Suggested role for neutrophil extracellular trap formation in Ewing sarcoma immune microenvironment

Rachel Shukrun, Szilvia Baron, Victoria Fidel, Anna Shusterman, Osnat Sher, Netanya Kollender, Dror Levin, Yair Peled, Yair Gortzak, Yoav Ben-Shahar, Revital Caspi, Sagi Gordon, Michal Manisterski, Ronit Elhasid*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Ewing sarcoma (EWS) is a highly aggressive cancer with a survival rate of 70%–80% for patients with localized disease and under 30% for those with metastatic disease. Tumor-infiltrating neutrophils (TIN) can generate extracellular net-like DNA structures known as neutrophil extracellular traps (NETs). However, little is known about the presence and prognostic significance of tumor-infiltrating NETs in EWS. Herein, we investigated 46 patients diagnosed with EWS and treated in the Tel Aviv Medical Center between 2010 and 2021. TINs and NETs were identified in diagnostic biopsies of EWS by immunofluorescence. In addition, NETs were investigated in neutrophils isolated from peripheral blood samples of EWS patients at diagnosis and following neoadjuvant chemotherapy. The relationships between the presence of TINs and NETs, pathological and clinical features, and outcomes were analyzed. Our results demonstrate that TIN and NETs at diagnosis were higher in EWS patients with metastatic disease compared with those with local disease. High NET formation at diagnosis predicted poor response to neoadjuvant chemotherapy, relapse, and death from disease (p < 0.05). NET formation in peripheral blood samples at diagnosis was significantly elevated among patients with EWS compared with pediatric controls and decreased significantly following neoadjuvant chemotherapy. In conclusion, NET formation seems to have a role in the EWS immune microenvironment. Their presence can refine risk stratification, predict chemotherapy resistance and survival, and serve as a therapeutic target in patients with EWS.

Original languageEnglish
Pages (from-to)36-47
Number of pages12
JournalCancer Science
Issue number1
StatePublished - Jan 2024


  • Ewing sarcoma
  • neutrophil
  • neutrophil extracellular traps (NETs)
  • prognosis
  • tumor microenvironment


Dive into the research topics of 'Suggested role for neutrophil extracellular trap formation in Ewing sarcoma immune microenvironment'. Together they form a unique fingerprint.

Cite this