成人多形性横纹肌肉瘤：在国家癌症数据库中评估与放疗和化疗使用相关的结果

Adult Pleomorphic Rhabdomyosarcomas: Assessing Outcomes Associated with Radiotherapy and Chemotherapy Use in the National Cancer Database.

作者信息

Reddy Vishruth K, Jain Varsha, Wilson Ii Robert J, Hartner Lee P, Diamond Mark, Sebro Ronnie A, Weber Kristy L, Maki Robert G, Shabason Jacob E

机构信息

Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA.

Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, PA, USA.

出版信息

Sarcoma. 2021 Mar 13;2021:9712070. doi: 10.1155/2021/9712070. eCollection 2021.

DOI:10.1155/2021/9712070

PMID:33814964

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7987456/

Abstract

PURPOSE

Practice patterns for treatment of localized adult pleomorphic rhabdomyosarcoma (PRMS) remain quite variable given its rarity. Current national guidelines recommend management similar to that of other high-grade soft tissue sarcomas (STS), which include surgery with perioperative radiation (RT) with or without chemotherapy. Using the National Cancer Database (NCDB), we assessed practice patterns and overall outcomes of patients with localized PRMS. . Patients with stage II/III PRMS treated with surgical resection from 2004 to 2015 were identified from the NCDB. Predictors of RT and chemotherapy use were assessed using multivariable logistic regression analysis. The association of radiation and chemotherapy status on overall survival was assessed using Kaplan-Meier and Cox proportional hazards analyses.

RESULTS

Of 243 total patients, RT and chemotherapy were not uniformly utilized, with 44% receiving chemotherapy and in those who did not undergo amputation 62% receiving RT. In those who did not undergo amputation, RT was associated with improved survival on both univariate (HR: 0.49, 95% CI 0.32-0.73, < 0.001) and multivariate analysis (HR: 0.40, 95% CI 0.26-0.62, < 0.001), corresponding to greater 5-year overall survival (59% vs. 38%, < 0.001). Chemotherapy was associated with a higher rate of 5-year overall survival (63% vs. 39%, < 0.001). However, the survival benefit of chemotherapy did not reach statistical significance on multivariate analysis (HR: 0.65, 95% CI 0.41-1.03, =0.064). Notable predictors of omission of RT included female gender (OR: 0.40, 95% CI 0.22-0.74, < 0.01) and age ≥ 70 (OR: 0.55, 95% CI 0.30-1.00, =0.05). Correspondingly, factors associated with omission of chemotherapy included age ≥70 (OR: 0.17, 95% CI 0.08-0.39, < 0.001).

CONCLUSIONS

A significant proportion of patients with localized adult PRMS are not receiving RT. Likewise, use of chemotherapy was heterogeneous. Our findings note potential benefits and underutilization of RT, for which further investigation is warranted.

摘要

目的

鉴于局限性成人多形性横纹肌肉瘤（PRMS）较为罕见，其治疗模式仍存在很大差异。当前的国家指南推荐采用与其他高级别软组织肉瘤（STS）相似的管理方法，包括手术联合围手术期放疗（RT），可联合或不联合化疗。我们利用国家癌症数据库（NCDB）评估了局限性PRMS患者的治疗模式和总体预后。从NCDB中识别出2004年至2015年接受手术切除的II/III期PRMS患者。使用多变量逻辑回归分析评估放疗和化疗使用的预测因素。使用Kaplan-Meier和Cox比例风险分析评估放疗和化疗状态与总生存的关联。

结果

在243例患者中，放疗和化疗的使用并不统一，44%的患者接受了化疗，在未接受截肢手术的患者中，62%接受了放疗。在未接受截肢手术的患者中，放疗在单变量分析（HR：0.49，95%CI 0.32-0.73，<0.001）和多变量分析（HR：0.40，95%CI 0.26-0.62，<0.001）中均与生存改善相关，对应5年总生存率更高（59%对38%，<0.001）。化疗与5年总生存率较高相关（63%对39%，<0.001）。然而，化疗的生存获益在多变量分析中未达到统计学意义（HR：0.65，95%CI 0.41-1.03，=0.064）。未进行放疗的显著预测因素包括女性（OR：0.40，95%CI 0.22-0.74，<0.01）和年龄≥70岁（OR：0.55，95%CI 0.30-1.00，=0.05）。相应地，与未进行化疗相关的因素包括年龄≥70岁（OR：0.17，95%CI 0.08-0.39，<0.001）。