Treatment Of Sarcoma Research Articles

DKI and 1H-MRS in angiogenesis evaluation of soft tissue sarcomas: a prospective clinical study based on MRI-pathology control method

BackgroundThe vascular endothelial growth factor (VEGF) and microvessel density (MVD) have been widely employed as angiogenesis indicators in the diagnosis and treatment of soft tissue sarcomas. While diffusion kurtosis imaging (DKI) and proton magnetic resonance spectroscopy (1H-MRS) imaging hold potential in assessing angiogenesis in other tumors, their reliability in correlating with angiogenesis in soft tissue sarcomas remains uncertain, contingent upon accurately acquiring the region of interest (ROI).Methods23 patients with soft tissue sarcomas (STSs) confirmed by pathology were selected, underwent DKI and 1H-MRS at 3.0T MRI. The DKI parameters mean diffusivity (MD), mean kurtosis (MK), kurtosis anisotropy (KA), and 1H-MRS parameters choline (Cho), lipid/lactate (LL) were measured by two radiologists. Two pathologists obtained pathological slices using a new sampling method called MRI-pathology control and evaluated VEGF and MVD in the selected regions. Correlations between MRI parameters and angiogenesis markers were assessed by Person or Spearman tests.ResultsThe DKI parameters MD and KA, and the 1H-MRS parameters Cho and LL, have varying degrees of correlation with the expression levels of VEGF and MVD. Among them, Cho exhibits the strongest correlation (r = 0.875, P < 0.001; r = 0.807, P < 0.001).ConclusionBased on this preliminary clinical studies, DKI and 1H-MRS parameters are correlated with angiogenesis markers obtained through the “MRI-pathology control” method.

Cost Utility of Various Biologic Versus Endoprosthetic Reconstruction for Primary Bone Sarcoma of the Knee

Background: Currently, the treatment of primary bone sarcoma has been developed to increase survival rate and enable patients to undergo limp sparing surgery. The cost-utility study of reconstructive surgery methods could also benefit developing treatment plans as well as national policies. Materials and Methods: The present research was conducted among 27 patients with primary bone sarcoma of the knee undergoing limp sparing surgery by analyzing the cost-utility of various biologic versus endoprosthesis reconstruction. The result reported in the quality-adjusted-life years (QALY), cost per year of well-being (Cost/QALY), ratio of additional sanitary years (QALY gain), and creating alternatives to adjust costs to an acceptable range with one-way sensitivity analysis. Results: The QALY of endoprosthesis was the highest at 5.316 years, while the lowest number was recycled bone autograft at 3.712 years. Compared with the Cost/QALY, the recycled bone autograft indicated the most breakeven method, while endoprosthesis showed the lowest. For analyzing by QALY gain, the additional investment totaled 171,314.27 THB. Conclusion: Prosthesis as a good option, have side effects and the highest number of QALY but did not breakeven. However, reducing the cost by 27.004% was almost the same as the most breakeven method. For this method, an additional investment, equivalent to the minimum wage in Thai law averaging within 1 year, was not needed because this extra investment cost only about the minimum Thai civil servant salary for 1 year. Keywords: Primary bone sarcoma of the knee; Bone reconstruction around the knee; Cost-utility analysis; Various biologic versus endoprosthesis reconstruction

Sarcoma: Last Year's Practice Changing Papers.

