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Guertin MP, Lee Y, Stewart SJ, Ramirez J, Nguyen A, Paraliticci G, Pretell-Mazzini JA. Soft Tissue Sarcomas in Octogenarian Patients: Are Treatment Options and Oncological Outcomes Different? A SEER Retrospective Study. Clin Oncol (R Coll Radiol) 2023; 35:269-277. [PMID: 36710153 DOI: 10.1016/j.clon.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/06/2023] [Indexed: 01/15/2023]
Abstract
AIMS As the US population continues to age, oncological strategies and outcomes for soft tissue sarcomas (STSs) should continue to be examined for varying age groups. The aim of this study was analyse and compare treatment strategies and oncological outcomes for octogenarian patients with STSs. MATERIALS AND METHODS Data from the Surveillance, Epidemiology and End Results (SEER) national database were used. Varying treatment modalities were studied when utilised for specific tumour staging with respect to the eighth edition of the American Joint Committee on Cancer. RESULTS In total, 24 666 patients were included for analysis, where 3341 (14%) were 80 years old or older. The octogenarian group was diagnosed with more advanced disease (stages II-IV), relative to their younger counterparts (85% versus 75%, P < 0.001). However, a smaller proportion of the older patients underwent surgical resection (74% versus 86%, P < 0.001). Likewise, the octogenarians received less chemotherapy (4% versus 21%, P < 0.001) and radiotherapy (29% versus 42%, P = 0.010). Surgical resection and chemotherapy significantly improved overall survival for those older patients with stage II STS, whereas surgical resection and radiotherapy improved mortality in this cohort with both stage III and IV STS. Overall survival at 1 and 5 years of follow-up was lower within the octogenarian group compared with the younger group (1 year: 68% versus 88%, P < 0.001 and 5 years: 7% versus 58%, P < 0.001). CONCLUSIONS Octogenarian patients, in most cases, are diagnosed with stage III or metastatic disease. Surgical resection of the primary tumour was beneficial in both age cohorts, with radiotherapy correlating to better overall survival when used in those patients with higher stage STS. Chemotherapy was associated with better mortality in the younger cohort with respect to tumour stage. The octogenarian overall survival at 1 and 5 years was lower than for younger patients.
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Affiliation(s)
- M P Guertin
- Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA.
| | - Y Lee
- Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - S J Stewart
- Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - J Ramirez
- Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - A Nguyen
- University of Illinois College of Medicine, Chicago, Illinois, USA
| | - G Paraliticci
- Musculoskeletal Oncology Division, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA
| | - J A Pretell-Mazzini
- Musculoskeletal Oncology Division, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA
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2
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Weiss MC. Systemic Treatment of Soft Tissue Sarcomas in the Geriatric Population. Curr Treat Options Oncol 2022; 23:855-863. [PMID: 35389146 DOI: 10.1007/s11864-022-00972-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2022] [Indexed: 11/24/2022]
Abstract
OPINION STATEMENT As the population ages, there will be an increase in the incidence and prevalence of soft tissue sarcoma (STS) within the geriatric population. As this disease disproportionately affects older adults, the percentage of adults >65 years old is expected to increase in the coming years. Geriatric patients are often more vulnerable to disease-related symptoms and have more difficulty tolerating treatment-related side effects. While there are no formal existing guidelines to direct the care of this geriatric patient population, it is of utmost importance to consider each patients' fitness and co-morbidities when selecting treatment plans. This review focuses on the current state of research of older adults with advanced or metastatic soft tissue sarcoma, highlighting the lack of representation of this patient population in clinical trials. Given that chronological age does not necessarily equate to physiologic age, integration of comprehensive geriatric and quality of life assessments is needed in the care of geriatric patients to help guide therapeutic decisions.
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Affiliation(s)
- Mia C Weiss
- Division of Medical Oncology, Washington University in St. Louis, St. Louis, MO, 63110, USA. .,Siteman Cancer Center, St. Louis, MO, 63110, USA.
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3
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Nakamura T, Sudo A. Treatment Strategy for Elderly Patients with Soft Tissue Sarcoma. Curr Oncol Rep 2022; 24:563-571. [PMID: 35192116 DOI: 10.1007/s11912-022-01244-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Surgical resection is the standard treatment for localized soft tissue sarcoma (STS), while systemic chemotherapy for advanced STS may be considered. However, less aggressive treatment is often administered to elderly patients with STS. Undertreatment may compromise the cure rate and survival of these individuals. We review the literatures and emphasize the importance of standard treatment for STS in elderly patients. RECENT FINDINGS The outcome of surgical resection of STS in older individuals is comparable to that of younger ones, as long as patients are selected based on American Society of Anesthesiologists Physical Status (ASA-PS). Likewise, systemic treatment may prove beneficial as long as the risk of complications is estimated with a geriatric assessment. Elderly patients with STS benefit from standard treatment as long as the risks of surgical and systemic complications are assessed respectively with the ASA-PS and GA. Novel clinical trials with broader eligibility criteria are also necessary for elderly patients because of the increasing population of the elderly patients in the future.
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Affiliation(s)
- Tomoki Nakamura
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu-city, Mie, 514-8507, Japan.
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu-city, Mie, 514-8507, Japan
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4
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Nigam A, Aminpour N, Zeymo A, Desale S, Villano AM, Unger KR, Aboulafia AJ, Al-Refaie WB. National evaluation of patterns and predictors of underuse of multimodal therapy for high-risk extremity soft tissue sarcoma. Surgery 2022; 171:1348-1357. [DOI: 10.1016/j.surg.2021.10.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 12/01/2022]
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Lafontaine J, Cardin GB, Malaquin N, Boisvert JS, Rodier F, Wong P. Senolytic Targeting of Bcl-2 Anti-Apoptotic Family Increases Cell Death in Irradiated Sarcoma Cells. Cancers (Basel) 2021; 13:cancers13030386. [PMID: 33494434 PMCID: PMC7866159 DOI: 10.3390/cancers13030386] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/14/2021] [Accepted: 01/18/2021] [Indexed: 01/10/2023] Open
Abstract
Simple Summary Limited volumetric change after pre-operative radiotherapy (RT) suggests that sarcomas generally do not undergo cell death. Senolytic drugs represent a highly promising field as a new therapy approach to drive senescent cancer cells towards cell death to enhance treatment response. Here, we demonstrate that the Bcl-2 family of anti-apoptotic proteins in irradiated senescent sarcoma cells represents a senotherapeutic target to improve the cell death response in RT. This study paves the way for new treatment options in soft tissue sarcoma management. Abstract Radiotherapy (RT) is a key component of cancer treatment. Most of the time, radiation is given after surgery but for soft-tissue sarcomas (STS), pre-surgical radiation is commonly utilized. However, despite improvements in RT accuracy, the rate of local recurrence remains high and is the major cause of death for patients with STS. A better understanding of cell fates in response to RT could provide new therapeutic options to enhance tumour cell killing by RT and facilitate surgical resection. Here, we showed that irradiated STS cell cultures do not die but instead undergo therapy-induced senescence (TIS), which is characterized by proliferation arrest, senescence-associated β-galactosidase activity, secretion of inflammatory cytokines and persistent DNA damage. STS-TIS was also associated with increased levels of the anti-apoptotic Bcl-2 family of proteins which rendered cells targetable using senolytic Bcl-2 inhibitors. As oppose to radiation alone, the addition of senolytic agents Venetoclax (ABT-199) or Navitoclax (ABT-263) after irradiation induced a rapid apoptotic cell death in STS monolayer cultures and in a more complex three-dimensional culture model. Together, these data suggest a new promising therapeutic approach for sarcoma patients who receive neoadjuvant RT. The addition of senolytic agents to radiation treatments may significantly reduce tumour volume prior to surgery and thereby improve the clinical outcome of patients.
