1 Center for Behavioral Research in Cancer, Cancer Council Victoria, Melbourne, Australia.
2 School of Psychology, Deakin University, Melbourne, Australia.
J Adolesc Young Adult Oncol. 2019 Jun;8(3):272-280. doi: 10.1089/jayao.2018.0136. Epub 2019 Mar 1.
While overall survival (OS) for cancer in adolescents and young adults (AYA) has improved, there has been little change in AYA survival for several types of sarcomas. Using national data for Australia we describe (1) the treatment centers caring for AYA sarcoma, (2) treatments provided, and (3) survival outcomes. National population-based study assessing treatment of 15-24 year-olds diagnosed with soft tissue sarcoma (STS), bone sarcoma (BS), and Ewing family tumors (ET) between 2007 and 2012. Treatment details were abstracted from hospital medical records. Treatment centers were classified as pediatric or adult specialist AYA/sarcoma center, or other adult. Cox proportional hazard regression analyses examined associations between type of treatment center and OS. Sixty-one hospitals delivered treatment to 318 patients (135 STS; 91 BS, 92 ET), with 9%, 22%, and 17% of STS, BS, and ET, respectively, treated at pediatric and 62%, 59%, and 71% at adult specialist hospitals. Of 18-24 year-olds, 82% of BS, 90% of ET, and 73% of rhabdomyosarcomas at adult specialist centers were on a trial or standard protocol, compared with 42%, 89%, and 100%, respectively, at nonspecialist adult hospitals. After adjusting for disease and patient characteristics, survival was not associated with treatment center type for any disease type. However, ET survival was poorer for patients not receiving a standard chemotherapy protocol. Around 10% of AYA sarcoma patients attending adult hospitals were not on a standard protocol. Poorer survival for ET patients not on a standard protocol highlights the importance of ensuring all patients receive optimal care.
尽管青少年和年轻成人（AYA）癌症的总体生存率（OS）有所提高，但某些类型肉瘤的 AYA 生存率几乎没有变化。我们使用澳大利亚的全国数据，描述了（1）治疗青少年和年轻成人肉瘤的中心，（2）提供的治疗方法，以及（3）生存结果。这是一项全国性的基于人群的研究，评估了 2007 年至 2012 年间诊断为软组织肉瘤（STS）、骨肉瘤（BS）和尤文氏家族肿瘤（ET）的 15-24 岁患者的治疗情况。从医院病历中提取治疗细节。治疗中心分为儿科或成人 AYA/肉瘤中心，或其他成人。Cox 比例风险回归分析检查了治疗中心类型与 OS 之间的关联。61 家医院为 318 名患者提供了治疗（135 名 STS；91 名 BS，92 名 ET），STS、BS 和 ET 分别有 9%、22%和 17%在儿科和 62%、59%和 71%在成人专科医院治疗。在 18-24 岁的患者中，82%的 BS、90%的 ET 和 73%的横纹肌肉瘤在成人专科中心接受试验或标准方案治疗，而非专科成人医院的比例分别为 42%、89%和 100%。在调整疾病和患者特征后，任何疾病类型的生存都与治疗中心类型无关。然而，未接受标准化疗方案的 ET 患者的生存率较差。在接受成人医院治疗的 AYA 肉瘤患者中，约有 10%未接受标准方案。未接受标准方案的 ET 患者生存率较差，突出了确保所有患者获得最佳治疗的重要性。