In 2023 and 2024, a wide variety of new studies have been published in the field of soft tissue sarcomas, representing the enormous heterogeneity of sarcoma histotypes, anatomical location, treatment variability, and biological behavior. This article summarizes the, in our view, seven most important publications in the field that will have an impact on the surgical practice and future treatment strategies of our patients. In the last year, we gained more insight in the genetic background of patients with sarcoma from a large Australian study, which will have an impact on future counseling and screening of our patients. Also, the role of radiotherapy in retroperitoneal liposarcoma became clearer in the combined STRASS-STREXIT study. Radiotherapy for extremity sarcomas can now also be done in a 3-week, hypofractioned manner, which is a major improvement for our patients. Furthermore, more evidence has been presented regarding the improved outcome of patients with retroperitoneal sarcoma when treated in high volume centers. Landmark studies with systemic treatment include the positive trial with nirogacestat in desmoid tumors, which have finally shifted the paradigm of desmoid treatment from surgery to systemic treatment. Also, the results of 2 phase 3 randomized controlled trials recently showed 1) that the combination of doxorubicin with trabectedin significantly improved progression free survival for patients with leiomyosarcoma when compared with doxorubicin alone and 2) that the combination of neoadjuvant pembrolizumab and radiotherapy followed by 1-yr adjuvant pembrolizumab significantly improved disease free survival for patients with primary localized undifferentiated pleomorphic sarcoma/myxofibrosarcoma or dedifferentiated/pleomorphic liposarcoma of the extremities or girdles. Key papers from the last year informs us that management of soft tissues sarcoma is constantly improving, since more data became available to guide us in defining the best treatment strategies.

The role of perioperative treatment in radiation-associated soft tissue sarcomas

The role of perioperative treatment in radiation-associated soft tissue sarcomas

Retrospective analysis of the clinical outcomes of paraspinal soft-tissue sarcoma

Background ContextDue to the rarity and heterogeneity, paraspinal soft-tissue sarcomas represent a unique and challenging clinical entity for musculoskeletal oncologist. Reports on the treatment of paraspinal soft-tissue sarcoma are limited and the best treatment modality for this rare sarcoma type has not yet been well defined. PurposeTo introduce a modified classification of paraspinal sarcoma, review the outcome of patients treating in our center and determine the effective treatment for paraspinal soft-tissue sarcoma. Study Design/SettingRetrospective review of prospectively collected data. Patient SampleThe study included patients with paraspinal soft-tissue sarcomas in our center. Outcome MeasuresClinical outcomes, complications and survival. MethodsTwenty-five patients with paraspinal soft-tissue sarcomas treating at our center from April 2017 to December 2023 were retrieved from the hospital database. The treatment of these patients included surgery, chemotherapy, radiation, targeted therapy and immunological therapy according to respective tumor type. Patient demographics, tumor characteristics, treatment history, clinical outcomes and survival were collected from electronical medical records. ResultsAccording to the modified classification of paraspinal sarcoma, Type 1 tumors were diagnosed in 15 cases, Type 2 in 4, Type 3 in 5 and Type 4 in 1. All the patients received surgery. No patients in the study received intralesional resection, wide or marginal margins were achieved. Eleven patients received post-operative radiotherapy. The median follow-up duration in this study was 27 months (range 8-67 months). Three patients suffered from wound infection post-operatively and were successfully treated by debridement and antibiotics. Three patients had muscular weakness after surgery and gained improved muscular strength with rehabilitation. There was no implant failure complication. Three recurrence cases were recorded. Four patients died of brain or lung metastasis. Five patients survived with the disease and the remaining 16 patients were alive with disease free. ConclusionsCorrect pathological diagnosis before treatment is vital, and the modified classification can guide the surgical strategy for paraspinal soft-tissue sarcoma. Paraspinal soft-tissue sarcoma is best treated by comprehensive treatment approach with surgery as the main method, which can yield good outcomes.

Selective Synergy of Recombinant Methioninase Plus Docetaxel Against Docetaxel-resistant and -sensitive Fibrosarcoma Cells Compared to Normal Fibroblasts.

