Background Neoadjuvant radiotherapy (RT) is increasingly advocated in the management of soft tissue sarcoma (STS). Therefore, we sought to characterize the impact of neoadjuvant RT on rates of R0 resection and overall survival (OS) in extremity STS patients undergoing surgery. Methods From January 2003 to December 2012, we identified patients with a diagnosis of extremity STS from the National Cancer Database. After excluding patients with age < 18 years, not undergoing surgery, metastases at diagnosis, intraoperative RT, and missing/unknown data, we identified 27,969 patients. Using logistic regression and Cox-proportional hazard analysis, we compared rates of R0 resection among preoperative, postoperative and no RT cohorts and determined predictors of R0 resection and OS. Results The mean age was 59.5 (±17.1) years, and 45.9% were female. Median tumor size was 10.5cm. 51% of patients did not receive RT, 11.8% received pre-operative RT and 37.2% received post-operative RT. Rates of R0 resection for preoperative RT, postoperative RT, and no RT cohorts were 90.1%, 74.9%, and 79.9%, respectively (P<0.001). Independent predictors of achieving R0 resection included academic facility type (OR 1.36, 95% CI 1.20-1.55), histologic subtype, tumor size (OR 0.99, 95% CI 0.99-0.99), Charlson score (OR 0.92, 95% CI 0.84 – 0.99), and preoperative RT (OR 1.83, 95% CI 1.61-2.07). R0 resection as well as RT (pre-operative or post-operative) was associated with increased OS. Conclusions Pre-operative RT independently predicts higher rates of R0 resection in patients with extremity STS undergoing surgical resection. Negative surgical margins and pre-operative or post-operative RT are associated with improved OS.

BackgroundMalignant bowel obstruction (MBO) is often a terminal event in end-stage cancer patients. The decision to intervene surgically is complex, given the risk of harm in patients with a limited lifespan. Therefore, we sought to compare clinically meaningful outcomes in MBO patients treated with surgical versus medical management using population-based data.MethodsWe performed a retrospective analysis of hospitalized patients with MBO from 2006 to 2010 using the California Office of Statewide Health Planning and Development dataset. Hospital-free days (HFDs) at 30-, 90-, and 180-days were calculated accounting for all hospitalization, emergency department visit, and skilled nursing facility lengths of stay. Adjusted regression models were used to compare HFDs, disposition, complications, in-hospital death, and survival for surgical versus medical MBO cohorts, using inverse probability of treatment weighting with propensity scores.ResultsOf 4576 MBO patients, 3421 (74.8%) were treated medically and 1155 (25.2%) were treated surgically. Surgical patients had higher rates of complications (44.0% vs. 21.3%, p < 0.0001) and in-hospital death (9.5% vs. 3.9%, p < 0.0001) with lower rates of disposition to home (76.3% vs. 89.8%, p < 0.0001). Surgical patients had fewer 30- and 90-day HFDs compared to medical patients (p < 0.01). However, at 180-days, there were no differences in HFDs between treatment groups. There was no difference in overall survival between surgical and medical patients (median 6.5 vs. 6.4 months).ConclusionIn this population-based analysis, medical management was associated with less hospital utilization at 30- and 90-days, fewer in-hospital deaths, and more frequent discharges to home. These data underscore the potential benefits of medical management for MBO patients at the end-of-life.Electronic supplementary materialThe online version of this article (10.1186/s12885-018-5108-9) contains supplementary material, which is available to authorized users.

While high-volume hospitals have fewer adverse outcomes, there is no relationship between surgical volume and costs, which suggests that, in itself, surgical volume is not an indicator of improved healthcare efficiency reflected by lower costs. Patient referral to high-volume centers may not reduce overall healthcare expenditures for pancreatic operations.

We have previously reported radiation-induced sensitization of canine osteosarcoma (OSA) to natural killer (NK) therapy, including results from a first-in-dog clinical trial. Here, we report correlative analyses of blood and tissue specimens for signals of immune activation in trial subjects. Among 10 dogs treated with palliative radiotherapy (RT) and intra-tumoral adoptive NK transfer, we performed ELISA on serum cytokines, flow cytometry for immune phenotype of PBMCs, and PCR on tumor tissue for immune-related gene expression. We then queried The Cancer Genome Atlas (TCGA) to evaluate the association of cytotoxic/ immune-related gene expression with human sarcoma survival. Updated survival analysis revealed five 6-month survivors, including one dog who lived 17.9 months. Using feeder line co-culture for NK expansion, we observed maximal activation of dog NK cells on day 17-19 post isolation with near 100% expression of granzyme B and NKp46 and high cytotoxic function in the injected NK product. Among dogs on trial, we observed a trend for higher baseline serum IL-6 to predict worse lung metastasis-free and overall survival (P = 0.08). PCR analysis revealed low absolute gene expression of CD3, CD8, and NKG2D in untreated OSA. Among treated dogs, there was marked heterogeneity in the expression of immune-related genes pre-and post-treatment, but increases in CD3 and CD8 gene expression were higher among dogs that lived > 6 months compared to those who did not. Analysis of the TCGA

Introduction The modified frailty index (mFI) is an important method to risk-stratify surgical patients and has been validated for general surgery and selected surgical subspecialties. However, there are currently no data assessing the efficacy of the mFI to predict acute morbidity and mortality in patients undergoing surgery for retroperitoneal sarcoma (RPS). Methods Using the American College of Surgeons’ National Surgical Quality Improvement Program from 2007 to 2012, we performed a retrospective analysis of patients with a diagnosis of primary malignant retroperitoneal neoplasm who underwent surgical resection. The mFI was calculated according to standard published methods. Univariate and multivariate statistical analyses including χ2 and logistic regression were utilized to identify predictors of 30-day overall morbidity, 30-day severe morbidity (Clavien III/IV), and 30-day mortality. Results We identified 846 patients with the diagnosis of primary malignant retroperitoneal neoplasm who underwent surgical resection. The distribution mFI scores was 0 (48.5%) or 1 (36.3%), with only 4.5% of patients presenting with a score ≥3. Rates of 30-day overall morbidity, serious morbidity, and mortality were 22.6%, 12.9%, and 1.2%, respectively. Only selected mFI scores were associated with serious morbidity and overall morbidity on multivariate analysis (p<0.05), and mFI did not predict 30-day mortality (p>0.05). Conclusion Our data demonstrate that the majority of patients undergoing RPS resections have few, if any, comorbidities. The mFI was a limited predictor of overall and serious complications and was not a significant predictor of mortality. Better discriminators of preoperative risk stratification may be needed for this patient population.