University of Heidelberg, Mannheim University Medical Center, Mannheim, Germany.
Eur J Cancer. 2013 Jan;49(2):449-56. doi: 10.1016/j.ejca.2012.08.007. Epub 2012 Sep 10.
We conducted a retrospective study, pooling data from two clinical trials in high risk soft tissue sarcoma (STS) patients, with the objective of comparing two different age groups: 15-29 years (adolescents and young adults (AYA) population) and ≥ 30 years. The aim was to determine prognostic factors for the AYA population.
Patients selected for analysis were treated in two randomised trials of adjuvant chemotherapy in STS (European Organisation for Research and Treatment of Cancer (EORTC) 62771 and 62931). A total of 793 patients were included with a median follow-up (FU) of 8.74 years (AYA population: n=161, median FU 9.46 years; patients ≥ 30 years: n=632, median FU 8.62 years). Study endpoints were overall survival (OS) and relapse-free survival (RFS). The variables of the multivariate analysis were gender, subtype and grade, tumour size and localisation (limb versus other), absence or presence of local recurrence and treatment (control arm versus adjuvant chemotherapy).
Patients' characteristics were globally similar with two exceptions, histological subtype (p=0.0043) and tumour size (p<.0001). The commonest sarcoma subtype in the AYA population was synovial sarcoma (29%), whereas leiomyosarcoma (18%), malignant fibrous histiocytoma (MFH, presently being termed undifferentiated pleomorphic sarcoma (UPS), 16%) and liposarcoma (15%) were more frequent in patients ≥ 30 years. For OS, independent favourable prognostic factors were low grade and small tumour size for both groups; radical resection and MFH or liposarcoma subtype were favourable factors for patients ≥ 30 years only. For RFS, favourable prognostic factors were small tumour size and low grade for both groups; tumour location in the extremities was a favourable factor for the AYA population only, whereas radical resection and adjuvant chemotherapy treatment were favourable factors for patients ≥ 30y ears only.
Significant differences could be found concerning prognostic factors between the AYA population and older patients. Interestingly, adjuvant chemotherapy was associated with improved RFS only in patients ≥ 30 years. The results may have further implications for the treatment of STS patients in different age groups, as well as the design of future clinical trials.
我们进行了一项回顾性研究，将两个高危软组织肉瘤（STS）患者临床试验的数据进行了汇总，目的是比较两个不同的年龄组：15-29 岁（青少年和年轻成人（AYA）人群）和≥30 岁。目的是确定 AYA 人群的预后因素。
选择分析的患者接受了 STS 辅助化疗的两项随机试验（欧洲癌症研究与治疗组织（EORTC）62771 和 62931）的治疗。共纳入 793 例患者，中位随访（FU）时间为 8.74 年（AYA 人群：n=161，中位 FU 9.46 年；≥30 岁患者：n=632，中位 FU 8.62 年）。研究终点是总生存（OS）和无复发生存（RFS）。多变量分析的变量为性别、亚型和分级、肿瘤大小和定位（肢体与其他部位）、是否存在局部复发以及治疗（对照组与辅助化疗）。
患者的特征总体上相似，但有两个例外，组织学亚型（p=0.0043）和肿瘤大小（p<.0001）。AYA 人群中最常见的肉瘤亚型是滑膜肉瘤（29%），而平滑肌肉瘤（18%）、恶性纤维组织细胞瘤（MFH，现为未分化多形性肉瘤（UPS），16%）和脂肪肉瘤（15%）在≥30 岁的患者中更为常见。对于 OS，独立的有利预后因素是两组的低分级和肿瘤小；根治性切除和 MFH 或脂肪肉瘤亚型是≥30 岁患者的有利因素。对于 RFS，有利的预后因素是两组的肿瘤小和低分级；肿瘤位于四肢是 AYA 人群的有利因素，而根治性切除和辅助化疗是≥30 岁患者的有利因素。
在预后因素方面，AYA 人群与老年患者之间存在显著差异。有趣的是，辅助化疗仅与≥30 岁患者的 RFS 改善相关。这些结果可能对不同年龄组 STS 患者的治疗以及未来临床试验的设计有进一步的影响。
