Extremity soft tissue sarcoma in the elderly: Are we overtreating or undertreating this potentially vulnerable patient population?

Alicia A. Gingrich, Sarah B. Bateni, Arta M Monjazeb, Steven W. Thorpe, Amanda Kirane, Richard J Bold, Robert J Canter

Research output: Contribution to journalArticle

Abstract

Background: As the U.S. population ages, differences in oncologic outcomes among the elderly have been recognized. Our objective was to analyze the clinical, pathologic, and treatment outcomes for elderly soft tissue sarcoma (STS) patients, hypothesizing significant differences in the management and response to therapy. Methods: Using the National Cancer Database, we identified 33 859 patients with nonmetastatic extremity STS. We defined elderly as ≥74 years in age and compared patient and treatment variables between adult and elderly patients. Cox-proportional hazards analysis was used to determine predictors of overall survival (OS). Results: We identified 8504 elderly patients. Significant differences in histologic subtype, grade, and facility type between elderly and nonelderly patients (P < 0.05) exist. Elderly patients were less likely to undergo R0 resection (P = 0.001) and had a higher 90-day mortality (P = 0.001). Surgical elderly patients experienced superior OS compared with nonsurgical patients (P = 0.001). Among elderly patients, younger age, and female sex, lower Charlson-Deyo score, lower grade, smaller tumors, surgical resection, negative surgical margins, and radiation therapy were associated with better OS. Conclusions: Key differences exist in elderly extremity STS patients, including a narrower benefit/risk ratio with surgical management. These data highlight that elderly patients represent a distinct cohort for whom more careful selection appears indicated.

Original languageEnglish (US)
Pages (from-to)1087-1098
Number of pages12
JournalJournal of Surgical Oncology
Volume119
Issue number8
DOIs
StatePublished - Jun 15 2019

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Vulnerable Populations
Sarcoma
Extremities
Survival
Neoplasms
Radiotherapy
Odds Ratio
Databases

Keywords

  • elderly
  • soft tissue sarcoma
  • surgical resection
  • survival

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Extremity soft tissue sarcoma in the elderly : Are we overtreating or undertreating this potentially vulnerable patient population? / Gingrich, Alicia A.; Bateni, Sarah B.; Monjazeb, Arta M; Thorpe, Steven W.; Kirane, Amanda; Bold, Richard J; Canter, Robert J.

In: Journal of Surgical Oncology, Vol. 119, No. 8, 15.06.2019, p. 1087-1098.

Research output: Contribution to journalArticle

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