A. Gingrich1, S. Bateni1, R. Bold1, A. Kirane1, A. Monjazeb3, M. Darrow4, S. Thorpe2, R. Canter1 1University Of California – Davis,Surgery,Sacramento, CA, USA 2University Of California – Davis,Orthopedics,Sacramento, CA, USA 3University Of California – Davis,Radiation Oncology,Sacramento, CA, USA 4University Of California – Davis,Pathology,Sacramento, CA, USA
Background: The surgical management of elderly cancer patients is a topic of increasing attention, especially as the population ages. Although disparities in access to care and outcomes are a key focus of health services research, few studies have examined differences in patterns of care and outcomes among elderly cancer patients, especially in soft tissue sarcoma (STS). Our objective was to analyze and compare the clinical, pathologic, and treatment characteristics for elderly STS patients to younger patients, hypothesizing that elderly STS patients represent a distinct cohort of patients for whom more age-specific algorithms are indicated.
Methods: Using the National Cancer Database (2004-2012), we identified 33,859 adult patients (18 -99 years) with non-metastatic STS. We defined “elderly” patients as ≥ 74 years (top quartile of age, n=8,504). We compared patient demographics, tumor characteristics, types of treatment and outcomes among the “elderly” to the non-elderly cohort. We also analyzed survival in the elderly undergoing surgery versus no surgery. Cox proportional hazard analysis was used to analyze multivariate predictors of overall survival among elderly patients.
Results: Age, tumor size, geographic location, rural/urban, and receipt of radiotherapy (RT) were similar between non-elderly and elderly patients. However, significant differences were observed in histologic grade, histologic subtype, and facility type (P<0.05). Elderly patients were less likely to be black (5.8 vs 12.3%, P = 0.001), more likely to have higher comorbidity scores (26.5 vs. 15.2%, P=0.001), and less likely to undergo R0 resection (59.7 vs. 70%, P = 0.001). 90-day mortality was also 3.5 times greater in elderly patients (4.3% vs. 1.2%, P = 0.001). Yet, among elderly patients undergoing surgery, median survival was 43.8 months versus 15.4 months in those who did not undergo surgery (P = 0.001). On Cox proportional hazard analysis of the elderly cohort, predictors of superior survival were comparable to non-elderly patients, including younger age, female sex, lower Charlson-Deyo score, histologic subtype, lower grade, smaller tumor size, surgical resection, R0 resection and receipt of radiation therapy (p<0.05). Chemotherapy did not offer survival benefit (p>0.05).
Conclusions: Key clinical, pathologic, and treatment differences exist in elderly patients with STS. Although elderly patients have worse rates of R0 resection and 90-day mortality, surgery remains associated with superior long term survival. Better understanding of these important differences in the presentation and management of STS in the elderly are important in the context of the aging population, including the narrower benefit to risk ratio with surgical management of localized disease.