Nigam Aradhya, Aminpour Nathan, Zeymo Alexander, Desale Sameer, Villano Anthony M, Unger Keith R, Aboulafia Albert J, Al-Refaie Waddah B
MedStar-Georgetown Surgical Outcomes Research Center, Washington, DC; Department of Surgery, MedStar-Georgetown University Hospital, Washington, DC.
Georgetown University School of Medicine, Washington, DC.
Surgery. 2022 May;171(5):1348-1357. doi: 10.1016/j.surg.2021.10.034. Epub 2022 Feb 2.
Treatment of high-risk extremity soft tissue sarcomas remains widely varied. Despite growing support for a multimodal approach for treatment of these rare and aggressive neoplasms, its dissemination remains underused. This national study aimed to evaluate variations in treatment patterns and uncover factors predictive of underuse of multimodal therapy in high-risk extremity soft tissue sarcomas.
The 2010 to 2015 National Cancer Database was used to evaluate trends in 3 common treatment patterns: surgery alone, surgery + adjuvant therapy, and neoadjuvant therapy + surgery. Demographic-, sarcoma-, hospital-, and treatment-level factors of 6,725 surgically treated patients with stage II or III intermediate- to high-grade extremity soft tissue sarcomas were evaluated by types of treatment modality. Stepwise multivariable logistic regression was performed to identify factors predictive of each treatment modality.
When compared to surgery alone (34.6%) and adjuvant therapy (41.2%), use of neoadjuvant therapy + surgery for high-risk extremity soft tissue sarcomas remained low (25.3%). However, time trend analysis demonstrated that neoadjuvant therapy + surgery has significantly increased by 7% per year, whereas surgery alone decreased by 4% every year (P < .05 for both). Factors predictive of surgery alone were older age, nonprivate insurance, increasing travel distance, and multimorbidity (P < .05). Conversely, factors associated with neoadjuvant therapy + surgery were private insurance, higher education, and care at academic or high-volume institutions (for all, P < .05). Tumor-related factors predictive for neoadjuvant therapy + surgery included size <5 cm and higher-grade tumors (P < .05).
Adoption of multimodality therapy for high-risk extremity soft tissue sarcomas remains low and gradual in the United States. Dissemination of multimodality therapy will require attention to access and hospital factors to maximize these therapies for high-risk extremity soft tissue sarcomas.
高危肢体软组织肉瘤的治疗方法仍存在很大差异。尽管对于这些罕见且侵袭性肿瘤采用多模式治疗方法的支持日益增加，但其推广应用仍未得到充分利用。这项全国性研究旨在评估治疗模式的差异，并找出高危肢体软组织肉瘤多模式治疗未得到充分利用的预测因素。
利用2010年至2015年的国家癌症数据库评估三种常见治疗模式的趋势：单纯手术、手术+辅助治疗以及新辅助治疗+手术。根据治疗方式类型，对6725例接受手术治疗的II期或III期肢体中高级别软组织肉瘤患者的人口统计学、肉瘤、医院和治疗水平因素进行评估。进行逐步多变量逻辑回归分析，以确定每种治疗方式的预测因素。
与单纯手术（34.6%）和辅助治疗（41.2%）相比，高危肢体软组织肉瘤采用新辅助治疗+手术的比例仍然较低（25.3%）。然而，时间趋势分析表明，新辅助治疗+手术每年显著增加7%，而单纯手术每年下降4%（两者P均<.05）。单纯手术的预测因素包括年龄较大、非私人保险、旅行距离增加和多种疾病（P<.05）。相反，与新辅助治疗+手术相关的因素包括私人保险、高等教育以及在学术机构或大型机构接受治疗（所有P<.05）。新辅助治疗+手术的肿瘤相关预测因素包括肿瘤大小<5 cm和高级别肿瘤（P<.05）。
在美国，高危肢体软组织肉瘤多模式治疗的采用率仍然较低且增长缓慢。多模式治疗的推广需要关注可及性和医院因素，以最大限度地将这些治疗应用于高危肢体软组织肉瘤。