Docetaxel combined with gemcitabine is a second-line treatment for soft-tissue sarcoma; however, its effectiveness is limited because of docetaxel resistance. The objective of the present study was to determine the potential of recombinant methioninase (rMETase) to enhance the efficacy of docetaxel on high-docetaxel-resistant human fibrosarcoma cells in vitro. Docetaxel-resistant HT1080 (DTR-HT1080) human fibrosarcoma cells were established by culturing them in by progressively increasing concentrations of docetaxel from 0.02 to 9 nM in vitro. The IC50 values for docetaxel and rMETase, as well as the efficacy of their combination, in inhibiting HT1080 human fibrosarcoma cells, DTR-HT1080 cells, and Hs27 normal human fibroblasts were determined. Four experimental groups were examined in vitro: control group without treatment; docetaxel alone; rMETase alone; docetaxel combined with rMETase. The IC50 of docetaxel for DTR-HT1080 cells was 7.57 nM, compared to the parental HT1080 cells with an IC50 of 1.68 nM, a 4.5-fold increase. The IC50 of docetaxel on Hs27 fibroblasts was 4.46 nM. The IC50 of rMETase on HT1080 cells was 0.75 U/ml (data from [6]). The IC50 of rMETase on DTR-HT1080 cells was 0.55 U/ml. The IC50 of rMETase on Hs27 fibroblasts was 0.93 U/ml (data from [6]). Docetaxel (1.68 nM [IC50]) plus rMETase (0.75 U/ml [IC50]) synergistically reduced the viability of HT1080 cells (p<0.05). In contrast, docetaxel (4.46 nM) plus rMETase (0.93 U/ml) did not reduce the viability of Hs27 fibroblasts, compared to either agent alone. The combination of rMETase (0.55 U/ml [IC50]) and docetaxel (1.68 nM [IC50 of the parental cells]) overcame docetaxel resistance of DTR-HT1080 cells, resulting in an inhibition of 48.1% compared to docetaxel alone (6.8%) or rMETase alone (37.5%) (p<0.05). rMETase thus increased the efficacy of docetaxel 7-fold on docetaxel-resistant human fibrosarcoma cells. The combination of docetaxel and rMETase was synergistic on HT1080 fibrosarcoma cells, but not normal fibroblasts. rMETase plus docetaxel synergistically reduced the high docetaxel resistance of DTR-HT1080 cells. The present results indicate the clinical potential of rMETase to reduce docetaxel resistance in soft-tissue sarcoma patients in the future.

Current Status of Intraoperative Radiotherapy use for Sarcoma Treatment in Spain: Results from a National Survey

Current Status of Intraoperative Radiotherapy use for Sarcoma Treatment in Spain: Results from a National Survey

The Role of Adenosine in Overcoming Resistance in Sarcomas.

Resistance to systemic therapies in sarcomas poses a significant challenge to improving clinical outcomes. Recent research has concentrated on the tumor microenvironment's role in sarcoma progression and treatment resistance. This microenvironment comprises a variety of cell types and signaling molecules that influence tumor behavior, including proliferation, metastasis, and resistance to therapy. Adenosine, abundant in the tumor microenvironment, has been implicated in promoting immunosuppression and chemoresistance. Targeting adenosine receptors and associated pathways offers a novel approach to enhancing immune responses against tumors, potentially improving immunotherapy outcomes in cancers, including sarcomas. Manipulating adenosine signaling also shows promise in overcoming chemotherapy resistance in these tumors. Clinical trials investigating adenosine receptor antagonists in sarcomas have fueled interest in this pathway for sarcoma treatment. Ultimately, a comprehensive understanding of the tumor and vascular microenvironments, as well as the adenosine pathway, may open new avenues for improving treatment outcomes and overcoming resistance in sarcoma. Further studies and clinical trials are crucial to validate these findings and optimize therapeutic strategies, particularly for osteosarcoma. This study provides a literature review exploring the potential role of the adenosine pathway in sarcomas.

External Hemipelvectomy in Soft Tissue Sarcomas: Are They Still Needed?

The development of new technologies, the interpretation of amputations as therapeutic failures by society, and the high morbidity and mortality associated with external hemipelvectomies make these mutilating surgical procedures appear obsolete. Herein, we review the scientific literature on the topic and present two cases of high-grade ulcerated soft tissue sarcomas in the gluteal region which show exceptional behavior and different outcomes. We performed a literature review of the PubMed databases from 2014 to April 2024. Additionally, we present two cases of soft tissue sarcomas in an 18-year-old female patient and in a 71-year-old female patient, which were treated with extended external hemipelvectomies with anterior flap, in combination with an abdominoperineal amputation and a colostomy in one case. After 4 years of follow-up, case 1 is living a relatively normal life. She had an uncomplicated pregnancy and a cesarean section delivery. Case 2 underwent emergency surgery for intestinal perforation and sepsis. She died 2.5 months following the surgery. External hemipelvectomy for soft tissue sarcoma treatment is a demanding surgical procedure with purpose in selected cases after review by multidisciplinary committees and with informed patient consent. This should be similarly individualized and extended to other pathologies when possible.

