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Advances in Primary and Secondary Bone and Soft Tissue Tumors
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Advances in Primary and Secondary Bone and Soft Tissue Tumors

A special issue of Cancers (ISSN 2072-6694).

Deadline for manuscript submissions: 31 May 2026 | Viewed by 1523

Special Issue Editor

Prof. Dr. Frank Traub

E-Mail Website
Guest Editor
1. Center for Orthopedic and Trauma Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
2. Rhein-Main Sarcoma Center at University Cancer Center, University Medical Center of Mainz, Mainz, Germany
Interests: orthopedic surgery; orthopedic oncology; bone sarcoma; soft tissue sarcoma; pathological fractures; metastatic disease; benign bone tumours and tumour-like lesions; osteology; benign soft tissue tumors
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

This Special Issue aims to highlight recent advances in the understanding, diagnosis, and treatment of bone and soft tissue tumors, including both primary and metastatic disease. We invite contributions covering basic (laboratory-based) science, translational research, and clinical investigations. Topics of interest include molecular and cellular mechanisms of tumor initiation, progression, and metastasis; innovations in imaging and diagnostic methods; advances in surgical, systemic, and targeted therapies; and the integration of immunotherapy and precision medicine. Submissions that bridge fundamental research and clinical application are particularly encouraged, with the goal of improving outcomes for patients with these challenging malignancies. 

Prof. Dr. Frank Traub
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • primary bone tumors
  • soft tissue sarcomas
  • metastatic bone disease
  • molecular diagnostics including liquid biopsy
  • surgical management including reconstruction
  • immunotherapy
  • tumor microenvironment
  • biomarkers and prognostic factors
  • cancer surveillance
  • translational oncology

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Published Papers (3 papers)

