John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA.
Children's Healthcare of Atlanta, Atlanta, GA.
Surgery. 2018 Feb;163(2):324-329. doi: 10.1016/j.surg.2017.10.027. Epub 2017 Dec 6.
Multimodal therapy is the standard treatment for pediatric rhabdomyosarcoma, but for adolescents and young adults (AYAs: ages 15-39) and older adults with rhabdomyosarcoma, the use of adjuvant therapy is variable, and survival is greatly decreased compared with younger patients.
All patients with rhabdomyosarcoma who had a curative operative were identified from the 1998-2012 National Cancer Database. Regression analyses identified independent factors relating to receipt of multimodal therapy (resection + chemotherapy + radiation) and the influence of multimodal therapy on 5-year overall survival.
Of 2,312 patients, 44% were pediatric (age < 15 years), 22% AYA (ages 15-39), and 34% adult (age ≥ 40 years). Adults received multimodal therapy least often (pediatric: 62%, AYA: 46%, adults: 24%; P < .001), even after controlling for demographic characteristics, tumor features, and stage. In the entire cohort, multimodal therapy was associated with a decreased risk of death within 5 years (hazard ratio [HR] 0.72, 95% confidence interval [CI] 0.62-0.84), with similar findings after stratification by age (pediatric: HR 0.64, 95% CI 0.48-0.85; AYA: HR 0.72, 95% CI 0.55-0.95; adult: HR 0.74, 95% CI 0.58-0.93). In AYAs only, black and Hispanic patients had an increased risk of death within 5 years (black patients: HR 1.64, 95% CI 1.14-2.37; Hispanic patients: HR 1.62, 95% CI 1.11-2.36).
This first large national study suggests that multimodal therapy is independently associated with improved survival for both AYAs and adults with rhabdomyosarcoma, similar to pediatric patients, but multimodal therapy is appreciably underused. Implementation of multimodal therapy for all patients could potentially improve overall outcomes of patients with rhabdomyosarcoma.
多模式治疗是儿科横纹肌肉瘤的标准治疗方法，但对于青少年和年轻成人（15-39 岁）以及年龄较大的横纹肌肉瘤患者，辅助治疗的使用存在差异，与年轻患者相比，生存时间大大缩短。
从 1998 年至 2012 年国家癌症数据库中确定了所有接受根治性手术的横纹肌肉瘤患者。回归分析确定了与接受多模式治疗（切除+化疗+放疗）相关的独立因素，以及多模式治疗对 5 年总生存率的影响。
在 2312 名患者中，44%为儿科患者（年龄<15 岁），22%为青少年和年轻成人（15-39 岁），34%为成人（年龄≥40 岁）。成人接受多模式治疗的比例最低（儿科：62%，青少年和年轻成人：46%，成人：24%；P<.001），即使在控制了人口统计学特征、肿瘤特征和分期后也是如此。在整个队列中，多模式治疗与 5 年内死亡风险降低相关（风险比[HR]0.72，95%置信区间[CI]0.62-0.84），按年龄分层后也有类似发现（儿科：HR 0.64，95%CI 0.48-0.85；青少年和年轻成人：HR 0.72，95%CI 0.55-0.95；成人：HR 0.74，95%CI 0.58-0.93）。仅在青少年和年轻成人中，黑人和西班牙裔患者 5 年内死亡风险增加（黑人患者：HR 1.64，95%CI 1.14-2.37；西班牙裔患者：HR 1.62，95%CI 1.11-2.36）。
这是第一项大型全国性研究，表明多模式治疗与青少年和年轻成人以及儿科患者的生存改善独立相关，但多模式治疗的应用明显不足。为所有患者实施多模式治疗可能会提高横纹肌肉瘤患者的总体预后。