Dysregulation of miRNAs in Soft Tissue Sarcomas.

MicroRNAs (miRNAs) are pivotal regulators of gene expression, influencing key cellular processes such as proliferation, differentiation, apoptosis, and metastasis. In the realm of sarcomas-a diverse group of malignant tumors affecting soft tissues and bone sarcomas-miRNAs have emerged as crucial players in tumorigenesis and tumor progression. This review delves into the intricate roles of miRNAs across various soft tissue sarcoma subtypes, including rhabdomyosarcoma, liposarcoma, leiomyosarcoma, synovial sarcoma, fibrosarcoma, angiosarcoma, undifferentiated pleomorphic sarcoma (UPS), and malignant peripheral nerve sheath tumor (MPNST). We explore how dysregulated miRNAs function as oncogenes or tumor suppressors, modulating critical pathways that define the aggressive nature of these cancers. Furthermore, we discuss the diagnostic and prognostic potential of specific miRNAs and highlight their promise as therapeutic targets. By understanding the miRNA-mediated regulatory networks, this review aims to provide a comprehensive overview of current research while pointing towards future directions for miRNA-based therapies. Our findings underscore the potential of miRNAs to transform the landscape of sarcoma treatment, offering hope for more precise, personalized, and effective therapeutic strategies.

A forgotten chapter in the history of immunotherapy: cancer therapy with Blastomyces extracts.

This article recapitulates the discoveries and anti-tumoural therapeutical proposals by Francesco Sanfelice, who in 1931 published an essay entitled The Treatment of Cancer and Sarcoma with Cancrocidin (paraneoforming Blastomycetes). Sanfelice's discoveries are contextualised with subsequent scientific discoveries, especially with those by L. Scott McDaniel and G. Cozad, who evaluated the functionality of murine peritoneal macrophages previously sensitised precisely with Blastomyces dermatitidis antigen extracts. Finally, recent research on the topic of intratumoural microbiota is mentioned showing how Sanfelice's ideas, albeit partly outdated, can still inspire current biomolecular research.

Curative-intent surgery for solitary bone metastasis from extremity and trunk wall sarcoma: What are the outcomes and complications?

IntroductionApproximately 40–50 % of sarcoma patients will develop lung metastasis, but only 10 % will develop bone metastasis. The survival benefit of surgery for solitary bone metastasis remains unclear. MethodsFrom 1987 to 2019, 47 patients who underwent curative-intent treatment for localized bone or soft tissue sarcoma in the extremities or trunk wall developed solitary bone metastases as the first distant recurrence. Of them, 51 % (24/47) received curative-intent metastasectomy. We compared the clinicopathologic characteristics of the metastasectomy versus non-metastasectomy patients and evaluated the prognostic impact of solitary bone metastasectomy. The primary outcome measure was disease-specific survival (DSS) after developing solitary bone metastasis. ResultsThe post-metastasis DSS was worse with larger primary tumour size (HR 1.09; 95 % CI 1.02–1.16; p = 0.01) and bone metastasis in the pelvis or spine versus other bones (HR 3.79, 95 % CI 1.46–9.87; p = 0.01), and better with curative-intent surgery for the solitary bone metastasis (HR 0.14; 95 % CI 0.06–0.34; p < 0.001). The median DSS was 43 (95 % CI, 24–69) months for the metastasectomy group vs. 13 (95 % CI, 7–19) months for the non-metastasectomy group (p < 0.001). The metastasectomy group had fewer patients with metastasis in the spine or pelvis and longer metastasis-free interval. In the multivariate analysis, curative-intent surgery for solitary bone metastasis was associated with better survival (HR 0.21; 95 % CI 0.08–0.53; p = 0.001). ConclusionsCurative-intent surgery for solitary bone metastasis from sarcoma is associated with a better prognosis and is a reasonable treatment strategy whenever feasible.