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Affiliation(s)
- Julie Lafontaine
- Institut du Cancer de Montréal (ICM), Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), 900 St. Denis Street, Montreal, QC H2X 0A9, Canada; (J.L.); (G.B.C.); (N.M.); (J.-S.B.); (F.R.)
| | - Guillaume B. Cardin
- Institut du Cancer de Montréal (ICM), Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), 900 St. Denis Street, Montreal, QC H2X 0A9, Canada; (J.L.); (G.B.C.); (N.M.); (J.-S.B.); (F.R.)
| | - Nicolas Malaquin
- Institut du Cancer de Montréal (ICM), Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), 900 St. Denis Street, Montreal, QC H2X 0A9, Canada; (J.L.); (G.B.C.); (N.M.); (J.-S.B.); (F.R.)
| | - Jean-Sébastien Boisvert
- Institut du Cancer de Montréal (ICM), Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), 900 St. Denis Street, Montreal, QC H2X 0A9, Canada; (J.L.); (G.B.C.); (N.M.); (J.-S.B.); (F.R.)
- Plasma Processing Laboratory, Department of Chemical Engineering, McGill University, 3610 University Street, Montreal, QC H3A 0C5, Canada
| | - Francis Rodier
- Institut du Cancer de Montréal (ICM), Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), 900 St. Denis Street, Montreal, QC H2X 0A9, Canada; (J.L.); (G.B.C.); (N.M.); (J.-S.B.); (F.R.)
- Département de Radiologie, Radio-Oncologie et Médicine Nucléaire, Université de Montréal, C.P. 6128, Succursale Centre-Ville, Montreal, QC H3C 3J7, Canada
| | - Philip Wong
- Institut du Cancer de Montréal (ICM), Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), 900 St. Denis Street, Montreal, QC H2X 0A9, Canada; (J.L.); (G.B.C.); (N.M.); (J.-S.B.); (F.R.)
- Département de Radio-Oncologie, Centre Hospitalier de l’Université de Montréal (CHUM), 1051 Sanguinet Street, Montreal, QC H2X 3E4, Canada
- Department of Radiation Oncology, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, ON M5G 2M9, Canada
- Department of Radiation Oncology, University of Toronto, 149 College Street, Suite 504, Toronto, ON M5T 1P5, Canada
- Correspondence: ; Tel.: +1-416-946-4483
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6
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Age-related differences of oncological outcomes in primary extremity soft tissue sarcoma: a multistate model including 6260 patients. Eur J Cancer 2020; 141:128-136. [PMID: 33137588 DOI: 10.1016/j.ejca.2020.09.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/06/2020] [Accepted: 09/25/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE No studies extensively compared the young adults (YA, 18-39 years), middle-aged (40-69 years), and elderly (≥70 years) population with primary high-grade extremity soft tissue sarcoma (eSTS). This study aimed to determine whether the known effect of age on overall survival (OS) and disease progression can be explained by differences in tumour characteristics and treatment protocol among the YA, middle-aged and elderly population in patients with primary high-grade eSTS treated with curative intent. METHODS In this retrospective multicentre study, inclusion criteria were patients with primary high-grade eSTS of 18 years and older, surgically treated with curative intent between 2000 and 2016. Cox proportional hazard models and a multistate model were used to determine the association of age on OS and disease progression. RESULTS A total of 6260 patients were included in this study. YA presented more often after 'whoops'-surgery or for reresection due to residual disease, and with more deep-seated tumours. Elderly patients presented more often with grade III and larger (≥10 cm) tumours. After adjustment for the imbalance in tumour and treatment characteristics the hazard ratio for OS of the middle-aged population is 1.47 (95% confidence interval [CI]: 1.23-1.76) and 3.13 (95% CI: 2.59-3.78) in the elderly population, compared with YA. DISCUSSION The effect of age on OS could only partially be explained by the imbalance in the tumour characteristics and treatment variables. The threefold higher risk of elderly could, at least partially, be explained by a higher other-cause mortality. The results might also be explained by a different tumour behaviour or suboptimal treatment in elderly compared with the younger population.
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7
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Wellings EP, Wagner ER, Wilke BK, Asante D, Sangaralingham LR, Rose PS, Moran SL, Houdek MT. What are the predictors of emergency department utilization and readmission following extremity bone sarcoma resection? J Surg Oncol 2020; 122:1356-1363. [PMID: 32794224 DOI: 10.1002/jso.26173] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 07/18/2020] [Accepted: 08/05/2020] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Treatment for bone sarcomas are large undertakings. Emergency department (ED) visits and unplanned hospital readmissions are a potential target for cost containment. The purpose of this study was to evaluate the risk factors for ED visits and unplanned readmissions following extremity bone sarcoma surgery. METHODS Data from Optum Labs Data Warehouse, a national administrative claims database, was analyzed to identify patients with extremity bone sarcomas from 2006 to 2017. Multivariable logistic regression was used to identify factors associated with ED visits and readmissions. RESULTS Of 1390 (743 males, 647 female) adult patients, 137 (12%) visited the ED and 245 (18%) were readmitted within 30 days of discharge. The most common indication for ED visits (n = 63, 45.9%) and readmission (n = 119, 48.5%) were complications of surgery. Length of stay >10 days was associated with ED utilization (OR, 1.83; P = .01) and readmission (OR, 4.47; P < .001). CONCLUSION One in ten patients will use the ED, and one in five patients will be readmitted to the hospital within 30 days of discharge following extremity bone sarcoma surgery. Length of stay was associated with ED visits and readmission. These patients could be targeted with alternative management strategies in the outpatient setting with early clinical follow-up to minimize readmission.
