BACKGROUND: Previous reports of Ewing sarcoma cohorts suggested that there is a difference in incidence according to racial origin. However, to the authors' knowledge, this finding has never been tested in a population‐based database, and the impact of race on clinical outcome and the significance of known risk factors stratified to racial groups have not been reported. METHODS: Patients who had Ewing sarcoma diagnosed between 1973 and 2005 were identified in the Surveillance, Epidemiology, and End Results database. Patient demographic and clinical characteristics; incidence; year of diagnosis; tumor location, tumor size, and disease stage at diagnosis; treatment(s); cause of death; and survival were extracted. Kaplan‐Meier, log‐rank, and Cox regressions were used to analyze the significance of prognostic factors. RESULTS: Race‐specific incidence indicated that Caucasians have the highest incidence (0.155), followed by Asians/Pacific Islanders (0.082), and African Americans (0.017). The difference in incidence between Caucasians and African Americans was 9‐fold and significant (P < .001). The incidence of Ewing sarcoma increased over the past 3 decades among Caucasians (P < .05). Survival was not impacted by race. Local disease stage, primary tumor location in the appendicular skeleton, and tumor size ≤8 cm conferred a significant survival benefit. Women demonstrated improved survival among the Caucasian patients (P < .03). CONCLUSIONS: To the authors' knowledge, this is the first report focusing on racial disparity in incidence of Ewing sarcoma. Caucasians were affected more frequently, although outcomes were similar between races. It is noteworthy that being a woman constituted a survival benefit only among the Caucasian patients. Further studies will need to clarify the reasons for racial disparities in incidence and for sex differences in survival. Cancer 2009. © 2009 American Cancer Society.

This analysis of a large cohort of adults with PLB indicated that the only identifiable prognostic indicators were localized disease and younger age. The authors concluded that future treatment for patients with PLB need to be based on strict staging criteria and adherence to successful published protocols using collaborative clinical trials.

The transsulfuration enzyme cystathionine-β-synthase (CBS) and its product hydrogen sulfide (H2S) are aberrantly upregulated in colorectal cancers, where they contribute to tumor growth and progression by both autocrine and paracrine mechanisms. However, it is unknown whether the CBS/H2S axis plays a role in colorectal carcinogenesis. Here, we report upregulation of CBS in human biopsies of precancerous adenomatous polyps and show that forced upregulation of CBS in an adenoma-like colonic epithelial cell line is sufficient to induce metabolic and gene expression profiles characteristic of colorectal cancer cells. Differentially expressed metabolites (65 increased and 20 decreased) clustered into the glycolytic pathway, nucleotide sugars, intermediates of the pentose phosphate pathway, and lipogenesis, including primarily phospholipids, sphingolipids, and bile acids. CBS upregulation induced broad changes in the NCM356 cell transcriptome with over 350 differentially expressed genes. These genes overlapped significantly with gene sets related to glycolysis, hypoxia, and a colon cancer cell phenotype, including genes regulated by NF-κB, KRAS, p53, and Wnt signaling, genes downregulated after E-cadherin knockdown, and genes related to increased extracellular matrix, cell adhesion, and epithelial-to-mesenchymal transition. The CBS-induced switch to an anabolic metabolism was associated with increased NCM356 cell bioenergetics, proliferation, invasion through Matrigel, resistance to anoikis, and CBS-dependent tumorigenesis in immune compromised mice. Genetic ablation of CBS in CBS heterozygous mice (CBS+/−) reduced the number of mutagen-induced aberrant colonic crypt foci. Taken together, these results establish that activation of the CBS/H2S axis promotes colon carcinogenesis.

Current stratification of prognosis in patients with epithelioid sarcoma (ES) is based largely on data reported by individual centers with a limited number of patients. We sought to identify the important prognostic parameters using the Surveillance, Epidemiology, and End Results (SEER) database. We identified 441 patients with ES in the database and extracted information regarding patient demographics and clinical characteristics. KaplanMeier, log-rank, and Cox regression were used for analysis.

The level of evidence for this article is 2.

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The earliest attempt at classifying avascular necrosis of the femoral head was proposed by Ficat and Arlet in 1964 [2], before the advent of MRI. The purpose of the classification was to provide prognostic insight and compare treatment options. Ficat modified the classification to include invasive testing procedures and a preclinical, preradiographic stage in 1985 [1]. Since then the system has been modified a few times to include MRI findings, patient symptoms, modify the description of radiographic findings, and exclude the invasive testing procedures originally described [13, 17]. In a systematic review of the literature, Mont et al. [13] identified 16 different classification systems used to classify and describe avascular necrosis. Of these, the Ficat classification [1, 2] was the most frequently used system (63%), followed by the University of Pennsylvania system [18] (20%), the Association Research Circulation Osseous (ARCO) system [4, 15] (12%), and the Japanese Orthopaedic Association system [7] (5%). Purpose An ideal classification system should be practical, valid, reliable, and of prognostic importance. It also would help to choose between different treatment options and facilitate communication between researchers. This would form the basis for uniform reporting of results. There is controversy surrounding the classification of osteonecrosis of the femoral head and indications and success of the various treatment options in preservation of the femoral head [13]. The controversy surrounds the natural history of progression and whether the treatment more frequently preserves the contour of the femoral head than would occur without treatment. Lack of a universally accepted classification system makes it difficult to compare and analyze the data emanating from different centers. Osteonecrosis of the femoral head typically affects patients with a mean age in the middle thirties [11, 13], and for the majority of patients, leads to collapse of the femoral head if left untreated [13]. Spontaneous resolution of femoral head necrosis also has been reported among patients who have had renal transplants [9, 14, 16, 20]. Hip arthroplasty is not associated with expected longevity (72% 10-year survival in the Finnish registry for patients younger than 55 years) in this younger age group [3, 5, 10, 13]. Thus preservation of the femoral head is the objective of diagnostic and treatment strategies. A useful classification system would outline the criteria of early diagnosis. However, there is no specific radiographic appearance for Each author certifies that he or she, or a member of their immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.