Comparative analysis of fetal dose sparing between a C-arm linac and an O-ring linac in a SIB-VMAT sarcoma treatment for a pregnant patient: A technical note and case report.

To compare the effect of two linacs designs on fetal dose sparing on a pregnant patient, including estimation of the fetal dose, and the effect of a lead apron. A patient with a high-grade sarcoma located in the right knee/lower thigh was prescribed 51Gy (1.7Gy/Fx) with a simultaneous-integrated-boost (SIB) of 60Gy to a smaller volume, starting in the 26thgestational week. Volumetric modulated radiation therapy (VMAT) plans with 6MV-FFF were developed using identical dosimetric constraints on a Varian Truebeam Edge with HD-MLC and a Varian Halcyon with double-stacked MLC. Based on patient dimension measurements, an anthropomorphic phantom was constructed using a Rando phantom and saline bags in the patient's Vac-Lok bag. Phantom measurements were performed using OSLDs and TLDs placed at three different planes, corresponding to the pubis, the umbilicus, and the fundus based on patient measurements and projected gestational age, to estimate the fetal dose. Three experimental scenarios were measured, each with CBCT-based image guidance for an accurate, reproducible setup: Edge, Halcyon, and Halcyon with a tri-folded lead apron (0.5mm×3=1.5mmPb) over the phantom abdomen. Plan quality and total MUs are comparable between the Edge and Halcyon plans. The OSLD-measured whole-course dose to the pubis, umbilicus, and fundus were 18.8, 13.1, and 11.7 cGy, respectively, on Halcyon, on average 27.8% lower than Edge. The repeatability within either dosimeter was good, although TLD showed systematically lower doses. Importantly, both dosimetry systems showed a lower measured fetal dose for the Halcyon plan compared with the Edge plan. Adding a tri-folded lead apron over the abdomen did not meaningfully lower the measured dose. In this case study, Halcyon demonstrated a better sparing of out-of-field fetal dose compared to TrueBeam Edge. It was shown that lead aprons do not provide additional fetal dose sparing.

SARCP, a Clinical Next-Generation Sequencing Assay for the Detection of Gene Fusions in Sarcomas: A Description of the First 652 Cases

An amplicon-based targeted next generation sequencing (NGS) assay for the detection of gene fusions in sarcomas was developed, validated, and implemented. This assay can detect fusions in targeted regions of 138 genes and BCOR internal tandem duplications. This study reviews our experience with testing on the first 652 patients analyzed. Gene fusions were detected in 238 of 652 (36.5%) of cases, including 83 distinct fusions in the 238 fusion positive cases, 10 of which had not been previously described. Among the 238 fusion positive cases, the results assisted in establishing a diagnosis for 137 (58%) cases, confirmed a suspected diagnosis in 66 (28%) cases, changed a suspected diagnosis in 25 (10%) cases and were novel fusions with unknown clinical significance in 10 (4%) cases. Twenty-six cases had gene fusions (ALK, ROS1, NTRK1, NTRK3, and COL1A1::PDGFB) for which there are targetable therapies. BCOR ITDs were identified in 6 of 485 (1.2%) patients. Among the 138 genes in the panel, 66 were involved in one or more fusions and 72 were not involved in any fusions. There was little overlap between the genes involved as 5’-partners (31 different genes) and 3’-partners (37 different genes). This study demonstrates the clinical utility of a next generation sequencing gene fusion detection assay for the diagnosis and treatment of sarcomas.

One-Stage Surgical Resection and Functional Reconstruction for Upper Limb Soft Tissue Sarcoma.

