National evaluation of patterns and predictors of underuse of multimodal therapy for high-risk extremity soft tissue sarcoma

Nigam, Aradhya; Aminpour, Nathan; Zeymo, Alexander; Desale, Sameer; Villano, Anthony M.; Unger, Keith; Aboulafia, Albert J.; Al‐Refaie, Waddah B.

doi:10.1016/j.surg.2021.10.034

Cited by 2 publications

(3 citation statements)

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“…28 A study by Nigam et al used NCBD data to examine predictors of and trends in the use of neoadjuvant therapy in trunk and extremity STS and found an overall increase in the application neoadjuvant therapies as composite treatment modality across the study years, though this study did not specifically examine trends in the use of NCT. 29 In addition, a 2014 NCDB study by Sherman et al identified similar predictors of receipt of NCT for STS patients as the current study though did specifically examine patients receiving NRT and did not report upon any differences in patient outcomes. 30 In the current study, factors associated with NCT included younger patient age, treatment at an academic medical center, and a higher clinical disease stage.…”

Section: Discussionmentioning

confidence: 50%

“…For example, a recent retrospective study by Graham et al demonstrated an overall survival advantage for patients undergoing NCT in the setting of radiation therapy regardless of the timing of radiation relative to surgical resection 28 . A study by Nigam et al used NCBD data to examine predictors of and trends in the use of neoadjuvant therapy in trunk and extremity STS and found an overall increase in the application neoadjuvant therapies as composite treatment modality across the study years, though this study did not specifically examine trends in the use of NCT 29 . In addition, a 2014 NCDB study by Sherman et al identified similar predictors of receipt of NCT for STS patients as the current study though did specifically examine patients receiving NRT and did not report upon any differences in patient outcomes 30 …”

Section: Discussionmentioning

confidence: 99%

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Neoadjuvant chemotherapy in patients undergoing neoadjuvant radiation for trunk and extremity soft tissue sarcoma

Tortorello

Sharon

et al. 2023

Journal of Surgical Oncology

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IntroductionMany patients with high‐risk soft tissue sarcoma (STS) develop distant metastases. Meta‐analyses suggest that chemotherapy confers a small survival benefit, though few studies focus on neoadjuvant chemotherapy (NCT). There has been more frequent use of neoadjuvant radiation therapy (NRT) in STS, but the utility of NCT for these patients remains unclear.MethodsPatients with stage II−III trunk/extremity STS who underwent NRT and resection were identified using the National Cancer Database (2006−2019). Predictors of NCT were analyzed using logistic regression. Change in rate of NCT use over time was assessed using log‐linear regression modeling. Survival was examined using Kaplan−Meier (KM) and Cox proportional hazard modeling.ResultsOf 5740 patients, 25% underwent NCT. The overall median age was 62, 55% of patients were male, and 67% had stage III disease. The most common histological subtypes were fibrosarcoma/myxofibrosarcoma (39%) and liposarcoma (16%). Use of NCT decreased by 4.0% per year throughout the study period (p < 0.01). Predictors of NCT included younger age (median 54, IQR 42−64 vs. median 65, IQR 53−75, p < 0.01), treatment at an academic center (odds ratio [OR] 1.5, p < 0.01), and stage III disease (OR 2.2, p < 0.01). Histologic predictors of NCT included synovial sarcoma (52%) and angiosarcoma (45%). With a median follow‐up time of 77 months, NCT was associated with improved 5‐year survival compared to NRT alone on KM analysis (70% vs. 63%, p < 0.01). This difference persisted on multivariate analysis (hazard ratio 0.86, p = 0.027) and after propensity matching (70% vs. 65%, p = 0.0064).ConclusionDespite risk of distant failure in high‐risk STS, use of NCT has decreased over time in patients receiving NRT. In this retrospective analysis, NCT was associated with a modestly improved overall survival.

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Section: Discussionmentioning

confidence: 50%

Section: Discussionmentioning

confidence: 99%

Neoadjuvant chemotherapy in patients undergoing neoadjuvant radiation for trunk and extremity soft tissue sarcoma

Tortorello

Sharon

et al. 2023

Journal of Surgical Oncology

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“…Insurance coverage has been a well-documented factor affecting cancer outcomes, but data regarding the STS patient population are heterogeneous. Prior studies examining the impact of insurance status on STS patient outcomes analyzed STS along with primary bone sarcoma [14][15][16][17][18], included pediatric and adolescent populations [15][16][17]19], examined STS without delineation of localization to the trunk versus extremities [8,13,20], or examined insurance coverage broadly [21,22]. To the authors' knowledge, this is the first study to examine lower-extremity STS outcomes in the context of Medicare plan subtypes.…”

Section: Discussionmentioning

confidence: 99%

Medicare Advantage in Soft Tissue Sarcoma May Be Associated with Worse Patient Outcomes

Wang

Liu

Gettleman

et al. 2023

JCM

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Medicare Advantage healthcare plans may present undue impediments that result in disparities in patient outcomes. This study aims to compare the outcomes of patients who underwent STS resection based on enrollment in either traditional Medicare (TM) or Medicare Advantage (MA) plans. The Premier Healthcare Database was utilized to identify all patients ≥65 years old who underwent surgery for resection of a lower-extremity STS from 2015 to 2021. These patients were then subdivided based on their Medicare enrollment status (i.e., TM or MA). Patient characteristics, hospital factors, and comorbidities were recorded for each cohort. Bivariable analysis was performed to assess the 90-day risk of postoperative complications. Multivariable analysis controlling for patient sex, as well as demographic and hospital factors found to be significantly different between the cohorts, was also performed. From 2015 to 2021, 1858 patients underwent resection of STS. Of these, 595 (32.0%) had MA coverage and 1048 (56.4%) had TM coverage. The only comorbidities with a significant difference between the cohorts were peripheral vascular disease (p = 0.027) and hypothyroidism (p = 0.022), both with greater frequency in MA patients. After controlling for confounders, MA trended towards having significantly higher odds of pulmonary embolism (adjusted odds ratio (aOR): 1.98, 95% confidence interval (95%-CI): 0.58–6.79), stroke (aOR: 1.14, 95%-CI: 0.20–6.31), surgical site infection (aOR: 1.59, 95%-CI: 0.75–3.37), and 90-day in-hospital death (aOR 1.38, 95%-CI: 0.60–3.19). Overall, statistically significant differences in postoperative outcomes were not achieved in this study. The authors of this study hypothesize that this may be due to study underpowering or the inability to control for other oncologic factors not available in the Premier database. Further research with higher power, such as through multi-institutional collaboration, is warranted to better assess if there truly are no differences in outcomes by Medicare subtype for this patient population.

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National evaluation of patterns and predictors of underuse of multimodal therapy for high-risk extremity soft tissue sarcoma

Cited by 2 publications

References 35 publications

Neoadjuvant chemotherapy in patients undergoing neoadjuvant radiation for trunk and extremity soft tissue sarcoma

Neoadjuvant chemotherapy in patients undergoing neoadjuvant radiation for trunk and extremity soft tissue sarcoma

Medicare Advantage in Soft Tissue Sarcoma May Be Associated with Worse Patient Outcomes

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