Trends in Overall Survival among Patients Treated for Sarcoma at a Large Tertiary Cancer Center between 1986 and 2014

SIMPLE SUMMARY: Sarcomas are comparatively rare cancers; thus, large sarcoma studies covering extended time periods are lacking. Therefore, our study analyzed data from 2570 adolescents (15–39 years) and adults (≥40 years) treated at the Moffitt Cancer Center between 1986 and 2014. We aimed to evaluate the impact of characteristics such as sex, age, ethnicity, race, tobacco use, diagnosis, cancer metastasis, treatment, and family history on overall survival among individuals diagnosed with soft tissue or bone sarcomas. The collected data gave us the advantage of including a large patient number and made possible the evaluation of several sarcoma subtypes. Lastly, data collected over 28 years allowed us to look for changes over time, often not possible in small studies and capture improvements in treatment. Our study showed poorer overall survival rates in older adults (≥40 years), current smokers, patients with metastatic cancer, and patients not receiving first-line surgery treatment. There was a moderate improvement in overall survival rates over time, with gastrointestinal stromal tumors experiencing better overall survival in more recent years. We believe that our study provides important findings for the field of sarcoma research and highlights the need for future research to better understand barriers to survivorship. ABSTRACT: Sarcomas are relatively rare malignancies accounting for about 1% of all cancer diagnoses. Studies on sarcomas comprising large cohorts covering extended time periods are lacking. Therefore, this study aimed to evaluate the impact of demographic, behavioral, and clinical characteristics on overall survival (OS) among individuals diagnosed with soft tissue sarcoma (STS) or bone sarcoma at the Moffitt Cancer Center between 1986 and 2014. Unadjusted and multivariable Cox proportional hazard regression (CPHR) models were constructed to generate hazard ratios (HRs) and 95% confidence intervals (CIs) to evaluate associations between a range of demographic, behavioral, and clinical characteristics, and OS. Additionally, Kaplan–Meier survival curves, associated log-rank statistics, and adjusted CPHR models were generated by time periods based on the year of first contact (1986–1994, 1995–1999, 2000–2005, 2006–2010, 2011–2014) to evaluate for temporal differences in OS. Of the 2570 patients, 2037 were diagnosed with STS, whereas 533 were diagnosed with bone sarcoma. At the time of analysis, 50% of the population were alive. In multivariable analyses, we observed poorer survival for patients ≥ 40 years of age (HR = 1.54, 95% CI = 1.34–1.78), current smokers (HR = 1.18, 95% CI = 1.01–1.37), patients with metastasis (HR = 2.19, 95% CI = 1.95–2.47), and patients not receiving first-line surgery treatment (HR = 2.11, 95% CI = 1.82–2.45). We discovered limited improvements in OS over time among individuals diagnosed with STS or bone sarcomas with the exception of gastrointestinal stromal tumors (GIST), which showed a significant improvement in OS across time periods (p = 0.0034). Overall, we identified well-established characteristics associated with OS (e.g., metastasis) in addition to factors (e.g., smoking status) not previously reported to impact OS. Improvements in survival over time have been relatively modest, suggesting the need for improved therapeutic options, especially for those diagnosed with less frequent sarcomas.