Chemotherapy and Survival in Patients with Primary High-Grade Extremity and Trunk Soft Tissue Sarcoma.
Chemotherapy and Survival in Patients with Primary High-Grade Extremity and Trunk Soft Tissue Sarcoma.
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DOI：
10.3390/cancers12092389
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发表时间：
2020-08-24
期刊：
影响因子：
5.2
通讯作者：
Kalbasi A
中科院分区：
文献类型：
--
作者：
Graham DS;van Dams R;Jackson NJ;Onyshchenko M;Eckardt MA;DiPardo BJ;Nelson SD;Chmielowski B;Shabason JE;Singh AS;Eilber FC;Kalbasi A
对于四肢和躯干的原发性局限性软组织肉瘤 (STS) 是否使用前期化疗尚存在争议。目前尚不清楚化疗是否会增加临床获益、哪些患者可能受益，以及治疗时机是否会影响结果。我们使用国家癌症数据库 (NCDB) 检查了 5436 名患有五种最常见 STS 亚型且原发疾病局限于四肢或躯干的患者的总生存期 (OS) 与化疗之间的关联，这反映了新辅助化疗现代 3 期临床试验的患者群体。然后我们检查了多药化疗（新辅助或辅助）时机与 OS 之间的关联。我们使用 Cox 比例风险模型和倾向评分匹配 (PSM) 来解释包括人口统计、患者、临床、治疗和设施因素在内的协变量。在整个队列中，我们观察到多药化疗或其时机与 OS 改善之间没有关联。多药化疗与多个亚组的 OS 改善相关，包括肿瘤较大（> 5 cm）的患者、在大容量中心接受治疗的患者或接受放疗的患者。我们还发现老年人（> 70 岁）和非裔美国患者的 OS 受益于多药化疗。对于肿瘤>5厘米、接受放疗或在大容量中心接受护理的患者，多药化疗与提高生存率相关。较年轻的年龄和化疗时机均与更好的结果无关。这些“真实世界”的发现与最近的随机试验数据相一致，这些数据支持在患有局部 STS 的高危患者中使用多药化疗。
The use of upfront chemotherapy for primary localized soft tissue sarcoma (STS) of the extremity and trunk is debated. It remains unclear if chemotherapy adds clinical benefit, which patients are likely to benefit, and whether the timing of therapy affects outcomes. We used the National Cancer Database (NCDB) to examine the association between overall survival (OS) and chemotherapy in 5436 patients with the five most common subtypes of STS with primary disease localized to the extremity or trunk, mirroring the patient population of a modern phase 3 clinical trial of neoadjuvant chemotherapy. We then examined associations between timing of multi-agent chemotherapy (neoadjuvant or adjuvant) and OS. We used a Cox proportional hazards model and propensity score matching (PSM) to account for covariates including demographic, patient, clinical, treatment, and facility factors. In the overall cohort, we observed no association between multi-agent chemotherapy or its timing and improved OS. Multi-agent chemotherapy was associated with improved OS in several subgroups, including patients with larger tumors (>5 cm), those treated at high-volume centers, or those who received radiation. We also identified an OS benefit to multi-agent chemotherapy among the elderly (>70 years) and African American patients. Multi-agent chemotherapy was associated with improved survival for patients with tumors >5 cm, who receive radiation, or who receive care at high-volume centers. Neither younger age nor chemotherapy timing was associated with better outcomes. These ‘real-world’ findings align with recent randomized trial data supporting the use of multi-agent chemotherapy in high-risk patients with localized STS.
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影响因子：
50.5
作者：
Le Cesne, A.;Ouali, M.;Van der Graaf, W. T. A.
通讯作者：
Van der Graaf, W. T. A.
影响因子：
45.3
作者：
Frustaci, S;Gherlinzoni, F;Picci, P
通讯作者：
Picci, P
影响因子：
45.3
作者：
Bilimoria, Karl Y.;Bentrem, David J.;Ko, Clifford Y.
通讯作者：
Ko, Clifford Y.
影响因子：
3.7
作者：
Beane JD;Yang JC;White D;Steinberg SM;Rosenberg SA;Rudloff U
通讯作者：
Rudloff U
影响因子：
8.4
作者：
Gortzak, E;Azzarelli, A;Verweij, J
通讯作者：
Verweij, J