Variation in Management of Extremity Soft-Tissue Sarcoma in Younger vs Older Adults

Abstract

IMPORTANCE A large proportion of extremity soft-tissue sarcomas (ESS) occur among young adults, yet this group is underrepresented in clinical trials, resulting in limited data on this population. Younger patients present many complex challenges that affect clinical management. OBJECTIVE To investigate variations in treatment management in young adults vs older adults with ESS. DESIGN, SETTING, AND PARTICIPANTS This multicenter retrospective cohort study used the National Cancer Data Base (NCDB) to identify patients 18 years and older with ESS who received definitive treatment (ie, limb-sparing surgery [LSS] or amputation) between 2004 and 2014. Data analysis was conducted in November 2019. EXPOSURES Treatment regimen received among young adults (aged 18-39 years) and older adults (Ն40 years) after diagnosis with ESS. MAIN OUTCOMES AND MEASURES To detect unique factors associated with treatment decisions in young adults with ESS, multivariable analyses used logistic regressions for patterns of treatment and their association with demographic factors and tumor characteristics. RESULTSOverall, 8953 patients were identified, and among these, 1280 (14.3%) were young adults.From the full cohort, 4796 patients (53.6%) identified as male and 6615 (73.9%) identified as non-Hispanic White. More young adults than older adults underwent amputation (age 18-39 years, 104 of 1280 [8.1%]; age 40-64 years, 217 of 3937 [5.5%]; aged Ն65 years, 199 of 3736 [5.3%]), but the association was not statistically significant (age Ն65 years, odds ratio [OR], 1.49; 95% CI, 1.00-2.23; P = .05). Young adults were more likely to receive chemotherapy than older patients (age 40-65 years, OR, 0.52; 95% CI, 0.45-0.60; P = .001; Ն65 years, OR, 0.16; 95% CI, 0.12-0.20; P = .001). Conversely, young adults were less likely to receive radiation therapy compared with older

Emerging innovations and advancements in the treatment of extremity and truncal soft tissue sarcomas

“…167 Another factor seen in clinical treatment patterns includes variation in the management of extremity STS, where a study described age as being a factor of treatment, with young adults more likely to receive chemotherapy and less likely to receive RT when compared to older groups. 168 In a retrospective database review, the impact of age showed an overall lower local recurrence rate in primary amputations of elderly patients (over 90 years) when compared to limb salvage. 169 Patient-reported outcomes are another important aspect of clinical considerations, as they often guide a multidisciplinary approach to improving physical function 170 and quality of life through functional rehabilitation.…”

“…Conversely, a review of the NCDB identified 41,529 patients with STS and found that increased timing to treatment was associated with socioeconomic factors and issues within hospital systems 167 . Another factor seen in clinical treatment patterns includes variation in the management of extremity STS, where a study described age as being a factor of treatment, with young adults more likely to receive chemotherapy and less likely to receive RT when compared to older groups 168 . In a retrospective database review, the impact of age showed an overall lower local recurrence rate in primary amputations of elderly patients (over 90 years) when compared to limb salvage 169 .…”

What’s New in Musculoskeletal Tumor Surgery

“…Table II shows a number of recent studies on soft-tissue tumors [46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65] .…”

“…There is ongoing interest in identifying patient, tumor, and perioperative factors that impact both surgical and oncologic outcomes in patients with soft-tissue tumors [46][47][48][49]57,61,65 . Analyses of the impact of patient age on surgical management and oncologic outcomes have demonstrated similar rates of limbsalvage surgery with significant differences in the choice of systemic therapies 65 .…”

“…There is ongoing interest in identifying patient, tumor, and perioperative factors that impact both surgical and oncologic outcomes in patients with soft-tissue tumors [46][47][48][49]57,61,65 . Analyses of the impact of patient age on surgical management and oncologic outcomes have demonstrated similar rates of limbsalvage surgery with significant differences in the choice of systemic therapies 65 . Hartley et al reported on the outcomes of nonagenarians undergoing a surgical procedure for soft-tissue sarcomas and advocated for curative management for nonagenarian patients on a case-by-case basis 47 .…”