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Affiliation(s)
| | - Eric R Wagner
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.,Department of Orthopedic Surgery, Emory University, Atlanta, Georgia
| | - Benjamin K Wilke
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Dennis Asante
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota.,OptumLabs, Cambridge, Massachusetts
| | - Lindsey R Sangaralingham
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota.,OptumLabs, Cambridge, Massachusetts
| | - Peter S Rose
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Steven L Moran
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota
| | - Matthew T Houdek
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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8
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Imanishi J, Chan LWM, Broadhead ML, Pang G, Ngan SY, Slavin J, Sharp S, Choong PFM. Clinical Features of High-Grade Extremity and Trunk Sarcomas in Patients Aged 80 Years and Older: Why Are Outcomes Inferior? Front Surg 2019; 6:29. [PMID: 31214596 PMCID: PMC6554445 DOI: 10.3389/fsurg.2019.00029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 05/07/2019] [Indexed: 11/13/2022] Open
Abstract
Background: The population of many countries is aging and a significant number of elderly patients with soft-tissue sarcoma are being seen at cancer centers. The unique therapeutic and prognostic implications of treating soft-tissue sarcoma in geriatric patients warrant further consideration in order to optimize outcomes. Patients and Methods: This is a single-institution retrospective study of consecutive non-metastatic primary extremity and trunk high-grade sarcomas surgically treated between 1996 and 2012, with at least 2 years of follow-up for survivors. Patient characteristics and oncological outcomes were compared between age groups (≥80 vs. <80 years), using Chi-square or Fisher-exact test and Log-Rank or Wilcoxon test, respectively. Deaths from other causes were censored for disease-specific survival estimation. A p< 0.05 was regarded as statistically significant. Results: A total of 333 cases were eligible for this study. Thirty-six patients (11%) were aged ≥80 years. Unplanned surgery incidence and surgical margin status were comparable between the age groups. Five-year local-recurrence-free, metastasis-free and disease-specific survivals were 72% (≥80 years) vs. 90% (<80 years) (p = 0.004), 59 vs. 70% (p = 0.07) and 55 vs. 80% (p < 0.001), respectively. A significantly earlier first metastasis after surgery (8.3 months vs. 20.5 months, mean) and poorer survival after first metastasis (p = 0.03) were observed. Cox analysis revealed "age ≥80 years" as an independent risk factor for local failure and disease-specific mortality, with hazard ratios of 2.41 (95% CI: 1.09-5.32) and 2.52 (1.33-4.13), respectively. A competing risks analysis also showed that "age ≥80 years" was significantly associated with the disease-specific mortality. Conclusions: Oncological outcomes were significantly worse in high-grade sarcoma patients aged ≥80 years. The findings of more frequent local failure regardless of a consistent primary treatment strategy, an earlier time to first metastasis after surgery, and poorer prognosis after first metastasis suggest that more aggressive tumor biology, in addition to multiple co-morbidity, may explain the inferiority.
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Affiliation(s)
- Jungo Imanishi
- Department of Orthopedics, St. Vincent's Hospital, Fitzroy, VIC, Australia.,Department of Orthopedic Oncology and Surgery, Saitama Medical University International Medical Center, Hidaka, Japan.,Department of Orthopaedic Surgery, Saitama Medical University Hospital, Moroyama, Japan
| | - Lester W M Chan
- Department of Orthopedics, St. Vincent's Hospital, Fitzroy, VIC, Australia.,Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | | | - Grant Pang
- Department of Orthopedics, St. Vincent's Hospital, Fitzroy, VIC, Australia.,Bone and Soft Tissue Tumour Unit, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Samuel Y Ngan
- Bone and Soft Tissue Tumour Unit, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - John Slavin
- Department of Pathology, St. Vincent's Hospital, Fitzroy, VIC, Australia
| | - Stephen Sharp
- Department of Surgery, University of Melbourne, Melbourne, VIC, Australia
| | - Peter F M Choong
- Department of Orthopedics, St. Vincent's Hospital, Fitzroy, VIC, Australia.,Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Department of Surgery, University of Melbourne, Melbourne, VIC, Australia
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9
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Bourcier K, Dinart D, Le Cesne A, Honoré C, Meeus P, Blay JY, Michot A, Le Loarer F, Italiano A. Outcome of Patients with Soft-Tissue Sarcomas: An Age-Specific Conditional Survival Analysis. Oncologist 2019; 24:e559-e564. [PMID: 31015315 DOI: 10.1634/theoncologist.2018-0641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 01/15/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Soft-tissue sarcomas (STSs) are a group of rare cancers that can occur at any age. Prognostic outcomes of patients with STS are usually established at the time of the patient's initial disease presentation. Conditional survival affords a dynamic prediction of prognosis for patients surviving a given period after diagnosis. Estimates of conditional survival can provide crucial prognostic information for patients and caregivers, guide subsequent cancer follow-up schedules, and impact decisions regarding management. This study aims to estimate conditional survival and prognostic factors in patients with STS according to age at diagnosis (≤75 years and ≥75 years). SUBJECTS, MATERIALS, AND METHODS A total of 6,043 patients with nonmetastatic STS at first diagnosis who underwent complete surgical resection (R0 or R1) were assessed. Cox proportional hazards regression was used to establish prognostic factors of conditional metastasis-free survival and overall survival at 1, 2, and 5 years after diagnosis. RESULTS Elderly patients have more adverse prognostic features at presentation and tend to receive less aggressive treatment than do younger patients. However, at baseline as well as at each conditional survival time point, the 5-year estimated probability of metastatic relapse decreases in both young and elderly patients and is almost identical in both groups at 2 years and 5 years after initial diagnosis. Prognostic factors for metastatic relapse and death change as patient survival time increases in both young and elderly patients. Grade, the strongest prognostic factor for metastatic relapse and death at baseline, is no longer predictive of metastatic relapse in patients surviving 5 years after initial diagnosis. Leiomyosarcoma is the histological subtype associated with the highest risk of metastatic relapse and death in young patients surviving 5 years after initial diagnosis. The positive impact on the outcome of peri-operative treatments tends to decrease and disappears in patients surviving 5 years after initial diagnosis. CONCLUSION Conditional survival estimates show clinically relevant variations according to time since first diagnosis in both young and elderly patients with STS. These results can help STS survivors adjust their view of the future and STS care providers plan patient follow-up. IMPLICATIONS FOR PRACTICE For patients with sarcoma who are followed up years after being treated for their disease, a common scenario is for the patient and caregivers to ask practitioners what the longer-term prognosis may be. The question posed to practitioners may be, "Doc, am I now cured? It's been 5 years since we finished treatment." Survival probability changes for patients who survive a given period of time after diagnosis, and their prognosis is more accurately described using conditional survival. By analyzing more than 6,000 sarcoma patients, an overall improvement was found in the risk of relapse as patients conditionally survive. Prognostic factors for metastatic relapse and death change as patient survival time increases in both young and elderly patients.
