Gingrich Alicia A, Bateni Sarah B, Monjazeb Arta M, Thorpe Steven W, Kirane Amanda R, Bold Richard J, Canter Robert J
Division of Surgical Oncology, Department of Surgery, UC Davis Medical Center, University of California, Sacramento, California.
Department of Radiation Oncology, UC Davis Medical Center, University of California, Sacramento, California.
J Surg Oncol. 2019 Jun;119(8):1087-1098. doi: 10.1002/jso.25470. Epub 2019 Apr 12.
As the U.S. population ages, differences in oncologic outcomes among the elderly have been recognized. Our objective was to analyze the clinical, pathologic, and treatment outcomes for elderly soft tissue sarcoma (STS) patients, hypothesizing significant differences in the management and response to therapy.
Using the National Cancer Database, we identified 33 859 patients with nonmetastatic extremity STS. We defined elderly as ≥74 years in age and compared patient and treatment variables between adult and elderly patients. Cox-proportional hazards analysis was used to determine predictors of overall survival (OS).
We identified 8504 elderly patients. Significant differences in histologic subtype, grade, and facility type between elderly and nonelderly patients (P < 0.05) exist. Elderly patients were less likely to undergo R0 resection (P = 0.001) and had a higher 90-day mortality (P = 0.001). Surgical elderly patients experienced superior OS compared with nonsurgical patients (P = 0.001). Among elderly patients, younger age, and female sex, lower Charlson-Deyo score, lower grade, smaller tumors, surgical resection, negative surgical margins, and radiation therapy were associated with better OS.
Key differences exist in elderly extremity STS patients, including a narrower benefit/risk ratio with surgical management. These data highlight that elderly patients represent a distinct cohort for whom more careful selection appears indicated.
随着美国人口老龄化，老年人肿瘤治疗结果的差异已得到认可。我们的目的是分析老年软组织肉瘤（STS）患者的临床、病理和治疗结果，推测其在治疗管理和反应方面存在显著差异。
利用国家癌症数据库，我们确定了33859例非转移性肢体STS患者。我们将老年人定义为年龄≥74岁，并比较了成年患者和老年患者的患者及治疗变量。采用Cox比例风险分析来确定总生存期（OS）的预测因素。
我们确定了8504例老年患者。老年患者与非老年患者在组织学亚型、分级和医疗机构类型方面存在显著差异（P<0.05）。老年患者接受R0切除的可能性较小（P=0.001），90天死亡率较高（P=0.001）。接受手术的老年患者与未接受手术的患者相比，总生存期更长（P=0.001）。在老年患者中，年龄较小、女性、较低的Charlson-Deyo评分、较低的分级、较小的肿瘤、手术切除、阴性手术切缘和放疗与较好的总生存期相关。
老年肢体STS患者存在关键差异，包括手术治疗的获益/风险比更窄。这些数据表明，老年患者是一个独特的群体，似乎需要更谨慎地进行选择。
