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Chemotherapy and Survival in Patients with Primary High-Grade Extremity and Trunk Soft Tissue Sarcoma

The use of upfront chemotherapy for primary localized soft tissue sarcoma (STS) of the extremity and trunk is debated. It remains unclear if chemotherapy adds clinical benefit, which patients are likely to benefit, and whether the timing of therapy affects outcomes. We used the National Cancer Datab...

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Autores principales: Graham, Danielle S., van Dams, Ritchell, Jackson, Nicholas J., Onyshchenko, Mykola, Eckardt, Mark A., DiPardo, Benjamin J., Nelson, Scott D., Chmielowski, Bartosz, Shabason, Jacob E., Singh, Arun S., Eilber, Fritz C., Kalbasi, Anusha
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7564235/
https://www.ncbi.nlm.nih.gov/pubmed/32846908
http://dx.doi.org/10.3390/cancers12092389
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author Graham, Danielle S.
van Dams, Ritchell
Jackson, Nicholas J.
Onyshchenko, Mykola
Eckardt, Mark A.
DiPardo, Benjamin J.
Nelson, Scott D.
Chmielowski, Bartosz
Shabason, Jacob E.
Singh, Arun S.
Eilber, Fritz C.
Kalbasi, Anusha
author_facet Graham, Danielle S.
van Dams, Ritchell
Jackson, Nicholas J.
Onyshchenko, Mykola
Eckardt, Mark A.
DiPardo, Benjamin J.
Nelson, Scott D.
Chmielowski, Bartosz
Shabason, Jacob E.
Singh, Arun S.
Eilber, Fritz C.
Kalbasi, Anusha
author_sort Graham, Danielle S.
collection PubMed
description The use of upfront chemotherapy for primary localized soft tissue sarcoma (STS) of the extremity and trunk is debated. It remains unclear if chemotherapy adds clinical benefit, which patients are likely to benefit, and whether the timing of therapy affects outcomes. We used the National Cancer Database (NCDB) to examine the association between overall survival (OS) and chemotherapy in 5436 patients with the five most common subtypes of STS with primary disease localized to the extremity or trunk, mirroring the patient population of a modern phase 3 clinical trial of neoadjuvant chemotherapy. We then examined associations between timing of multi-agent chemotherapy (neoadjuvant or adjuvant) and OS. We used a Cox proportional hazards model and propensity score matching (PSM) to account for covariates including demographic, patient, clinical, treatment, and facility factors. In the overall cohort, we observed no association between multi-agent chemotherapy or its timing and improved OS. Multi-agent chemotherapy was associated with improved OS in several subgroups, including patients with larger tumors (>5 cm), those treated at high-volume centers, or those who received radiation. We also identified an OS benefit to multi-agent chemotherapy among the elderly (>70 years) and African American patients. Multi-agent chemotherapy was associated with improved survival for patients with tumors >5 cm, who receive radiation, or who receive care at high-volume centers. Neither younger age nor chemotherapy timing was associated with better outcomes. These ‘real-world’ findings align with recent randomized trial data supporting the use of multi-agent chemotherapy in high-risk patients with localized STS.
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spelling pubmed-75642352020-10-26 Chemotherapy and Survival in Patients with Primary High-Grade Extremity and Trunk Soft Tissue Sarcoma Graham, Danielle S. van Dams, Ritchell Jackson, Nicholas J. Onyshchenko, Mykola Eckardt, Mark A. DiPardo, Benjamin J. Nelson, Scott D. Chmielowski, Bartosz Shabason, Jacob E. Singh, Arun S. Eilber, Fritz C. Kalbasi, Anusha Cancers (Basel) Article The use of upfront chemotherapy for primary localized soft tissue sarcoma (STS) of the extremity and trunk is debated. It remains unclear if chemotherapy adds clinical benefit, which patients are likely to benefit, and whether the timing of therapy affects outcomes. We used the National Cancer Database (NCDB) to examine the association between overall survival (OS) and chemotherapy in 5436 patients with the five most common subtypes of STS with primary disease localized to the extremity or trunk, mirroring the patient population of a modern phase 3 clinical trial of neoadjuvant chemotherapy. We then examined associations between timing of multi-agent chemotherapy (neoadjuvant or adjuvant) and OS. We used a Cox proportional hazards model and propensity score matching (PSM) to account for covariates including demographic, patient, clinical, treatment, and facility factors. In the overall cohort, we observed no association between multi-agent chemotherapy or its timing and improved OS. Multi-agent chemotherapy was associated with improved OS in several subgroups, including patients with larger tumors (>5 cm), those treated at high-volume centers, or those who received radiation. We also identified an OS benefit to multi-agent chemotherapy among the elderly (>70 years) and African American patients. Multi-agent chemotherapy was associated with improved survival for patients with tumors >5 cm, who receive radiation, or who receive care at high-volume centers. Neither younger age nor chemotherapy timing was associated with better outcomes. These ‘real-world’ findings align with recent randomized trial data supporting the use of multi-agent chemotherapy in high-risk patients with localized STS. MDPI 2020-08-24 /pmc/articles/PMC7564235/ /pubmed/32846908 http://dx.doi.org/10.3390/cancers12092389 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Graham, Danielle S.
van Dams, Ritchell
Jackson, Nicholas J.
Onyshchenko, Mykola
Eckardt, Mark A.
DiPardo, Benjamin J.
Nelson, Scott D.
Chmielowski, Bartosz
Shabason, Jacob E.
Singh, Arun S.
Eilber, Fritz C.
Kalbasi, Anusha
Chemotherapy and Survival in Patients with Primary High-Grade Extremity and Trunk Soft Tissue Sarcoma
title Chemotherapy and Survival in Patients with Primary High-Grade Extremity and Trunk Soft Tissue Sarcoma
title_full Chemotherapy and Survival in Patients with Primary High-Grade Extremity and Trunk Soft Tissue Sarcoma
title_fullStr Chemotherapy and Survival in Patients with Primary High-Grade Extremity and Trunk Soft Tissue Sarcoma
title_full_unstemmed Chemotherapy and Survival in Patients with Primary High-Grade Extremity and Trunk Soft Tissue Sarcoma
title_short Chemotherapy and Survival in Patients with Primary High-Grade Extremity and Trunk Soft Tissue Sarcoma
title_sort chemotherapy and survival in patients with primary high-grade extremity and trunk soft tissue sarcoma
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7564235/
https://www.ncbi.nlm.nih.gov/pubmed/32846908
http://dx.doi.org/10.3390/cancers12092389
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