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Affiliation(s)
- Kevin Bourcier
- Department of Medicine, Institut Bergonié, Bordeaux, France
| | - Derek Dinart
- Inserm CIC1401, Clinical and Epidemiological Research Unit, Institut Bergonié, Bordeaux, France
| | - Axel Le Cesne
- Department of Medicine, Institut Gustave Roussy, Villejuif, France
| | - Charles Honoré
- Department of Surgery, Institut Gustave Roussy, Villejuif, France
| | - Pierre Meeus
- Department of Surgery, Centre Léon Bérard, Lyon, France
| | - Jean-Yves Blay
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Audrey Michot
- Department of Surgery, Institut Bergonié, Bordeaux, France
| | | | - Antoine Italiano
- Department of Medicine, Institut Bergonié, Bordeaux, France
- University of Bordeaux, Bordeaux, France
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10
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Extremity soft tissue sarcoma in the elderly: Are we overtreating or undertreating this potentially vulnerable patient population? J Surg Oncol 2019; 119:1087-1098. [DOI: 10.1002/jso.25470] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 03/03/2019] [Accepted: 03/27/2019] [Indexed: 01/14/2023]
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11
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Hashimoto K, Nishimura S, Hara Y, Oka N, Tanaka H, Iemura S, Akagi M. Clinical outcomes of patients with primary malignant bone and soft tissue tumor aged 65 years or older. Exp Ther Med 2018; 17:888-894. [PMID: 30651877 DOI: 10.3892/etm.2018.7013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 11/11/2018] [Indexed: 12/11/2022] Open
Abstract
The number of elderly patients with sarcoma (65 years or older) has increased with the rise in the aging of society. As it is difficult to treat elderly sarcoma patients in the same manner as younger patients, the present study sought to compare treatment options currently available for elderly patients. The present study was comprised 34 Japanese patients (21 men and 13 women) with malignant bone or soft tissue tumors who underwent surgery in our department from September 2004 to March 2014. The median patient age was 72 years (range, 65-86 years). Histologically, 23 cases were categorized as high-grade and 11 as low-grade. Treatments included surgery with adequate margins (25 cases), surgery with inadequate margins and radiotherapy (4 cases), surgery with inadequate margins and chemotherapy (3 cases) and intralesional resection (2 cases). The postoperative follow-up period ranged from 7 to 112 months (average, 49 months). The 5-year survival rates were determined and compared using the Kaplan-Meier method and log-rank test, respectively. Eastern Cooperative Oncology Group Performance Status (ECOG-PS) and Anesthesiologists-Physical Status (ASA-PS) scores were also determined. The overall 5-year survival rate was 86.02%; it differed significantly between patients with high-grade (100%) vs. low-grade (74.3%) neoplasms P<0.001), but not between patients aged 65-69 (76.9%) vs. ≥70 (90.2%) years-old (P=0.65). Tumor status was classified as follows: i) Continuously disease-free, n=24 cases; ii) alive with disease, n=3 cases; iii) and dead of disease, n=7 cases. The ECOG-PS status scores were 0 in 9 cases, 1 in 21 cases, and 2 in 4 cases. ASA-PS scores were also I in 9 cases and II in 23 cases. Thus, the primary treatment for elderly patients with sarcoma should be surgery alone as no additional benefits were obtained when radiotherapy or chemotherapy was also performed. Adequate margins should be confirmed along with the histology of surgical specimens.
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Affiliation(s)
- Kazuhiko Hashimoto
- Department of Orthopedic Surgery, Kindai University Hospital, Osaka-Sayama, Osaka 589-8511, Japan
| | - Shunji Nishimura
- Department of Orthopedic Surgery, Kindai University Hospital, Osaka-Sayama, Osaka 589-8511, Japan
| | - Yukiko Hara
- Department of Orthopedic Surgery, Kindai University Hospital, Osaka-Sayama, Osaka 589-8511, Japan
| | - Naohiro Oka
- Department of Orthopedic Surgery, Kindai University Hospital, Osaka-Sayama, Osaka 589-8511, Japan
| | - Hiroki Tanaka
- Department of Orthopedic Surgery, Kindai University Hospital, Osaka-Sayama, Osaka 589-8511, Japan
| | - Shunki Iemura
- Department of Orthopedic Surgery, Kindai University Hospital, Osaka-Sayama, Osaka 589-8511, Japan
| | - Masao Akagi
- Department of Orthopedic Surgery, Kindai University Hospital, Osaka-Sayama, Osaka 589-8511, Japan
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12
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Okamoto M, Kito M, Yoshimura Y, Aoki K, Suzuki S, Tanaka A, Takazawa A, Yoshida K, Kato H. The status quo of treatment and clinical outcomes for patients over 80 years of age with high-grade soft tissue sarcoma: report from the soft tissue tumor registry in Japan. Jpn J Clin Oncol 2018; 48:900-905. [DOI: 10.1093/jjco/hyy118] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 07/31/2018] [Indexed: 12/21/2022] Open
Affiliation(s)
- Masanori Okamoto
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Munehisa Kito
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Yasuo Yoshimura
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Kaoru Aoki
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Shuichiro Suzuki
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Atsushi Tanaka
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Akira Takazawa
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Kazushige Yoshida
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Hiroyuki Kato
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
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Slump J, Hofer SO, Ferguson PC, Wunder JS, Griffin AM, Hoekstra HJ, Bastiaannet E, O'Neill AC. Flap choice does not affect complication rates or functional outcomes following extremity soft tissue sarcoma reconstruction. J Plast Reconstr Aesthet Surg 2018; 71:989-996. [DOI: 10.1016/j.bjps.2018.04.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 03/18/2018] [Accepted: 04/01/2018] [Indexed: 12/27/2022]
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14
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Tsuchie H, Emori M, Nagasawa H, Miyakoshi N, Murahashi Y, Mizushima E, Yamashita T, Shimada Y. The prognostic significance of surgical treatment for excessive elderly patients with soft tissue sarcoma. Int J Clin Oncol 2018; 23:775-782. [DOI: 10.1007/s10147-018-1255-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 02/20/2018] [Indexed: 10/17/2022]
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15
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Clinical outcomes of patients 80 years of age and older with soft tissue sarcoma. J Orthop Sci 2017; 22:951-957. [PMID: 28711412 DOI: 10.1016/j.jos.2017.06.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 06/11/2017] [Accepted: 06/26/2017] [Indexed: 02/09/2023]
Abstract
OBJECTIVES Although soft tissue sarcoma (STS) is rare, its incidence is increasing among older patients. Few studies have compared the outcomes between conservative and surgical treatments for STS patients aged ≥80 years. We assessed the outcomes of both treatments in this population and the association between older age and surgical outcome. METHODS We recruited consecutive patients with STS aged ≥80 years treated at our institution between January 2006 and May 2014. We recommended surgical resection for all patients without multiple distant metastases. Overall survival and sarcoma-specific survival were assessed using the Kaplan-Meier method. RESULTS Of the 39 patients with STS who presented at our institution, 37 were included in this analysis (19 men and 18 women with a median age of 85 [range 80-94] years). Tumors were classified as Stage IB (n = 3), IIA (n = 6), IIB (n = 3) or III (n = 24). Four patients underwent conservative therapy and 33 underwent surgical resection. The most common tumor site was the lower extremity, and the majority of tumors were classified as undifferentiated pleomorphic sarcoma. The follow-up rate was 100%. One-year sarcoma-specific survival rates were 25.0% in the conservative therapy group and 90.9% in the surgical resection group. No associations were found between age ≥85 years and perioperative complications or clinical outcome. CONCLUSIONS Surgical resection had relatively few complications, given the age group, and improved the prognosis of older patients with STS. Surgical resection of STS with curative intent should be considered in older patients.
