Verma Vivek, Denniston Kyle A, Lin Christopher J, Lin Chi
Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, USA.
Department of Radiation Oncology, St. Peter's Health Partners, Albany, NY, USA.
Front Oncol. 2017 May 8;7:82. doi: 10.3389/fonc.2017.00082. eCollection 2017.
This study sought to identify differences in clinical characteristics, outcomes, and treatments between adult and pediatric patients with the Ewing sarcoma family of tumors (ESFT).
By using the Surveillance, Epidemiology, and End Results database from 1983 to 2013, 1,870 patients were analyzed ( = 976 pediatric, = 894 adult). Between the two groups, demographic, tumor, and treatment characteristics were collated and compared. The chi-square test determined differences in proportions of the variables between groups. Survival analysis was performed using the Kaplan-Meier method; distributions were compared using the log-rank test. Univariate and multivariate analyses were performed to examine variables correlating with overall survival (OS), the primary endpoint.
Adult patients had a poorer prognosis and were more likely to present with primitive neuroectodermal tumor (PNET) histology, along with distant metastasis and soft tissue primary site. In patients undergoing surgery, radiation therapy (RT) was not associated with higher OS in either children or adults. If no surgery was performed, receipt of RT was associated with higher OS in adults but not children. Adulthood negatively correlated with OS on multivariate analysis when adjusting for potential confounding factors. Other salient factors associated with OS were male gender, metastatic disease, non-extremity bone location, treatment era, and PNET histology. However, when examining the most recent subset (patients treated from 2004 to 2013), RT was associated with improved OS in both pediatrics and adults, which was an independent predictor on multivariate analysis.
Adult patients with ESFT have inferior survival compared to pediatric patients, likely related to earlier clinical detection in the latter.
本研究旨在确定尤因肉瘤家族性肿瘤(ESFT)成年患者与儿科患者在临床特征、治疗结果及治疗方法上的差异。
利用1983年至2013年的监测、流行病学及最终结果数据库,对1870例患者进行分析(儿科患者976例,成年患者894例)。整理并比较两组患者的人口统计学、肿瘤及治疗特征。采用卡方检验确定两组间变量比例的差异。使用Kaplan-Meier方法进行生存分析;采用对数秩检验比较分布情况。进行单因素和多因素分析以检验与总生存期(OS)这一主要终点相关的变量。
成年患者预后较差,更易出现原始神经外胚层肿瘤(PNET)组织学类型,伴有远处转移及软组织原发部位。在接受手术的患者中,放疗(RT)对儿童或成年患者的总生存期提高均无关联。若未进行手术,接受放疗与成年患者较高的总生存期相关,但与儿童患者无关。在多因素分析中,校正潜在混杂因素后,成年与总生存期呈负相关。与总生存期相关的其他显著因素包括男性、转移性疾病、非四肢骨部位、治疗时代及PNET组织学类型。然而,在研究最近的亚组(2004年至2013年接受治疗的患者)时,放疗与儿科及成年患者总生存期的改善均相关,这在多因素分析中是一个独立预测因素。
ESFT成年患者的生存率低于儿科患者,这可能与儿科患者临床发现较早有关。