TY - JOUR
T1 - Age-related differences of oncological outcomes in primary extremity soft tissue sarcoma
T2 - a multistate model including 6260 patients
AU - PERSARC Study Group
AU - Acem, Ibtissam
AU - Verhoef, Cornelis
AU - Rueten-Budde, Anja J.
AU - Grünhagen, Dirk J.
AU - van Houdt, Winan J.
AU - van de Sande, Michiel A.J.
AU - Aston, Will
AU - Bonenkamp, Han
AU - Desar, Ingrid M.E.
AU - Ferguson, Peter C.
AU - Fiocco, Marta
AU - Gelderblom, Hans
AU - van Ginkel, Robert J.
AU - van der Graaf, Winette
AU - Griffin, Anthony M.
AU - Haas, Rick L.
AU - van der Hage, Jos A.
AU - Hayes, Andrew J.
AU - Jeys, Lee M.
AU - Keller, Johnny
AU - Laitinen, Minna K.
AU - Leithner, Andreas
AU - Maretty-Kongstad, Katja
AU - Ozaki, Toshifumi
AU - Pollock, Rob
AU - van Praag, Veroniek M.
AU - Smith, Myles J.
AU - Smolle, Maria A.
AU - Styring, Emelie
AU - Szkandera, Joanna
AU - Tanaka, Kazuhiro
AU - Tunn, Per Ulf
AU - Willegger, Madeleine
AU - Windhager, Reinard
AU - Wunder, Jay S.
AU - Zaikova, Olga
N1 - Publisher Copyright:
© 2020 The Authors
PY - 2020/12
Y1 - 2020/12
N2 - 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.
AB - 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.
KW - Adolescents and young adults
KW - Elderly
KW - Extremities
KW - Metastasis
KW - Middle-aged
KW - Recurrence
KW - Soft tissue sarcoma
KW - Survival
UR - http://www.scopus.com/inward/record.url?scp=85094210534&partnerID=8YFLogxK
U2 - 10.1016/j.ejca.2020.09.021
DO - 10.1016/j.ejca.2020.09.021
M3 - Article
C2 - 33137588
AN - SCOPUS:85094210534
SN - 0959-8049
VL - 141
SP - 128
EP - 136
JO - European Journal of Cancer
JF - European Journal of Cancer
ER -