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Woods RH, Potter JA, Reid JL, Louise J, Bessen T, Farshid G, Neuhaus SJ. Patterns of head and neck sarcoma in Australia. ANZ J Surg 2017; 88:901-906. [DOI: 10.1111/ans.14018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 02/15/2017] [Accepted: 03/04/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Roger H. Woods
- Department of Plastic Surgery; Royal Adelaide Hospital; Adelaide South Australia Australia
- Department of Plastic Surgery; Women's and Children's Hospital; North Adelaide South Australia Australia
| | - J. Alexa Potter
- Department of Plastic Surgery; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Jessica L. Reid
- Department of Surgery; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Jennie Louise
- The University of Adelaide; Adelaide South Australia Australia
| | - Taryn Bessen
- Department of Radiology; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Gelareh Farshid
- The University of Adelaide; Adelaide South Australia Australia
- SA Pathology; Adelaide South Australia Australia
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Andrä C, Klein A, Dürr HR, Rauch J, Lindner LH, Knoesel T, Angele M, Baur-Melnyk A, Belka C, Roeder F. External-beam radiation therapy combined with limb-sparing surgery in elderly patients (>70 years) with primary soft tissue sarcomas of the extremities : A retrospective analysis. Strahlenther Onkol 2017; 193:604-611. [PMID: 28229172 DOI: 10.1007/s00066-017-1109-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 01/27/2017] [Indexed: 12/30/2022]
Abstract
PURPOSE To report our experience with EBRT combined with limb-sparing surgery in elderly patients (>70 years) with primary extremity soft tissue sarcomas (STS). METHODS Retrospectively analyzed were 35 patients (m:f 18:17, median 78 years) who all presented in primary situation without nodal/distant metastases (Charlson score 0/1 in 18 patients; ≥2 in 17 patients). Median tumor size was 10 cm, mainly located in lower limb (83%). Stage at presentation (UICC7th) was Ib:3%, 2a:20%, 2b:20%, and 3:57%. Most lesions were high grade (97%), predominantly leiomyosarcoma (26%) and undifferentiated pleomorphic/malignant fibrous histiocytoma (23%). Limb-sparing surgery was preceded (median 50 Gy) or followed (median 66 Gy) by EBRT. RESULTS Median follow-up was 37 months (range 1-128 months). Margins were free in 26 patients (74%) and microscopically positive in 9 (26%). Actuarial 3‑ and 5‑year local control rates were 88 and 81% (4 local recurrences). Corresponding rates for distant control, disease-specific survival, and overall survival were 57/52%, 76/60%, and 72/41%. The 30-day mortality was 0%. Severe postoperative complications were scored in 8 patients (23%). Severe acute radiation-related toxicity was observed in 2 patients (6%). Patients with Charlson score ≥2 had a significantly increased risk for severe postoperative complications and acute radiation-related side effects. Severe late toxicities were found in 7 patients (20%), including fractures in 3 (8.6%). Final limb preservation rate was 97%. CONCLUSION Combination of EBRT and limb-sparing surgery is feasible in elderly patients with acceptable toxicities and encouraging but slightly inferior outcome compared to younger patients. Comorbidity correlated with postoperative complications and acute toxicities. Late fracture risk seems slightly increased.
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Affiliation(s)
- Claudia Andrä
- Department of Radiation Oncology, University Hospital of Munich (LMU), Marchioninistr. 15, 81377, Munich, Germany.
| | - Alexander Klein
- Department of Orthopedics, University Hospital of Munich (LMU), Munich, Germany
| | - Hans Roland Dürr
- Department of Orthopedics, University Hospital of Munich (LMU), Munich, Germany
| | - Josefine Rauch
- Department of Radiation Oncology, University Hospital of Munich (LMU), Marchioninistr. 15, 81377, Munich, Germany
| | - Lars Hartwin Lindner
- Deparment of Internal Medicine, University Hospital of Munich (LMU), Munich, Germany
| | - Thomas Knoesel
- Institute of Pathology, University Hospital of Munich (LMU), Munich, Germany
| | - Martin Angele
- Department of Surgery, University Hospital of Munich (LMU), Munich, Germany
| | - Andrea Baur-Melnyk
- Department of Radiology, University Hospital of Munich (LMU), Munich, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital of Munich (LMU), Marchioninistr. 15, 81377, Munich, Germany
| | - Falk Roeder
- Department of Radiation Oncology, University Hospital of Munich (LMU), Marchioninistr. 15, 81377, Munich, Germany.,CCU Molecular Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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18
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Tsuda Y, Ogura K, Kobayashi E, Hiruma T, Iwata S, Asano N, Kawai A, Chuman H, Ishii T, Morioka H, Kobayashi H, Kawano H. Impact of geriatric factors on surgical and prognostic outcomes in elderly patients with soft-tissue sarcoma. Jpn J Clin Oncol 2017; 47:422-429. [DOI: 10.1093/jjco/hyx016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 02/07/2017] [Indexed: 12/17/2022] Open
Affiliation(s)
- Yusuke Tsuda
- Department of Orthopedic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo
| | - Koichi Ogura
- Department of Orthopedic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo
- Division of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo
| | - Eisuke Kobayashi
- Division of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo
| | - Toru Hiruma
- Division of Musculoskeletal Tumor Surgery, Kanagawa Cancer Center, Kanagawa
| | - Shintaro Iwata
- Division of Orthopedic Surgery, Chiba Cancer Center, Chiba
| | - Naofumi Asano
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo
| | - Akira Kawai
- Division of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo
| | - Hirokazu Chuman
- Division of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo
| | - Takeshi Ishii
- Division of Orthopedic Surgery, Chiba Cancer Center, Chiba
| | - Hideo Morioka
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo
| | - Hiroshi Kobayashi
- Department of Orthopedic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo
| | - Hirotaka Kawano
- Department of Orthopedic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo
- Department of Orthopedic Surgery, Graduate School of Medicine, The University of Teikyo, Tokyo, Japan
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Hoven-Gondrie ML, Bastiaannet E, Ho VK, van Leeuwen BL, Liefers GJ, Hoekstra HJ, Suurmeijer AJH. Worse Survival in Elderly Patients with Extremity Soft-Tissue Sarcoma. Ann Surg Oncol 2016; 23:2577-85. [PMID: 26957498 PMCID: PMC4927613 DOI: 10.1245/s10434-016-5158-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Nearly half of soft-tissue sarcoma (STS) patients are over the age of 65, and the behavior of cancer in these elderly patients is poorly understood. The aim of this study was to assess the impact of age, sarcoma histotype, grade, stage, and treatment modalities on survival of extremity STS (ESTS) patients. METHODS Patients ≥18 years diagnosed with ESTS between 1989 and 2008 were selected from the Netherlands Cancer Registry. Survival rates and patient and treatment characteristics were analyzed for all patients. Relative survival and relative excess risk of death were estimated for young (<65 years) and older (>65 years) patients. RESULTS Overall, 3066 patients were included in this study. Histotype was different between young (<65 years) and elderly (>65 years) patients (p < 0.001). Patients over the age of 65 were more often diagnosed with high-stage ESTS and an increasing proportion of high-grade ESTS (p < 0.001). The proportion of patients who received no treatment increased with age, and the elderly received fewer combined-modality treatments. Age was significantly associated with relative 5-year survival [72.7 % for younger patients and 43.8 % for the oldest elderly (>85 years)]. In multivariable analysis, age still remained a significant prognostic factor. CONCLUSIONS Different distribution of sarcoma histotypes, more high-stage and high-grade sarcomas at diagnosis, less aggressive treatment, and worse survival rates emphasize the need for optimizing sarcoma research and care of the elderly.
