Chemotherapy and Survival in Patients with Primary High-Grade Extremity and Trunk Soft Tissue Sarcoma
| Autor: | Fritz C. Eilber, Nicholas Jackson, Anusha Kalbasi, Arun S. Singh, Scott D. Nelson, Mark A. Eckardt, Danielle S. Graham, Mykola Onyshchenko, Benjamin J DiPardo, Jacob E. Shabason, Bartosz Chmielowski, Ritchell van Dams |
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| Rok vydání: | 2020 |
| Předmět: |
0301 basic medicine
Oncology Cancer Research medicine.medical_specialty medicine.medical_treatment Oncology and Carcinogenesis Phases of clinical research chemotherapy lcsh:RC254-282 Article law.invention surgery 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law Clinical Research Internal medicine Medicine Cancer Chemotherapy business.industry Proportional hazards model Soft tissue sarcoma Evaluation of treatments and therapeutic interventions medicine.disease lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens radiation 030104 developmental biology National Cancer Database 030220 oncology & carcinogenesis soft tissue sarcoma 6.1 Pharmaceuticals Cohort Propensity score matching business |
| Zdroj: | Cancers, vol 12, iss 9 Cancers Volume 12 Issue 9 Cancers, Vol 12, Iss 2389, p 2389 (2020) |
| Popis: | 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 &lsquo real-world&rsquo findings align with recent randomized trial data supporting the use of multi-agent chemotherapy in high-risk patients with localized STS. |
| Databáze: | OpenAIRE |
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