Academic Facility Utilization and Survival Outcomes in Adult Head and Neck Sarcomas: An NCDB Analysis

Abstract

Objectives To investigate clinicopathologic and treatment factors associated with survival in adult head and neck sarcomas in the National Cancer Database (NCDB). To analyze whether treatment settings and therapies received influence survival outcomes and to compare trends in utilization via an aggregated national data set. Study Design Prospectively gathered data. Setting NCDB. Subjects and Methods The study comprised a total of 6944 adult patients treated for a head and neck sarcoma from January 2004 to December 2013. Overall survival (OS) was the primary outcome. Results Increased age and tumor size, nodal involvement, and poorly differentiated histology had significantly reduced OS ( P < .001). Angiosarcoma, malignant nerve sheath tumor, malignant fibrous histiocytoma, osteosarcoma, and rhabdomyosarcoma histologic subtypes had significantly reduced OS, while liposarcoma, chondrosarcoma, and chordoma had improved OS ( P < .001). Utilization of surgical therapy was associated with improved OS, while positive surgical margins were associated with treatment at a community-based cancer program and had reduced OS ( P < .001). On multivariate analysis, treatment with radiation and/or chemotherapy was not significantly associated with OS; however, primary treatment with definitive chemoradiotherapy had significantly reduced OS. Patients treated at academic/research cancer programs (n = 3874) had significantly improved 5- and 10-year OS (65% and 54%, respectively) when compared with patients treated at community-based cancer programs (n = 3027; 49% and 29%; P < .001). The percentage utilization of these programs (56% vs 44%) did not change over the study period. Conclusion For adult head and neck sarcomas, treatment at an academic/research cancer program was associated with improved survival; however, despite increasing medical specialization, the percentage utilization of these programs for this rare tumor remains constant.

Adjuvant radiation for positive margins in adult head and neck sarcomas is associated with improved survival: Analysis of the National Cancer Database

“…5,22,24,33 A recent study by Cannon, et al demonstrated that for patients with head and neck sarcomas, disease treatment at academic/research institutions was associated with fewer positive surgical margins, increased use of adjuvant therapies, and importantly, increased overall survival. 26 The study did not, however, specifically address whether patients with positive surgical margins faired significantly better with adjuvant radiation therapy. This present study was born out of that lingering question.…”

“…Accordingly, prior analysis revealed that patients with sarcomas of the head and neck fared worse than their counterparts with sarcomas of other anatomical sites . Recent studies of the SEER database and NCDB describe prognostic indicators, however they do not address the setting in which adjuvant radiation improves survival …”

“…19,25 Recent studies of the SEER database and NCDB describe prognostic indicators, however they do not address the setting in which adjuvant radiation improves survival. 1,26 Adjuvant therapies aid the physician when satisfactory surgical margins cannot be achieved. 27 Radiation therapy is often given as an adjunct for the treatment of high-grade sarcomas of the head and neck, yet there are no randomized trials demonstrating its importance in their treatment.…”

Untitled

“…No menos trascendente es el uso de quimioterapia neoadyuvante que podría modificar el límite correcto de la resección. Loree y col. 23 realizaron un estudio en 82 pacientes donde el margen tumoral fue tatuado antes de comenzar la quimioterapia neoadyuvante. Pese a que los pacientes presentaban una remisión tumoral macroscópica superior al 90%, en el análisis histopatológico posterior de la pieza hallaron enfermedad submucosa residual hasta el área tatuada.…”

“…The use of neoadjuvant chemotherapy could modify the correct limit of resection. Loree et al 23 evaluated 82 patients in whom tumor margins were tattooed before starting neoadjuvant chemotherapy. Despite macroscopic remission was more than 90%, the subsequent histopathological analysis of the specimen showed residual submucosal disease up to the tattooed area.…”