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Affiliation(s)
- Miriam L. Hoven-Gondrie
- />Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Esther Bastiaannet
- />Department of Surgery, University of Leiden, Leiden University Medical Center, Leiden, The Netherlands
- />Department of Gerontology and Geriatrics, University of Leiden, Leiden University Medical Center, Leiden, The Netherlands
| | - Vincent K.Y. Ho
- />Comprehensive Cancer Center Netherlands, Utrecht, The Netherlands
| | - Barbara L. van Leeuwen
- />Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gerrit-Jan Liefers
- />Department of Surgery, University of Leiden, Leiden University Medical Center, Leiden, The Netherlands
| | - Harald J. Hoekstra
- />Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Albert J. H. Suurmeijer
- />Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Iwai T, Hoshi M, Takada J, Oebisu N, Aono M, Takami M, Ieguchi M, Nakamura H. Prognostic factors for elderly patients with primary malignant bone and soft tissue tumors. Oncol Lett 2015; 10:1799-1804. [PMID: 26622753 DOI: 10.3892/ol.2015.3432] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 06/11/2015] [Indexed: 12/27/2022] Open
Abstract
The number of patients with primary malignant bone and soft tissue tumors in Japan is increasing in line with the increasing size of the elderly population. The aim of the present study was to determine the prognostic factors of primary malignant bone or soft tissue tumors in elderly patients. Clinical data was obtained from 90 patients, aged ≥65 years, with primary malignant bone or soft tissue tumors (bone, 20 cases; and soft tissue, 70 cases), treated at the Osaka City University Hospital between 1993 and 2013. Clinical information prior to treatment and tumor type, location, size, depth, grade and American Society of Anesthesiologists-Physical Status (ASA-PS) score were evaluated in order to identify prognostic factors using the Cox proportional hazards regression model. In addition, 5-year survival rates were evaluated using the Kaplan-Meier method. The average follow-up period was 44.8 months and the 5-year overall survival rate was 77.5%. In the multivariate analysis, ASA-PS score and high-grade sarcoma were found to be associated with a poorer overall survival. No significant differences were observed between the patient group aged 65-74 years and that aged ≥75 years. In general, aging is associated with physically reduced function and an increased prevalence of comorbidities. It was therefore expected that increasing age may be a predictive factor for poor prognosis. However, the results of the present study suggested that ASA-PS score and tumor grade were significant factors associated with poor prognosis, whereas increasing age was not. Therefore, the treatment of elderly patients with primary bone and soft tissue tumors should not be based on age.
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Affiliation(s)
- Tadashi Iwai
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Abeno-Ku, Osaka 545-8585, Japan
| | - Manabu Hoshi
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Abeno-Ku, Osaka 545-8585, Japan
| | - Jun Takada
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Abeno-Ku, Osaka 545-8585, Japan
| | - Naoto Oebisu
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Abeno-Ku, Osaka 545-8585, Japan
| | - Masanari Aono
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Abeno-Ku, Osaka 545-8585, Japan
| | - Masatsugu Takami
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Abeno-Ku, Osaka 545-8585, Japan
| | - Makoto Ieguchi
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Abeno-Ku, Osaka 545-8585, Japan
| | - Hiroaki Nakamura
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Abeno-Ku, Osaka 545-8585, Japan
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CORR Insights: What is the effect of advanced age and comorbidity on postoperative morbidity and mortality after musculoskeletal tumor surgery? Clin Orthop Relat Res 2014; 472:3979-81. [PMID: 25227558 PMCID: PMC4397761 DOI: 10.1007/s11999-014-3951-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 09/09/2014] [Indexed: 01/31/2023]
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22
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What is the effect of advanced age and comorbidity on postoperative morbidity and mortality after musculoskeletal tumor surgery? Clin Orthop Relat Res 2014; 472:3971-8. [PMID: 25138472 PMCID: PMC4397778 DOI: 10.1007/s11999-014-3889-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Accepted: 08/07/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although the elderly population is increasing rapidly, little information is available regarding how the risk of postoperative mortality and morbidity increases when combined with age and comorbidity burden in patients undergoing musculoskeletal tumor surgery. QUESTIONS/PURPOSES We evaluated the effect of age and comorbidity burden on the (1) postoperative complication rate and (2) in-hospital mortality rate after musculoskeletal tumor surgery. METHODS We identified 5716 patients undergoing musculoskeletal tumor surgery during 2007 to 2012 using a Japanese national inpatient database. Logistic regression analyses were performed to examine the relationships of various factors with the rates of mortality and morbidity. RESULTS The postoperative complication rate (6.7%) was associated with male sex (p = 0.033), age 80 years or older (p = 0.001), tumor located in the lower extremity (p = 0.001) or trunk (p = 0.019), Charlson Comorbidity Index of 4 or greater (p < 0.001), blood transfusion (p < 0.001), and duration of anesthesia of 240 minutes or longer (p < 0.001). The in-hospital mortality (0.8%) was related to the Charlson Comorbidity Index of 4 or greater (p < 0.001), blood transfusion (p < 0.001), and high hospital volume (p = 0.016). The morbidity (21.6%; OR, 3.29; p < 0.001) and mortality (4.1%; OR, 5.95; p < 0.001) in patients 80 years or older with a Charlson Comorbidity Index of 4 or greater was increased three and six times, respectively, compared with patients 64 years or younger with no comorbidity. CONCLUSIONS We found that age and comorbidity burden together greatly increased the risk of morbidity and mortality. Our study showed quantitative evidence that will assist physicians in assessing perioperative risk accurately and provide a more informative explanation to elderly patients undergoing musculoskeletal tumor surgery. LEVEL OF EVIDENCE Level IV, prognostic study. See the Instructions for Authors for a complete description of levels of evidence.
