musculoskeletal Oncology Service, National Cancer Center Hospital
Musculoskeletal Oncology Service, Keio University Hospital
Tail-like pattern of myxofibrosarcoma
October, 15-18th, 2014 InterContinental Berlin Hotel Berlin, Germany
Tail-like Pattern
poor prognosis?
(Manoso MW, et al. 2006)
Tail-like pattern
High invasive activity
High local recurrence rate
Musculoskeletal Oncology Service, National Cancer Center Hospital
Musculoskeletal Oncology Service, Keio University Hospital
Tail-like pattern of myxofibrosarcoma
October, 15-18th, 2014 InterContinental Berlin Hotel Berlin, Germany
Tail-like pattern is more prevalent
in the superficial layer
Superficial
Deep
Tail-like
pattern
Solid
pattern
(Mentzel T, et al. 1996)
Musculoskeletal Oncology Service, National Cancer Center Hospital
Musculoskeletal Oncology Service, Keio University Hospital
Tail-like pattern of myxofibrosarcoma
October, 15-18th, 2014 InterContinental Berlin Hotel Berlin, Germany
The tumor with a Tail-like Pattern lead to
Poorer Prognosis
5-year RFS
5-year DFS
(Kikuta K, et al. 2014)
Musculoskeletal Oncology Service, National Cancer Center Hospital
Musculoskeletal Oncology Service, Keio University Hospital
Tail-like pattern of myxofibrosarcoma
October, 15-18th, 2014 InterContinental Berlin Hotel Berlin, Germany
Conclusions
Musculoskeletal Oncology Service, National Cancer Center Hospital
Musculoskeletal Oncology Service, Keio University Hospital
Tail-like pattern of myxofibrosarcoma
October, 15-18th, 2014 InterContinental Berlin Hotel Berlin, Germany
Conclusions
►This study identified the significant relationship
between the tail-like pattern and
superficial location.
►MFS with the tail-like pattern had worse prognosis.
►Further studies are warranted to elucidate the
biological nature of the tail-like pattern of MFS.
Musculoskeletal Oncology Service, National Cancer Center Hospital
Musculoskeletal Oncology Service, Keio University Hospital
Tail-like pattern of myxofibrosarcoma
October, 15-18th, 2014 InterContinental Berlin Hotel Berlin, Germany
Danke
für deine Aufmerksamkeit!!
Musculoskeletal Oncology Service, National Cancer Center Hospital
Musculoskeletal Oncology Service, Keio University Hospital