Van Meekeren Milan, Fiocco Marta, Ho Vincent K Y, Bovée Judith V M G, Gelderblom Hans, Haas Rick L
Department of Medical Oncology, Leiden University Medical Center, Leiden, Netherlands.
Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, Netherlands.
Sarcoma. 2021 Jul 22;2021:9976122. doi: 10.1155/2021/9976122. eCollection 2021.
Standard therapy for localized soft tissue sarcoma (STS) is wide, limb-sparing resection. For intermediate- or high-grade tumors, (neo)adjuvant therapies are frequently added to the treatment plan. In this study, data from a Dutch nationwide database are used to (1) assess whether perioperative management of STS follows ESMO guidelines, (2) characterize prognostic factors for overall survival (OS), and (3) assess the association between perioperative treatment and survival.
All intermediate- or high-grade, localized STS cases, who have undergone surgery and diagnosed between 2000 and 2017, were identified in the Netherlands Cancer Registry (NCR) database. Variables with demographic, treatment, and survival data were obtained. Survival curves were estimated by Kaplan-Meier's method, and the effect of prognostic factors on OS was assessed in a multivariable Cox regression analysis.
A total of 4957 patients were identified. There were slightly more males (54.7%). Median age at diagnosis was 64 years, and 53.6% of the tumors were located in the extremities. Radiotherapy (RT) was administered to 2481 (50.1%) patients, and 252 (5.1%) patients were treated with perioperative systemic chemotherapy. The total use of perioperative RT did not significantly change in the last 20 years, but the timing followed clinical guidelines: preoperative RT increased significantly (2000-2008: 3.7%, 2009-2017: 22.3%; < 0.001), whereas the use of postoperative RT diminished (2000-2008: 45.9%, 2009-2017: 26.1%; < 0.001). The use of perioperative chemotherapy slightly decreased (2000-2008: 5.9%, 2009-2017: 4.4%; = 0.015). 5-year OS was 59.6% (95% CI: 58.2-61.0). Sex, age, year of diagnosis, tumor location, tumor size, histological grade, depth, histological subtype, surgical margins, and the use of perioperative RT were identified as independent predictors for OS.
Preoperative RT is gradually replacing postoperative RT for localized STS in the Netherlands. The use of perioperative chemotherapy is rare and has slightly decreased in recent years. Identified baseline characteristics and treatment factors predicting OS may aid in future treatment decisions.
局限性软组织肉瘤（STS）的标准治疗方法是进行广泛的保肢切除术。对于中高级别肿瘤，（新）辅助治疗通常会被纳入治疗方案。在本研究中，来自荷兰全国性数据库的数据被用于：（1）评估STS的围手术期管理是否遵循欧洲肿瘤内科学会（ESMO）指南；（2）确定总生存期（OS）的预后因素；（3）评估围手术期治疗与生存之间的关联。
在荷兰癌症登记处（NCR）数据库中识别出所有在2000年至2017年期间接受手术并被诊断为中高级别局限性STS的病例。获取了包含人口统计学、治疗和生存数据的变量。通过Kaplan-Meier方法估计生存曲线，并在多变量Cox回归分析中评估预后因素对OS的影响。
共识别出4957例患者。男性略多（54.7%）。诊断时的中位年龄为64岁，53.6%的肿瘤位于四肢。2481例（50.1%）患者接受了放疗（RT），252例（5.1%）患者接受了围手术期全身化疗。在过去20年中，围手术期RT的总使用量没有显著变化，但时间安排遵循临床指南：术前RT显著增加（2000 - 2008年：3.7%，2009 - 2017年：22.3%；P < 0.001），而术后RT的使用减少（2000 - 2008年：45.9%，2009 - 2017年：26.1%；P < 0.001）。围手术期化疗的使用略有下降（2000 - 2008年：5.9%，2009 - 2017年：4.4%；P = 0.015）。5年总生存率为59.6%（95%置信区间：58.2 - 61.0）。性别、年龄、诊断年份、肿瘤位置、肿瘤大小、组织学分级、深度、组织学亚型、手术切缘以及围手术期RT的使用被确定为OS的独立预测因素。
在荷兰，术前RT正逐渐取代局限性STS的术后RT。围手术期化疗的使用很少，且近年来略有下降。确定的预测OS的基线特征和治疗因素可能有助于未来的治疗决策。
