Department of Radiation Oncology, Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas; Baylor College of Medicine, Houston, Texas.
Department of Radiation Oncology, Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
Int J Radiat Oncol Biol Phys. 2019 May 1;104(1):127-136. doi: 10.1016/j.ijrobp.2018.12.032. Epub 2018 Dec 26.
We aimed to investigate the relationship between survival and time to local therapy after initiation of up-front chemotherapy in the treatment of patients with localized Ewing sarcoma.
The National Cancer Database was queried for patients with localized Ewing sarcoma treated with primary chemotherapy and subsequent local therapy. Kaplan-Meier survival curves were generated for patients initiating local therapy 6 to 15 weeks and ≥16 weeks after chemotherapy initiation. Multivariable binomial logistic regression was used to identify factors associated with prolonged time to local therapy. A multivariable Cox proportional hazards model was used to identify factors associated with overall survival (OS).
The final cohort included 1318 patients. A higher proportion of patients initiating local therapy 6 to 15 weeks after chemotherapy initiation versus ≥16 weeks after chemotherapy initiation were ≤21 years old (79.5% vs 72.0%; P = .004). Age >21 years (P < .001; hazard ratio, 1.65; 95% confidence interval, 1.28-2.12), tumor size >8 cm (P = .016), and time to local therapy ≥16 weeks (P = .005; hazard ratio, 1.41; 95% confidence interval, 1.11-1.80) were associated with reduced OS; after review of margin status, negative margins were associated with improved OS compared with gross disease (P = .029). Patients initiating local therapy at 6 to 15 weeks versus ≥16 weeks had a 5-year OS of 78.7% versus 70.4% and a 10-year OS of 70.3% versus 57.1%, respectively (P < .001). The difference in OS according to time to local therapy was particularly more important in patients receiving radiation therapy alone. Age >21 years and treatment by radiation therapy alone were associated with delayed time (>16 weeks) to local therapy, whereas private insurance and income >$48,000 were less likely to be associated with delayed local therapy.
Delayed time to local therapy ≥16 weeks after chemotherapy initiation was independently associated with worse survival in patients with localized Ewing sarcoma.
我们旨在研究在接受初始化疗的局限性尤文肉瘤患者中，开始局部治疗与生存之间的关系。
国家癌症数据库查询了接受初始化疗和随后局部治疗的局限性尤文肉瘤患者。为在化疗开始后 6 至 15 周和≥16 周开始局部治疗的患者生成 Kaplan-Meier 生存曲线。多变量二项逻辑回归用于确定与局部治疗时间延长相关的因素。多变量 Cox 比例风险模型用于确定与总生存（OS）相关的因素。
最终队列包括 1318 名患者。与化疗开始后≥16 周开始局部治疗的患者相比，在化疗开始后 6 至 15 周开始局部治疗的患者中，≤21 岁的患者比例更高（79.5% vs. 72.0%；P=0.004）。年龄>21 岁（P<0.001；风险比，1.65；95%置信区间，1.28-2.12）、肿瘤大小>8cm（P=0.016）和局部治疗时间≥16 周（P=0.005；风险比，1.41；95%置信区间，1.11-1.80）与降低 OS 相关；在复查边缘状态后，与大体疾病相比，阴性边缘与改善 OS 相关（P=0.029）。与化疗开始后≥16 周开始局部治疗的患者相比，在化疗开始后 6 至 15 周开始局部治疗的患者的 5 年 OS 率分别为 78.7%和 70.4%，10 年 OS 率分别为 70.3%和 57.1%（P<0.001）。根据局部治疗时间的生存差异在仅接受放疗的患者中更为重要。年龄>21 岁和仅接受放疗是局部治疗时间延迟（>16 周）的相关因素，而私人保险和收入>48000 美元不太可能与局部治疗延迟相关。
在接受初始化疗后≥16 周开始局部治疗的时间延迟与局限性尤文肉瘤患者的生存较差独立相关。