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Favorable outcome after complete resection in elderly soft tissue sarcoma patients: Japanese Musculoskeletal Oncology Group study. Eur J Surg Oncol 2014; 40:49-54. [DOI: 10.1016/j.ejso.2013.09.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 08/31/2013] [Accepted: 09/01/2013] [Indexed: 11/21/2022] Open
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Garbay D, Maki RG, Blay JY, Isambert N, Piperno Neumann S, Blay C, Zanardi E, Boudou-Rouquette P, Bozec L, Duffaud F, Bertucci F, Italiano A. Advanced soft-tissue sarcoma in elderly patients: patterns of care and survival. Ann Oncol 2013; 24:1924-1930. [PMID: 23493135 DOI: 10.1093/annonc/mdt059] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND There are no data regarding the management of advanced soft-tissue sarcoma (STS) in elderly patients. PATIENTS AND METHODS We retrospectively reviewed the charts of patients ≥75 years old diagnosed with metastatic or unresectable STS between 1991 and 2011 in 11 French and American centers. RESULTS The study included 361 patients. Of these, 223 patients (62%) received systemic therapy, whereas 123 patients (34%) were managed with best supportive care (BSC) only. Patients who received BSC were more likely to be ≥80 years, with performance status (PS) ≥ 2, Charlson comorbidity score ≥ 10, and metastatic disease. The median progression-free survival of patients treated with systemic therapy was 4 months (95% CI: 2.9-5.1). Thirty-six patients (16%) stopped chemotherapy because of toxicity. Median overall survival (OS) of patients managed with specific therapy was 10.9 months (95% CI: 8.3-13.5) versus 5.3 months (95% CI: 3.6-7.1) for patients managed with BSC (P = 0.001). On multivariate analysis, age ≥ 80 years, PS ≥ 2, and number of metastatic sites were the only independent factors associated with OS. CONCLUSION A high proportion of elderly patients with advanced STS were denied chemotherapy. Further efforts are needed to define better the optimal care for fit and unfit elderly patients with STS.
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Affiliation(s)
- D Garbay
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - R G Maki
- Memorial Sloan Kettering Cancer Center, New York, USA
| | - J Y Blay
- Department of Medicine, Centre Léon Bérard, Lyon
| | - N Isambert
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon
| | | | - C Blay
- Department of Medical Oncology, Centre Eugène Marquis, Rennes
| | - E Zanardi
- Department of Medicine, Institut Gustave Roussy, Villejuif
| | | | - L Bozec
- Department of Medical Oncology, Institut Curie, Paris
| | - F Duffaud
- Department of Medical Oncology, Hopital La Timone, Marseille
| | - F Bertucci
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - A Italiano
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France.
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Styring E, Billing V, Hartman L, Nilbert M, Seinen JM, Veurink N, Vult von Steyern F, Rydholm A. Simple guidelines for efficient referral of soft-tissue sarcomas: a population-based evaluation of adherence to guidelines and referral patterns. J Bone Joint Surg Am 2012; 94:1291-6. [PMID: 22810399 DOI: 10.2106/jbjs.k.01271] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Optimal treatment of soft-tissue sarcoma requires multidisciplinary management at a sarcoma center. However, these rare tumors are often misinterpreted as benign and many are inadequately treated outside a sarcoma center, with an increased risk of local recurrence that often requires further extensive surgical treatment. To improve referral and centralization of soft-tissue sarcoma management in the southern Sweden health care region, an open-access outpatient clinic at our sarcoma center and simple referral guidelines have been established for the past thirty years. The guidelines call for referral of all deep-seated soft-tissue tumors and of all ≥5-cm superficial tumors before open biopsy or surgery. We evaluated adherence to these guidelines and characterized referral patterns. We also studied the consequences of our strategy with regard to the relative numbers of benign and malignant diagnoses among referred patients. METHODS Adherence to guidelines, referral pathways, and time to referral to the sarcoma center were analyzed in a population-based series of 100 consecutive patients with soft-tissue sarcoma in the extremities or trunk wall. We also analyzed diagnosis and management of benign and malignant tumors in a second cohort consisting of 464 consecutive patients referred to the sarcoma center because of a soft-tissue tumor. RESULTS Ninety-seven of the 100 patients with soft-tissue sarcoma were referred to the sarcoma center. All fifty-eight of the deep-seated soft-tissue sarcomas and twenty-eight of the forty-two superficial tumors were referred before open biopsy or surgery. Three-quarters of the patients with soft-tissue sarcoma first presented to a general practitioner. One-quarter of these patients were directly referred to the sarcoma center, which cut the referral time in half compared with patients initially referred to a local hospital. One-quarter of all patients referred to the outpatient clinic were diagnosed with a malignancy, with the majority of the malignancies being soft-tissue sarcoma. CONCLUSIONS Our simple referral guidelines and open-access outpatient clinic resulted in nearly complete referral of patients with soft-tissue sarcoma to the sarcoma center. The "excess work" associated with referral of benign tumors according to our strategy was limited to the diagnosis of three benign tumors for each malignant tumor. We consider this surplus evaluation of benign tumors acceptable and probably necessary to achieve a high referral rate of soft-tissue sarcoma before initial surgery. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- E Styring
- Departments of Orthopedics, Institute of Clinical Sciences, Skåne University Hospital in Lund, SE-22185 Lund, Sweden
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Biau DJ, Ferguson PC, Turcotte RE, Chung P, Isler MH, Riad S, Griffin AM, Catton CN, O'Sullivan B, Wunder JS. Adverse Effect of Older Age on the Recurrence of Soft Tissue Sarcoma of the Extremities and Trunk. J Clin Oncol 2011; 29:4029-35. [DOI: 10.1200/jco.2010.34.0711] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To examine the effect of age on the recurrence of soft tissue sarcoma in the extremities and trunk. Patients and Methods This was a multicenter study that included 2,385 patients with median age at surgery of 57 years. The end points considered were local recurrence and metastasis. Cox proportional hazards models were used to estimate hazard ratios across the age ranges with and without adjustment for known confounding factors. Results Older patients presented with tumors that were larger (P < .001) and of higher grade (P < .001). The proportion of positive margins increased significantly as patients age (P < .001), but radiation therapy was relatively underused in patients older than age 60 years. The 5-year cumulative incidences of local recurrence were 7.2% (95% CI, 4% to 11.7%) for patients age 30 years or younger and 12.9% (95% CI, 9.1% to 17.5%) for patients age 75 years or older. The corresponding 5-year cumulative incidences of metastasis were 17.5% (95% CI, 12.1% to 23.7%) and 33.9% (95% CI, 28.1% to 39.8%) for the same groups. Regression models showed that age was significantly associated with local recurrence (P < .001) and metastasis (P < .001) in nonadjusted models. After adjusting for imbalance in presentation and treatment variables, age remained significantly associated with local recurrence (P = .031) and metastasis (P = .019). Conclusion Older patients have worse outcomes because they tend to present with worse tumors and are treated less aggressively. However, there remained a significant increase in the risk of both local and systemic recurrence associated with increasing age that could not be explained by tumor or treatment characteristics.
