Alexandre Rochwerger

Amplification of MDM2 is the molecular hallmark of atypical lipomatous tumor/well-differentiated liposarcoma (ALT/WDL) and dedifferentiated liposarcoma (DDL). While fluorescence in situ hybridization (FISH) is widely used for diagnosis, the diagnostic and prognostic value of droplet digital PCR (ddPCR) remains poorly defined. We retrospectively analyzed 341 primary adipocytic tumors, including 85 liposarcomas (22 DDL), using ddPCR to quantify MDM2 copy number variation (CNV). Diagnostic performance was compared with FISH, and associations with clinicopathological variables and outcomes were evaluated using non-parametric tests, ROC analysis, survival analysis, and Firth’s penalized Cox models. Comparison with FISH confirmed the diagnostic utility of ddPCR for detecting MDM2 amplification, while quantitative CNV assessment provided additional prognostic information. CNV values were significantly higher in deep-seated and dedifferentiated tumors and were strongly associated with local recurrence. ROC analysis identified a threshold of 16.85 copies predicting both dedifferentiation and recurrence (AUC 0.982 and 0.942, respectively). Patients with CNV ≥ 16.85 copies had significantly shorter recurrence-free and overall survival. In multivariable analysis, high CNV remained an independent predictor of recurrence (HR 36.6, 95% CI 4.0–4914.2). These findings support ddPCR as a robust method for MDM2 assessment and suggest that quantitative MDM2 copy number may improve both diagnosis and risk stratification in liposarcoma.

Background: Whether re-excision (RE) of a soft tissue sarcoma (STS) of limb or trunk should be systematized as adjuvant care and if it would improve metastatic free survival (MFS) are still debated. The impact of resection margins after unplanned macroscopically complete excision (UE) performed out of a NETSARC reference center or after second resection was further investigated. Methods: This large nationwide series used data from patients having experienced UE outside of a reference center from 2010 to 2019, collected in a French nationwide exhaustive prospective cohort NETSARC. Patient characteristics and survival distributions in patients reexcised (RE) or not (No-RE) are reported. Multivariate Cox proportional hazard model was conducted to adjust for classical prognosis factors. Subgroup analysis were performed to identify which patients may benefit from RE. Results: Out of 2371 patients with UE for STS performed outside NETSARC reference centers, 1692 patients were not reviewed by multidisciplinary board before treatment decision and had a second operation documented. Among them, 913 patients experienced re-excision, and 779 were not re-excised. Characteristics were significantly different regarding patient age, tumor site, size, depth, grade and histotype in patients re-excised (RE) or not (No-RE). In univariate analysis, final R0 margins are associated with a better MFS, patients with R1 margins documented at first surgery had a better MFS as compared to patients with first R0 resection. The study identified RE as an independent favorable factor for MFS (HR 0.7, 95% CI 0.53–0.93; p = 0.013). All subgroups except older patients (>70 years) and patients with large tumors (>10 cm) had superior MFS with RE. Conclusions: RE might be considered in patients with STS of limb or trunk, with UE with macroscopic complete resection performed out of a reference center, and also in originally defined R0 margin resections, to improve LRFS and MFS. Systematic RE should not be advocated for patients older than 70 years, or with tumors greater than 10 cm.

Il existe plusieurs types de malformations vasculaires en fonction du vaisseau altéré et du flux rhéologique. Les malformations veineuses (MV) sont classées dans les malformations vasculaires à flux lent. Elles ont une évolution progressive et variable selon les individus. Cette étude rétrospective, monocentrique, descriptive sur une année inclut dix patients présentant une ou plusieurs MV du pied ou de la cheville. L’objectif de l’étude était de décrire la MV du pied et d’évaluer les résultats fonctionnels et esthétiques des différents traitements réalisés en particulier de la sclérothérapie.

Soft tissue sarcoma (STS) are rare and aggressive tumours. Their classification includes numerous histological subtypes of frequent poor prognosis. Liposarcomas (LPS) are the most frequent type among them, and the aggressiveness and deep localization of dedifferentiated LPS are linked to high levels of recurrence. Current treatments available today lead to five-year overall survival has remained stuck around 60–70% for the past three decades. Here, we highlight a correlation between Aurora kinasa A (AURKA) and AURKB mRNA overexpression and a low metastasis-free survival. AURKA and AURKB expression analysis at genomic and protein level on a 9-STS cell lines panel highlighted STS heterogeneity, especially in LPS subtype. AURKA and AURKB inhibition by RNAi and drug targeting with AMG 900, a pan Aurora Kinase inhibitor, in four LPS cell lines reduces cell survival and clonogenic proliferation, inducing apoptosis and polyploidy. When combined with doxorubicin, the standard treatment in STS, aurora kinases inhibitor can be considered as an enhancer of standard treatment or as an independent drug. Kinome analysis suggested its effect was linked to the inhibition of the MAP-kinase pathway, with differential drug resistance profiles depending on molecular characteristics of the tumor. Aurora Kinase inhibition by AMG 900 could be a promising therapy in STS.