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      The clinical outcomes of total femur prosthesis in patients with musculoskeletal tumors

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          Introduction: Reconstruction using a total femur prosthesis (TFP) remains a challenging procedure in musculoskeletal tumor surgery. The purpose of this study was to show the clinical outcomes of total femur replacement (TFR) in our institute.

          Methods: Nine patients underwent reconstruction with a TFP after the wide resection of malignant bone and soft-tissue tumors of the femur between January 2003 and April 2014. The mean age of the patients at the time of TFR was 47.5 years, and the mean follow-up period was 52.9 months. The histological diagnoses were as follows: bone sarcoma ( n = 4), soft-tissue sarcoma invading the femoral bones ( n = 4), and metastatic bone tumor ( n = 1).

          Results: The oncological outcomes were as follows: three patients achieved continuous disease free, two patients were alive with disease, and four patients died from disease. The 3- and 5-year overall survival rates were 88.9% and 55.6%, respectively. The rate of the overall survival in patients with primary bone tumors (100% at 5 years) was significantly better than that in patients with primary soft tissue sarcomas (0% at 5 years) ( p = 0.015). A deep infection occurred postoperatively in one patient, but the patient was successfully treated with surgical debridement and revision surgery. There were no patients who showed dislocation or aseptic loosening. The mean Musculo-Skeletal Tumor Society functional score was 58.5% (46.7–80.0), with scores of 65.5% in patients with a primary bone tumor and 50.8% in those with a primary soft-tissue sarcoma.

          Discussion: In the present study, the patients who underwent TFR due to bone invasion by soft tissue sarcoma had a worse prognosis than the bone sarcoma patients.

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          Most cited references 16

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          The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM.

          The American Joint Committee on Cancer and the International Union for Cancer Control update the tumor-node-metastasis (TNM) cancer staging system periodically. The most recent revision is the 7th edition, effective for cancers diagnosed on or after January 1, 2010. This editorial summarizes the background of the current revision and outlines the major issues revised. Most notable are the marked increase in the use of international datasets for more highly evidenced-based changes in staging, and the enhanced use of nonanatomic prognostic factors in defining the stage grouping. The future of cancer staging lies in the use of enhanced registry data standards to support personalization of cancer care through cancer outcome prediction models and nomograms.
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            Analysis of prognostic factors in 1,041 patients with localized soft tissue sarcomas of the extremities.

            To identify specific independent adverse clinicopathologic factors for event-free survival in a cohort of consecutively treated patients with extremity soft tissue sarcomas. Prospectively collected data from a population of 1,041 adult patients with localized (American Joint Committee on Cancer [AJCC] stage IA to IIIB) extremity soft tissue sarcomas were analyzed. Patients were treated at a single institution between 1982 and 1994. Patient, tumor, and pathologic factors were analyzed by univariate and multivariate techniques to identify independent prognostic factors for the end points of local recurrence, distant recurrence, disease-specific survival, and post-metastasis survival. The 5-year survival rate for this cohort of patients was 76%, with a median follow-up time of 3.95 years. Significant independent adverse prognostic factors for local recurrence were age greater than 50 years, recurrent disease at presentation, microscopically positive surgical margins, and the histologic subtypes fibrosarcoma and malignant peripheral-nerve tumor. For distant recurrence, intermediate tumor size, high histologic grade, deep location, recurrent disease at presentation, leiomyosarcoma, and nonliposarcoma histology were independent adverse prognostic factors. For disease-specific survival, large tumor size, high grade, deep location, recurrent disease at presentation, the histologic subtypes leiomyosarcoma and malignant peripheral-nerve tumor, microscopically positive surgical margins, and lower extremity site were adverse factors. For post-metastasis survival, only large tumor size ( > 10 cm) was an adverse prognostic factor. The independent adverse prognostic factors for distant recurrence and disease specific survival differ from those identified for subsequent local recurrence. Patients with microscopically positive surgical margins or patients who present with locally recurrent disease are at increased risk for subsequent local recurrence and tumor-related mortality. Specific histopathologic subtypes are associated with increased risks for local failure and tumor-related mortality.
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              A system of staging musculoskeletal neoplasms.

               W F Enneking (1986)
              A system for staging benign and malignant musculoskeletal lesions is presented. This system, first devised at the University of Florida in 1977, was based on data assembled from 1968 through 1976. It was field tested by the Musculoskeletal Tumor Society and published in Clinical Orthopaedics and Related Research in 1980. In the ensuing five years, the system has undergone refinement. It has recently been adapted by the American Joint Committee Task Force on Bone Tumors and proposed by them to the International Union Against Cancer (IUCC) for international usage. Based upon histologic grade (G), anatomic site (T), and presence or absence of metastases (M), it describes the progressive stages, irrespective of histogenesis, that assess the progressive degrees of risk to which the patient is subject. This system articulates well with current radiologic techniques of staging and serves as a useful guide in the selection of an appropriate definitive surgical procedure. Its usage permits comparative end result studies on the effect of surgical and nonsurgical methods of management.

                Author and article information

                SICOT J
                SICOT J
                EDP Sciences
                28 June 2019
                : 5
                : ( publisher-idID: sicotj/2019/01 )
                [1 ] Department of Orthopaedic Surgery, Mie University Graduate School of Medicine 2-174 Edobashi Tsu City Mie 514-8507 Japan
                [2 ] Department of Orthopedics and Rehabilitation Medicine, Faculty of Medical Sciences, University of Fukui Matsuoka-shimoaizuki 23-3 Eiheiji Fukui 910-1193 Japan
                Author notes
                [* ]Corresponding author: matsumin@
                sicotj180129 10.1051/sicotj/2019020
                © The Authors, published by EDP Sciences, 2019

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Figures: 4, Tables: 2, Equations: 0, References: 15, Pages: 6
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