Currently, the gold standard of treatment for extremity soft tissue sarcoma (STS) is limb-sparing surgery. When the upper extremity is involved, the functional outcome is frequently poor. A 1-step resection and functional reconstruction would be advisable to obtain a fast recovery. Our study aims at retrospectively analyzing our case series of immediate nerves and tendons reconstructions of the upper limb after STS resection, while combining a review of the literature. A retrospective review was conducted on a consecutive series of patients who underwent an immediate functional reconstruction after STS resection of the upper limb between 2015 and 2022 among the IRCCS Foundation "Istituto Nazionale dei Tumori." The Disabilities of the Arm, Shoulder and Hand (DASH) score was considered the primary outcome. The obtained DASH scores were compared through groups that underwent different reconstructive procedures. The literature review was conducted according to the PRISMA (Preferred Reporting Items for Systematic review and Meta-Analysis) criteria among 3 databases (PubMed, EMBASE, and Cochrane) using the search parameters "(((upper extremity) OR (upper limb)) AND (functional reconstruction) AND (soft tissue sarcoma)." Between 2015 and 2022, 52 patients required a functional reconstruction. The mean follow-up time was 49.63 months. The DASH score analysis reported a mean value of 44.1 ± 26.7. A statistically significant difference was found between groups who underwent different reconstruction techniques, whereas no difference was found regarding exposure to neoadjuvant radiation therapy. The literature review reported few articles focusing on immediate functional reconstruction after STS resection, and only 6 articles were included in the review. Our review aimed at reporting our case series of immediate functional reconstructions after STS of the upper extremity, which is currently the most substantial one reported in literature to set an effective baseline for further studies in the field.

Histology-Tailored Approach to Soft Tissue Sarcoma.

Soft tissue sarcomas are a diverse and heterogeneous group of cancers of mesenchymal origin. Each histological type of soft tissue sarcoma has unique clinical particularities, which makes them challenging to diagnose and treat. Multidisciplinary management of these rare diseases is thus key for improved survival. The role of surgery has been well established, and it represents the cornerstone curative treatment for soft tissue sarcomas. To date, local recurrence is the leading cause of death in low-grade sarcomas located at critical sites, and distant metastasis in high-grade sarcomas, regardless of the site of origin. Management must be tailored to each individual histologic type. We describe the most common types of extremity, trunk, abdominal, and retroperitoneal soft tissue sarcoma along with characteristics to consider for optimized management.

Response to Central Boost Radiation Therapy in Unresectable Retroperitoneal Sarcoma: A Case Series

Optimal treatment of retroperitoneal sarcoma (RPS) remains undefined. Here, we report the feasibility of using high-dose boost radiation (3 to 4 Gy) to the central part of the tumor in patients with unresectable RPS. Five patients with unresectable RPS were treated with radiation therapy using a central boost technique with intensity modulated radiation therapy (IMRT). On average, doses of 25 Gy – 45 Gy were delivered to the outer part of the tumor (PTV1), while the central part of the tumor (PTV2) received 56 Gy – 75 Gy physical dose, which translates to 62.67 Gy – 87.5 Gy equivalent dose in 2 Gy fractions (EQD2). To minimize radiation toxicity to the adjacent bowel and other organs, we used sequential, interdigitated, or simultaneous integrated boost (SIB) techniques. In this case series of variable RPS histology, the median survival post radiation therapy was 30 months. Three of the five patients had clinically stable local disease on follow up scans and none of the patients experienced clinically significant toxicity. In summary, in this small case series of 5 patients, treatment was tolerated well, and excellent local responses were observed regardless of the timing of central boost. Given the high rates of metastatic disease that developed in responding patients, effective systemic therapy will likely be needed for unresectable RPS treated with aggressive radiation therapy to the central part of the tumor.