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Research

18 pages, 2209 KB  
Article
Integration of Circulating Immune Checkpoint Proteins and Osteopontin Refined Risk Stratification in Osteosarcoma
by Nguyen Tran Quang Sang, Nguyen Van Khanh, Hoang Hai, Tran Trung Dung, Tran Duc Thanh, Dang Minh Quang, Pham Tuan Anh, Nguyen Bui Tam Chi, Tran Van Bao, Nguyen Viet Trung, Tran Thi Thu Hien, Hidetomi Terai and Le Thi Thanh Thuy
Cancers 2026, 18(11), 1701; https://doi.org/10.3390/cancers18111701 - 23 May 2026
Viewed by 216
Abstract
Background: Osteosarcoma remains the most common primary malignant bone tumor in children and adolescents, with largely unchanged survival outcomes in recent decades. Non-invasive biomarkers for preoperative risk stratification are urgently needed. Circulating immune checkpoint proteins (ICPs) and bone remodeling factors (BRFs) represent promising [...] Read more.
Background: Osteosarcoma remains the most common primary malignant bone tumor in children and adolescents, with largely unchanged survival outcomes in recent decades. Non-invasive biomarkers for preoperative risk stratification are urgently needed. Circulating immune checkpoint proteins (ICPs) and bone remodeling factors (BRFs) represent promising candidates; however, their combined prognostic value in osteosarcoma remains unclear. Methods: We prospectively analyzed plasma samples from 47 patients with osteosarcoma, selecting the earliest available sample before disease progression or the last follow-up. A panel of ICPs and BRFs was quantified using multiplex immunoassays. sHVEM and sCD27 were used to construct a two-marker ICP signature (ICP2); subtypes were defined by unsupervised consensus clustering (k = 2) applied to log2-transformed sHVEM and sCD27 concentrations, and sOPN was included for integrative analysis. Survival associations were assessed using Kaplan–Meier analysis and Firth’s penalized Cox regression. The model performance was evaluated using Harrell’s C-index. Results: Two ICP2 subtypes were identified (type1, n = 26; type2, n = 21). ICP2-type2 was associated with significantly worse progression free survival (PFS) (p = 0.0045) and overall survival (OS) (p = 0.0024) and remained an independent predictor after adjusting clinicopathological factors. The ICP2 model demonstrated high discriminative performance (C-index 0.924 for PFS and 0.903 for OS). Internal validation by leave-one-out cross-validation (LOOCV), in which consensus clustering was re-derived at each fold, yielded corrected C-indices of 0.612 for PFS and 0.806 for OS (versus apparent estimates of 0.687 and 0.689, respectively), confirming acceptable-to-good discrimination after accounting for overfitting. Elevated sOPN was associated with poorer survival in the exploratory analyses, although its prognostic value was less consistent under a pre-specified cutoff. In the combined models, sOPN provided modest additional value for OS stratification, with the grdgfdgICP2-type2/OPN-high subgroup exhibiting the poorest outcome. Conclusions: The circulating sHVEM/sCD27 signature defines prognostically distinct osteosarcoma subtypes with a strong discriminative performance. This minimally invasive model may support preoperative risk stratification. Integration with sOPN suggests a potential biological link between immune regulation and bone remodeling, warranting validation in larger cohorts. Full article
(This article belongs to the Special Issue Advances in Primary and Secondary Bone and Soft Tissue Tumors)
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13 pages, 260 KB  
Article
From Survival to Living: A Comprehensive Analysis of Fibula Graft Complications, Functional Outcomes, and Quality of Life Following Reconstruction for Malignant Bone Tumors
by Beatrice Jung, Isabel Sperrhake, Saskia Sachsenmaier, Tilmann Busse, Eren Demir, Maria Christina Stefanescu, Constantin Doetsch, Sophie Zorn and Frank Traub
Cancers 2026, 18(10), 1548; https://doi.org/10.3390/cancers18101548 - 10 May 2026
Viewed by 493
Abstract
Background: Although survival rates for patients with malignant bone tumors have improved significantly, complications following tumor resection and limb-sparing reconstruction remain a major clinical challenge, particularly in young individuals. Intercalary resection often results in large bone defects, necessitating complex reconstructions. Fibula grafts offer [...] Read more.
Background: Although survival rates for patients with malignant bone tumors have improved significantly, complications following tumor resection and limb-sparing reconstruction remain a major clinical challenge, particularly in young individuals. Intercalary resection often results in large bone defects, necessitating complex reconstructions. Fibula grafts offer biological advantages; however, their long-term outcomes, especially regarding mechanical complications and comprehensive patient-reported well-being, require further detailed exploration, particularly in cohorts utilizing non-vascularized grafts. Objective: This retrospective study evaluated the complication rates, bone hypertrophy, limb function, and quality of life following non-vascularized fibular graft reconstruction for malignant bone tumors in a single-center cohort. This study offers insights into long-term success and patient well-being, with a particular focus on correlations with systemic therapy and defect size, factors that remain insufficiently explored in the current literature. Methods: In this single-center retrospective study, twenty-four non-vascularized fibular grafts were used to reconstruct intercalary bone defects following malignant tumor resection. Complications were categorized using the Clavien–Dindo classification. Graft hypertrophy was evaluated according to the method described by Weiland and de Boer. Functional outcomes were assessed using the MSTSs and TESSs, while quality of life was measured using the SF-36 questionnaire. Notably, the cohort analyzed represents a relatively large single-center series focusing exclusively on the outcomes of non-vascularized fibular grafts. Results: Our findings revealed significant rates of mechanical complications, with osteosynthesis material failure occurring in 50.0% of cases, pseudarthrosis in 47.6%, and fractures of the fibular grafts in 38.1% of cases. Importantly, there were significant correlations between mechanical complications and systemic therapy (p = 0.017), as well as between defect size and fractures (p = 0.013), identifying critical risk factors. Despite these considerable complication rates, patients achieved satisfactory limb function (MSTS: 74 ± 17; TESS: 83 ± 15) and quality of life scores comparable to national norms, with notably higher mental health indices, highlighting their psychological resilience. Conclusions: Non-vascularized fibular graft reconstruction, despite high mechanical complication rates, significantly facilitates long-term functional recovery and psychological well-being. These findings emphasize the necessity of risk-adapted surgical strategies and long-term follow-up protocols to mitigate complications, optimize long-term function, and ultimately advance patient-centered care. Full article
(This article belongs to the Special Issue Advances in Primary and Secondary Bone and Soft Tissue Tumors)
14 pages, 623 KB  
Article
Prospective Analysis of Multidisciplinary (MDT)-Based Cross-Sectional Imaging to Predict the Histology of Soft Tissue Tumors (BACH-Trial)
by Katja Fechner, Henriette Golcher, Maximilian Brunner, Norbert Meidenbauer, Sabine Semrau, Michael Uder, Georg F. Weber, Axel Denz, Abbas Agaimy and Robert Grützmann
Cancers 2026, 18(5), 784; https://doi.org/10.3390/cancers18050784 - 28 Feb 2026
Viewed by 457
Abstract
Background: The necessity of a pre-therapeutic biopsy for soft tissue tumors is assessed differently depending on imaging. We examined the concordance of histopathological and radiological imaging-based diagnoses of soft tissue tumors in a monocentric, multidisciplinary sarcoma board. Methods: From October 2022 [...] Read more.
Background: The necessity of a pre-therapeutic biopsy for soft tissue tumors is assessed differently depending on imaging. We examined the concordance of histopathological and radiological imaging-based diagnoses of soft tissue tumors in a monocentric, multidisciplinary sarcoma board. Methods: From October 2022 to December 2024, we prospectively included 184 patients presenting with preoperative imaging but without prior histology who are presented at the multidisciplinary sarcoma board of the University Hospital of Erlangen. We evaluated tumor dignity (benign/malignant) and most probable tumor subtype based on cross-sectional imaging assisted by the demographic and anatomic characteristics of individual cases. This assessment was then compared with the final pathological results. Results: We classified 75 tumors as benign and 109 tumors as malignant. Of the 75 patients with a suspected benign tumor, 66 (88%) had a benign diagnosis confirmed by pathological assessment, while two (2.7%) had a malignant tumor and seven (9.3%) an intermediate biology tumor. Of the 109 patients with suspected malignant tumors, 69 (63.3%) had a malignant pathology, while 30 (27.5%) had a benign pathology, and 10 (9.2%) an intermediate tumor. Matching the multidisciplinary sarcoma board’s assessment with the pathological results revealed significant sensitivity and a negative predictive value for malignant tumors, as well as a significant positive predictive value and specificity for benign tumors. Conclusions: The study shows that, despite the high degree of predictability at an experienced sarcoma center, imaging cannot completely replace biopsies and caution should be exercised when deciding against a biopsy. It is emphasized that the decision not to perform a biopsy can only be made in cases where lipomatous tumors appear benign in imaging procedures, and only in an experienced center. Full article
(This article belongs to the Special Issue Advances in Primary and Secondary Bone and Soft Tissue Tumors)
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