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

doi:10.3390/cancers12092389

Open AccessArticle

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

by

Danielle S. Graham

^1,†

,

Ritchell van Dams

^2,†,

Nicholas J. Jackson

³,

Mykola Onyshchenko

⁴,

Mark A. Eckardt

^1,5,6,

Benjamin J. DiPardo

^1,6,

Scott D. Nelson

^7,8,

Bartosz Chmielowski

^8,9,

Jacob E. Shabason

^10,11,

Arun S. Singh

^8,9,

Fritz C. Eilber

^1,8

and

Anusha Kalbasi

^1,2,8,*

¹

Division of Surgical Oncology, Department of Surgery, University of California, Los Angeles, CA 90095, USA

²

Department of Radiation Oncology, University of California, Los Angeles, CA 90095, USA

³

Department of Medicine Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA

⁴

Division of Hematology-Oncology, Department of Medicine, Harbor-UCLA Medical Center, The Lundquist Institute, Torrance, CA 90502, USA

⁵

Department of Surgery, Yale School of Medicine, New Haven, CT 06519, USA

⁶

Department of Surgery, Greater Los Angeles Veterans Health Administration, Los Angeles, CA 90073, USA

⁷

Department of Pathology, University of California, Los Angeles, CA 90095, USA

⁸

Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA 90095, USA

⁹

Division of Hematology-Oncology, Department of Internal Medicine, University of California, Los Angeles, CA 90095, USA

¹⁰

Abramson Family Cancer Research Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19106, USA

¹¹

Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA

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^*

Author to whom correspondence should be addressed.

^†

These authors contributed equally to this work.

Cancers 2020, 12(9), 2389; https://doi.org/10.3390/cancers12092389

Submission received: 30 June 2020 / Revised: 18 August 2020 / Accepted: 22 August 2020 / Published: 24 August 2020

(This article belongs to the Section Cancer Therapy)

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Abstract

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.

Keywords: soft tissue sarcoma; chemotherapy; radiation; surgery; National Cancer Database

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MDPI and ACS Style

Graham, D.S.; van Dams, R.; Jackson, N.J.; Onyshchenko, M.; Eckardt, M.A.; DiPardo, B.J.; Nelson, S.D.; Chmielowski, B.; Shabason, J.E.; Singh, A.S.; et al. Chemotherapy and Survival in Patients with Primary High-Grade Extremity and Trunk Soft Tissue Sarcoma. Cancers 2020, 12, 2389. https://doi.org/10.3390/cancers12092389

AMA Style

Graham DS, van Dams R, Jackson NJ, Onyshchenko M, Eckardt MA, DiPardo BJ, Nelson SD, Chmielowski B, Shabason JE, Singh AS, et al. Chemotherapy and Survival in Patients with Primary High-Grade Extremity and Trunk Soft Tissue Sarcoma. Cancers. 2020; 12(9):2389. https://doi.org/10.3390/cancers12092389

Chicago/Turabian Style

Graham, Danielle S., Ritchell van Dams, Nicholas J. Jackson, Mykola Onyshchenko, Mark A. Eckardt, Benjamin J. DiPardo, Scott D. Nelson, Bartosz Chmielowski, Jacob E. Shabason, Arun S. Singh, and et al. 2020. "Chemotherapy and Survival in Patients with Primary High-Grade Extremity and Trunk Soft Tissue Sarcoma" Cancers 12, no. 9: 2389. https://doi.org/10.3390/cancers12092389

APA Style

Graham, D. S., van Dams, R., Jackson, N. J., Onyshchenko, M., Eckardt, M. A., DiPardo, B. J., Nelson, S. D., Chmielowski, B., Shabason, J. E., Singh, A. S., Eilber, F. C., & Kalbasi, A. (2020). Chemotherapy and Survival in Patients with Primary High-Grade Extremity and Trunk Soft Tissue Sarcoma. Cancers, 12(9), 2389. https://doi.org/10.3390/cancers12092389

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

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