Characterization, survival analysis, and expression of IGFR in tumor samples from patients diagnosed with Ewing family tumors treated at the Barretos Cancer Hospital☆

Ferreira, Adriano Jander; Boldrini, Erica; López, Rossana Verónica Mendoza; Scapulatempo, Cristovam; Santos, Julie Francine Cerutti; Lopes, Luiz Fernando

doi:10.1016/j.rboe.2016.10.015

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ORIGINAL ARTICLE • Rev. bras. ortop. 52 (06) • Nov-Dec 2017 • https://doi.org/10.1016/j.rboe.2016.10.015 copy

Characterization, survival analysis, and expression of IGFR in tumor samples from patients diagnosed with Ewing family tumors treated at the Barretos Cancer Hospital^☆ ☆ Study conducted at Hospital de Câncer de Barretos, Barretos, SP, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVES:

Study the clinical characteristics of patients diagnosed with Ewing family tumors (EFTs) and survival analysis based on risk criteria and expression of the surface protein known as insulin-like growth factor (IGFR).

METHODS:

This was a retrospective cohort study based on clinical data from 77 patients diagnosed with EFTs treated by the Department of Pediatric Oncology at the Barretos Cancer Hospital in a period between 2003 and 2012. Biological samples of patients were examined for the presence of the surface receptor IGFR.

RESULTS:

The overall survival rate (OSR) of patients included in the study was 45% at five years, and EFS was 30% at five years. Metastasis at diagnosis was present in 44.2% of the sample; 88.2% of the sample was male (p < 0.001). The evaluation of the expression of IGFR in biological samples of patients was associated with the variable metastasis at diagnosis (p < 0.001). Worse prognosis was observed in patients with extrapulmonary metastasis (p = 0.009). The local treatment of neoplasia presented better prognosis in patients undergoing local surgical treatment (p < 0.001).

CONCLUSIONS:

These results showed a higher incidence of metastasis at diagnosis in patients with EFTs treated at the Barretos Cancer Hospital (BCH). Extrapulmonary metastases were a negative prognostic factor in this study. Surgical treatment of the primary tumor was a factor for better prognosis. Strong expression of IGFR was more frequent in patients with metastases at diagnosis, but did not represent a prognostic factor for EFTs.

Keywords:
Sarcoma; Ewing; Neuroectodermal tumors; Primitive; Peripheral; Insulin-like growth factor I; Survival analysis; Bone neoplasms; Oncology

Variable	n	(%)
Age
≤15 years	35	45.5
>15 years	42	54.5

Gender
Male	49	(63.6)
Female	28	(36.4)

Race
White	64	(83.1)
Black	2	(2.6)
Brown	10	(13.0)
Yellow	1	(1.3)

Location of the primary tumor
Skeletal	45	(58.4)
Axial	32	(71.1)
Extremity	13	(28.8)
Soft tissue	32	(41.6)
Axial	8	(25.0)
Extremity	24	(75.5)

Disease at diagnosis
Localized	43	(55.8)
Metastatic	34	(44.2)

Metastasis site
Lung	18	(52.9)
Bone	3	(8.8)
Lung + bone	8	(23.6)
Central nervous system	3	(8.8)
Other locations	2	(5.8)

Treatment protocol
Euro Ewing	10	(13)
Brazilian	46	(59.7)
South American	21	(27.3)

Local control
Surgery	18	(22.6%)
Radiotherapy	30	(39.4%)
Surgery + radiotherapy	15	(19.7%)
Without local control	14	(18.3%)

Serum LDH level ^a
<600 mg/dl	43	(61.4)
≥600 mg/dl	27	(38.6)

Expression of IGFR ^b
Weak positive	33	(48.5)
Strong positive	35	(51.5)

Variable	Overall survival			Cumulative event-free survival
	2-years	5-years	p Value	2-years	5-years	p Value
Overall survival	61%	45%		59%	30%
Age group			0.202			0.417
≤15 years	72%	51%		69%	30%
>15 years	47%	40%		48%	32%

Gender			0.555			0.587
Male	62%	37%		67%	30%
Female	58%	58%		50%	32%

Location			0.457			0.243
Skeletal	58%	35%		59%	18%
Soft tissue	64%	53%		60%	40%

Location			0.256			0.502
Axial	59%	32%		59%	18%
Extremity	63%	58%		60%	40%

Metastasis site			0.293			0.009
Without metastasis	69%	53%		63%	48%
Lung	88%	45%		75%	33%
Extrapulmonary	47%	40%		41%	10%

Local treatment			<0.001			0.008
No treatment	20%	20%		20%	20%
Radiotherapy	63%	53%		58%	44%
Surgery	75%	64%		58%	48%
Surgery + radiotherapy	67%	33%		85%	0%

Treatment protocol			0.840			0.647
Euro Ewing	78%	44%		67%	33%
Brazilian	57%	47%		58%	30%

Serum LDH level			0.710			0.747
<600 mg/dl	66%	46%		64%	15%
≥600 mg/dl	55%	46%		61%	34%

Expression of IGFR			0.502			0.628
Weak positive	70%	43%		60%	15%
Strong positive	65%	42%		61%	34%

Variable	Overall survival			Event-free survival
	2-years	5-years	p Value	2-years	5-years	p Value
Metastasis			0.164			0.015
Lung	88%	45%		75%	33%
Extrapulmonary	47%	40%		41%	10%

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

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[1] * Corresponding author. E-mails: adrianojander@hotmail.com, dr.adrianojander@hotmail.com (A.J. Ferreira).

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Characterization, survival analysis, and expression of IGFR in tumor samples from patients diagnosed with Ewing family tumors treated at the Barretos Cancer Hospital☆ ☆ Study conducted at Hospital de Câncer de Barretos, Barretos, SP, Brazil.

ABSTRACT

OBJECTIVES:

METHODS:

RESULTS:

CONCLUSIONS:

Characterization, survival analysis, and expression of IGFR in tumor samples from patients diagnosed with Ewing family tumors treated at the Barretos Cancer Hospital^☆ ☆ Study conducted at Hospital de Câncer de Barretos, Barretos, SP, Brazil.