老年尤文肉瘤患者的生存和治疗：国家癌症数据库分析。

Survival and treatment in older patients with ewing sarcoma: an analysis of the national cancer database.

机构信息

Creighton University School of Medicine, Omaha, NE, USA.

University of Minnesota Medical School, Minneapolis, MN, USA.

出版信息

Eur J Med Res. 2024 Jan 5;29(1):29. doi: 10.1186/s40001-023-01599-1.

DOI:10.1186/s40001-023-01599-1

PMID:38183148

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10768101/

Abstract

BACKGROUND

Ewing sarcoma (EWS) is a malignancy which primarily arises in adolescence and has been studied extensively in this population. Much less is known about the rare patient cohort over the age of 40 at diagnosis. In this study, we describe the survival outcomes and clinical characteristics of this population.

METHODS

This retrospective cohort study utilized the National Cancer Database (NCDB) to identify 4600 patients diagnosed between 2004 through 2019. Of these patients, 4058 were under the age of 40 and 542 were over 40. Propensity score 1:1 matching was performed according to sex and race. Univariate and multivariate logistic regression was performed to generate odds ratios (OR) and a Multivariate Cox regression model was used to generate a hazard ratio (HR) for patients over 40. Kaplan-Meier curves were used to estimate survival from diagnosis to death between age groups. Chi-square tests were used to compare demographic and socioeconomic patient characteristics. IBM statistics version 27.0 was used. p < 0.05 was used to indicate statistical significance.

RESULTS

EWS patients older than 40 experienced worse survival outcomes compared to patients under the age of 40. 5-year survival was 44.6% for older patients vs. 61.8% for younger patients (p < 0.05). A multivariate Cox proportional hazards model showed that age was independently associated with inferior survival. (HR 1.96; p < 0.05). EWS patients over the age of 40 were more likely to have tumors originating from the vertebral column (16.1% vs 8.9%; p < 0.05) and cranium (5.3% vs. 2.9%; p < 0.05) and had a higher rate of axial tumors (31.6% vs. 18.5%; p < 0.05) compared to patients under 40. Additionally, patients older than 40 experienced a significantly longer delay between the date of diagnosis and initiation of systemic treatment (36.7 days vs. 24.8 days; p < 0.05) and were less likely to receive adjuvant chemotherapy (93.4% vs. 97.9%; p < 0.05).

CONCLUSION

An age over 40 is associated with decreased survival for patients with EWS. Due to the rarity of EWS in this cohort, the optimal role of systemic treatment remains unknown and has yet to be clearly elucidated. Consequently, our findings suggest that older patients receive disparities in treatment which may be contributing to decreased survival rates.

摘要

背景

尤因肉瘤（EWS）是一种主要发生在青少年时期的恶性肿瘤，在该人群中已进行了广泛研究。对于诊断时年龄超过 40 岁的罕见患者群体，了解甚少。在本研究中，我们描述了这一人群的生存结果和临床特征。

方法

本回顾性队列研究利用国家癌症数据库（NCDB）确定了 2004 年至 2019 年期间诊断的 4600 例患者。其中 4058 例年龄小于 40 岁，542 例年龄大于 40 岁。根据性别和种族进行倾向评分 1:1 匹配。使用单变量和多变量逻辑回归生成优势比（OR），并使用多变量 Cox 回归模型生成年龄大于 40 岁患者的风险比（HR）。Kaplan-Meier 曲线用于估计两组之间从诊断到死亡的生存情况。卡方检验用于比较人口统计学和社会经济患者特征。使用 IBM statistics version 27.0。p<0.05 表示具有统计学意义。

结果

年龄大于 40 岁的 EWS 患者的生存结果较年龄小于 40 岁的患者差。5 年生存率为 44.6%（年龄较大的患者）与 61.8%（年龄较小的患者）（p<0.05）。多变量 Cox 比例风险模型显示，年龄与生存不良独立相关。（HR 1.96；p<0.05）。年龄大于 40 岁的 EWS 患者更有可能发生源自脊柱（16.1%比 8.9%；p<0.05）和颅（5.3%比 2.9%；p<0.05）的肿瘤，并且发生轴性肿瘤的比率更高（31.6%比 18.5%；p<0.05）与年龄小于 40 岁的患者相比。此外，年龄大于 40 岁的患者从诊断到开始系统治疗的时间明显延长（36.7 天比 24.8 天；p<0.05），并且接受辅助化疗的可能性较小（93.4%比 97.9%；p<0.05）。