Adult inguinoscrotal sarcomas: outcome analysis of 21 cases, systematic review of the literature and meta-analysis.

PURPOSE: Inguinoscrotal sarcomas are exceedingly rare tumors. The aim of this study was to enable clinicians an easy and rapid access to the available information on this tumor entity. METHODS: An updated series of 21 men treated for sarcoma of the inguinoscrotal region at our institution between 1992 and 2012 was analyzed, and a systematic review of the literature with meta-analysis of outcome data was performed. The review was focused on demographic data, survival rates, prognostic factors, sites of relapse and complete remissions or successful treatments for metastatic disease. RESULTS: With only 38 %, the proportion of high-grade tumors in our sample was lower than reported in the literature and the 10-year relapse-free, disease-specific and overall survival rates were favorable with 77, 93 and 81 %. Beside our series, twelve studies including 345 patients were identified in the literature. The weighed mean 10-year relapse-free, disease-specific and overall survival rates were 63, 64 and 50 %. Only in patients with rhabdomyosarcoma, durable control of metastatic disease has been reported in more than one case (n = 4). Successful treatment in these cases consisted of a combination of complete surgical resection of metastatic lesions, subsequent chemotherapy and (optional) radiotherapy. CONCLUSIONS: Overall, about two-thirds of inguinoscrotal sarcomas may be cured. In series with a predominance of low-grade tumors, the long-term survival rates in completely excised inguinoscrotal sarcomas may be as favorable as in testicular germ cell tumors. Life-long surveillance is advisable to detect late recurrences.

Polyclonal antibodies against kallikrein-related peptidase 4 (KLK4): immunohistochemical assessment of KLK4 expression in healthy tissues and prostate cancer.

KLK4 is a member of the human kallikrein-related peptidase family of (chymo)trypsin-like serine proteases. The aim of the present study was to generate polyclonal antibodies (pAb) directed against KLK4 for the analysis of KLK4 by immunohistochemistry in human tissues. Recombinantly expressed human mature KLK4 was used for immunization of chickens. pAb 617A is an affinity-purified monospecific pAb fraction reacting with a linear epitope within a flexible surface-exposed loop of KLK4. pAb 617C is the KLK-directed pAb fraction completely depleted from pAb 617A. In healthy adult tissues, KLK4 was immunodetected by both antibody fractions in kidney, liver, and prostate, but not in other organs such as colon and lung. To evaluate protein expression of KLK4 in prostate cancer, samples of tumor tissue plus corresponding tumor-free areas of 44 prostate cancer patients, represented on a tissue microarray, were investigated. Distinct KLK4 immunostaining was observed with both antibodies in cancerous glandular epithelial cells, but not in surrounding stromal cells. KLK4 expression was lower in stage pT3+4 than in pT1+2 tumors, which was highly significant when employing pAb 617A. Thus, our results indicate that KLK4, which is expressed in the healthy prostate, is upregulated in early-stage but not late-stage prostate cancer.

Adult urologic sarcoma: experience during 2 decades.

OBJECTIVE: To identify factors associated with long-term outcome and to report possibly meaningful clinical features in a unicentric sample of adult urologic sarcomas. MATERIALS AND METHODS: Thirty-five patients treated between 1992 and 2011 were studied. Except for 3 patients, surgery was the initial treatment. The median follow-up in the surviving (censored) patients was 11.3 years. Kaplan-Meier method and competing risk analysis were used to evaluate outcome. Disease recurrence, disease-specific mortality, and overall mortality were the study endpoints. Comparisons were made with the log rank and the Pepe-Mori tests. Cox proportional hazard models were used to identify independent predictors of disease recurrence. RESULTS: Only disease grade was significantly associated with all 3 study endpoints. The primary tumor site was significantly associated with disease-specific and recurrence-free survival but did not reach the significance level concerning overall survival. In the multivariate analysis, primary site and tumor grade were identified as predictors of disease recurrence. Whereas 10-year disease-specific survival was 100% in patients with low grade inguinoscrotal tumors, it was 0% in patients with high grade disease arising from other sites. CONCLUSIONS: Low grade and inguinoscrotal origin are factors associated with favorable outcome in urologic sarcomas. Repeat interventions to remove or to inactivate recurrent tumors or metastases seem to provide clinical benefit in individual cases.