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Affiliation(s)
- David J. Biau
- David J. Biau, Peter C. Ferguson, Soha Riad, Anthony M. Griffin, and Jay S. Wunder, Mount Sinai Hospital, Princess Margaret Hospital, and University of Toronto; Peter Chung, Charles N. Catton, and Brian O'Sullivan, Princess Margaret Hospital, University of Toronto, Toronto, Ontario; Robert E. Turcotte, McGill University Health Centre; and Marc H. Isler, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Peter C. Ferguson
- David J. Biau, Peter C. Ferguson, Soha Riad, Anthony M. Griffin, and Jay S. Wunder, Mount Sinai Hospital, Princess Margaret Hospital, and University of Toronto; Peter Chung, Charles N. Catton, and Brian O'Sullivan, Princess Margaret Hospital, University of Toronto, Toronto, Ontario; Robert E. Turcotte, McGill University Health Centre; and Marc H. Isler, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Robert E. Turcotte
- David J. Biau, Peter C. Ferguson, Soha Riad, Anthony M. Griffin, and Jay S. Wunder, Mount Sinai Hospital, Princess Margaret Hospital, and University of Toronto; Peter Chung, Charles N. Catton, and Brian O'Sullivan, Princess Margaret Hospital, University of Toronto, Toronto, Ontario; Robert E. Turcotte, McGill University Health Centre; and Marc H. Isler, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Peter Chung
- David J. Biau, Peter C. Ferguson, Soha Riad, Anthony M. Griffin, and Jay S. Wunder, Mount Sinai Hospital, Princess Margaret Hospital, and University of Toronto; Peter Chung, Charles N. Catton, and Brian O'Sullivan, Princess Margaret Hospital, University of Toronto, Toronto, Ontario; Robert E. Turcotte, McGill University Health Centre; and Marc H. Isler, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Marc H. Isler
- David J. Biau, Peter C. Ferguson, Soha Riad, Anthony M. Griffin, and Jay S. Wunder, Mount Sinai Hospital, Princess Margaret Hospital, and University of Toronto; Peter Chung, Charles N. Catton, and Brian O'Sullivan, Princess Margaret Hospital, University of Toronto, Toronto, Ontario; Robert E. Turcotte, McGill University Health Centre; and Marc H. Isler, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Soha Riad
- David J. Biau, Peter C. Ferguson, Soha Riad, Anthony M. Griffin, and Jay S. Wunder, Mount Sinai Hospital, Princess Margaret Hospital, and University of Toronto; Peter Chung, Charles N. Catton, and Brian O'Sullivan, Princess Margaret Hospital, University of Toronto, Toronto, Ontario; Robert E. Turcotte, McGill University Health Centre; and Marc H. Isler, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Anthony M. Griffin
- David J. Biau, Peter C. Ferguson, Soha Riad, Anthony M. Griffin, and Jay S. Wunder, Mount Sinai Hospital, Princess Margaret Hospital, and University of Toronto; Peter Chung, Charles N. Catton, and Brian O'Sullivan, Princess Margaret Hospital, University of Toronto, Toronto, Ontario; Robert E. Turcotte, McGill University Health Centre; and Marc H. Isler, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Charles N. Catton
- David J. Biau, Peter C. Ferguson, Soha Riad, Anthony M. Griffin, and Jay S. Wunder, Mount Sinai Hospital, Princess Margaret Hospital, and University of Toronto; Peter Chung, Charles N. Catton, and Brian O'Sullivan, Princess Margaret Hospital, University of Toronto, Toronto, Ontario; Robert E. Turcotte, McGill University Health Centre; and Marc H. Isler, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Brian O'Sullivan
- David J. Biau, Peter C. Ferguson, Soha Riad, Anthony M. Griffin, and Jay S. Wunder, Mount Sinai Hospital, Princess Margaret Hospital, and University of Toronto; Peter Chung, Charles N. Catton, and Brian O'Sullivan, Princess Margaret Hospital, University of Toronto, Toronto, Ontario; Robert E. Turcotte, McGill University Health Centre; and Marc H. Isler, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Jay S. Wunder
- David J. Biau, Peter C. Ferguson, Soha Riad, Anthony M. Griffin, and Jay S. Wunder, Mount Sinai Hospital, Princess Margaret Hospital, and University of Toronto; Peter Chung, Charles N. Catton, and Brian O'Sullivan, Princess Margaret Hospital, University of Toronto, Toronto, Ontario; Robert E. Turcotte, McGill University Health Centre; and Marc H. Isler, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
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Al-Refaie WB, Habermann EB, Dudeja V, Vickers SM, Tuttle TM, Jensen EH, Virnig BA. Extremity Soft Tissue Sarcoma Care in the Elderly: Insights into the Generalizability of NCI Cancer Trials. Ann Surg Oncol 2010; 17:1732-8. [DOI: 10.1245/s10434-010-1034-z] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Indexed: 01/02/2023]
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Lahat G, Dhuka AR, Lahat S, Lazar AJ, Lewis VO, Lin PP, Feig B, Cormier JN, Hunt KK, Pisters PWT, Pollock RE, Lev D. Complete Soft Tissue Sarcoma Resection is a Viable Treatment Option for Select Elderly Patients. Ann Surg Oncol 2009; 16:2579-86. [DOI: 10.1245/s10434-009-0574-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2009] [Revised: 05/20/2009] [Accepted: 05/22/2009] [Indexed: 11/18/2022]
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