The impact and correlation of lymphadenectomy with outcomes in patients with uterine sarcoma: A systematic review

Background: Sarcomas are an uncommon type of smooth muscle tumors in the uterus. The most popular form of treatment for uterine sarcomas is surgery. There is disagreement, nonetheless, over the best course of action for initial surgery. The aim of this systematic review was to examine the potential association between patient outcomes and the effects of LAD in individuals diagnosed with uterine sarcoma. Method: We conducted a comprehensive search of the PubMed database to identify publications assessing the impact of LAD on patients with uterine sarcoma that were published between 2009 and 2024. Based on the references in the studies that we included, we also conducted a search of the PubMed database. To find more relevant studies, the bibliographies of each pertinent paper were thoroughly reviewed. This review only includes studies that were published in English. Results: We included 7 papers in this systematic review, totaling 7896 patients. Four publications examined ESS, four studies examined LMS, two articles examined adenosarcoma, one study examined carcinosarcoma, and one study examined rhabdomyosarcoma. For individuals with low-grade ESS or adenosarcoma, LAD was not linked to a better prognosis. The survival rate was lower for patients with leiomyosarcoma who had LAD. Those who had LAD and had high-grade undifferentiated ESS fared better. LAD did not significantly correlate with RFS or OS in uterine sarcoma patients. Conclusion: Resection of lymph nodes or LAD has minimal potential benefit in terms of prognosis and clinical value.

B7-H3 is widely expressed in soft tissue sarcomas

PurposeTargeted therapy development in soft tissue sarcoma (STS) has been burdened by the heterogeneity of this group of rare tumors. B7 homolog 3 protein (B7-H3) is a molecule in the same family as programmed death-ligand 1 (PD-L1). It has limited expression in noncancerous tissues and is overexpressed in many cancers, making it an attractive target for cancer therapy, and clinical trials targeting B7-H3 are actively underway. While available data demonstrate high expression levels of B7-H3 in individual sarcoma subtypes, its expression patterns across STS subtypes are not well described. The purpose of this study was to characterize the expression patterns of B7-H3 in STS.Patients and methodsThis retrospective analysis evaluated STS tumor specimens from patients with a variety of different subtypes. Specimens were evaluated by immunohistochemistry (IHC) for expression and staining pattern of B7-H3 both in tumors and in associated vasculature.ResultsSpecimens from 153 sarcoma patients included 15 different STS subtypes. B7-H3 was broadly expressed in 97% of samples (95% CI 0.93–0.99) and 69.2% demonstrated high levels of B7-H3 expression (95% CI 0.61–0.76). No significant association between B7-H3 positivity or expression level and prior treatment(s), tumor size, tumor grade, or patient age. B7-H3 positivity in vessels was found in 94.7% (145/153) of samples. In tumors that had been previously assessed for PD-L1 and PD-1, there was no correlation between B7-H3 positivity or expression and the positivity or expression level of PD-L1 or PD-1.ConclusionThese data show high levels of B7-H3 positivity across soft tissue sarcoma subtypes, suggesting its feasibility as a therapeutic target for future sarcoma treatments. Future clinical trials are needed to evaluate whether targeting B7-H3 can provide clinical benefit to help patients with sarcoma.

From Data Integration to Precision Medicine: A Value-Based Healthcare Approach for Sarcoma Care.

The transformation of healthcare from a fee-for-service model to value-based care is particularly crucial in managing complex and rare diseases like sarcoma, where data fragmentation and variability present significant challenges. This manuscript reviews strategies for structured and harmonized data integration-a critical precursor to precision medicine in sarcoma care. We demonstrate how standardizing data formats, ontologies, and coding systems enable seamless integration of clinical, economic, and patient-reported outcomes across institutions, paving the way for comprehensive predictive analytics. By establishing robust value-based healthcare (VBHC) frameworks through digital transformation and predictive models, including digital twins, we create the foundation for personalized sarcoma treatment and real-world-time clinical decision-making. The manuscript also addresses practical challenges, including the need for system standardization, overcoming regulatory and privacy concerns, and managing high costs. We propose actionable strategies to overcome these barriers and discuss the role of advanced analytics and future research directions that further enhance VBHC and precision medicine. This work outlines the necessary steps to build a cohesive, data-driven approach that supports the transition to precision medicine, fundamentally improving outcomes for sarcoma patients.