Patterns of Chemotherapy Administration in High-Risk Soft Tissue Sarcoma and Impact on Overall Survival
Patterns of Chemotherapy Administration in High-Risk Soft Tissue Sarcoma and Impact on Overall Survival
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DOI：
10.6004/jnccn.2015.0165
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发表时间：
2015-11-01
影响因子：
13.4
通讯作者：
Handorf, Elizabeth
中科院分区：
文献类型：
--
作者：
Movva, Sujana;von Mehren, Margaret;Handorf, Elizabeth
背景：关于化疗在高危软组织肉瘤（STS）治疗中的益处，存在明确的数据。化疗的使用可能取决于患者、肿瘤和设施的特征。本研究试图确定这些因素，并比较治疗组之间的生存率。患者和方法：从1998年至2012年的国家癌症数据库（NCDB）中确定了III期STS患者。采用多元Logistic回归分析确定影响接受化疗概率的因素。在一个患者亚组中，我们使用Kaplan-Meier曲线和考克斯回归分析（调整倾向评分）确定化疗与总生存率之间的关系。我们还研究了化疗的影响，组织学亚组使用相互作用模型。结果：共纳入16，370例患者（生存分析N = 5，377）。年龄小于40岁、男性、有私人保险、收入较高、无合并症、患有滑膜肉瘤、血管肉瘤或“其他”组织学疾病、肿瘤高度、大于10 cm或来自下肢的患者更有可能接受化疗。非化疗组和化疗组的中位未校正总生存期（OS）分别为51.3和82.7个月（P <0.001）。经校正分析，生存获益仍然显著（风险比[HR]，0.85; P = 0.004）。未分化多形性肉瘤（UPS）组调整后的获益尤其明显，非化疗组与化疗组的中位OS分别为49.1和77.8个月（HR，0.77; P = 0.02）。结论：除了预期的肿瘤和患者因素外，组织学、原发肿瘤的位置和社会经济状况与III期STS接受/未接受化疗相关。在总体人群中，化疗的使用与OS改善相关，特别是在UPS亚组中。（J Natl Compr CancNetw 2015;13：1366-1374）
Background: Conflicting data exist on the benefit of chemotherapy in the management of high-risk soft tissue sarcoma (STS). Use of chemotherapy may be dependent on patient, tumor, and facility characteristics. This study sought to identify these factors and compare survival between treatment groups. Patients and Methods: Patients with stage III STS were identified from the National Cancer Data Base (NCDB) from 1998 to 2012. Multiple logistic regression analysis was used to determine factors that influenced the probability of receiving chemotherapy. In a subset of patients, we determined the relationship between chemotherapy use and overall survival, using Kaplan-Meier curves and Cox regression analysis with propensity score adjustment. We also examined the effect of chemotherapy by histologic subgroup using interaction models. Results: A total of 16,370 patients were included (N = 5,377 for survival analysis). Patients who were younger than 40 years; male; yprivately insured; earned a higher income; had no comorbidities; had synovial sarcoma, angiosarcoma or "other" histology; and whose tumors were high-grade, greater than 10 cm, or from the lower extremity were significantly more likely to receive chemotherapy. Median unadjusted overall survival (OS) in the nonchemotherapy and chemotherapy groups was 51.3 and 82.7 months, respectively (P < .001). On adjusted analysis, the survival benefit remained significant (hazard ratio [HR], 0.85; P = .004). The benefit was particularly strong in the undifferentiated pleomorphic sarcoma (UPS) group on adjustment, with a median OS of 49.1 and 77.8 months for nonchemotherapy versus chemotherapy, respectively (HR, 0.77; P = .02). Conclusions: In addition to expected tumor and patient factors, histology, location of primary tumor, and socioeconomic status are associated with receipt/nonreceipt of chemotherapy in stage III STS. Chemotherapy use was associated with improved OS in the overall population, and specifically in the UPS subgroup. (J Natl Compr Canc Netw 2015;13:1366-1374)