Impact of Metastasectomy and Aggressive Local Therapy in Newly Diagnosed Metastatic Soft Tissue Sarcoma: An Analysis of the NCDB

• Authors: Mustafa Abugideiri, New Hanover Regional Medical Center Radiation Oncology; James Janopaul-Naylor, Emory University; Jeffrey Switchenko, Emory University; Sibo Tian, Emory University; William Read, Emory University; Robert Press, New York Proton Center; Shervin Oskouei, Emory University; Nickolas Reimer, Emory University; Matthew Ferris, University of Maryland; Richard J Cassidy, Cancer Specialists of North Florida; Madhusmita Behera, Emory University; David Monson, Emory University; Jerome Landry, Emory University; Karen Godette, Emory University; Pretesh Patel, Emory University
• Journal Title: ANNALS OF SURGICAL ONCOLOGY
• Volume: Volume 29, Number 1
• Publisher: SPRINGER | 2021-07-16, Pages 649-659
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1245/s10434-021-10466-4
• Subjects: Health Sciences, Oncology; Biology, Biostatistics
• Keywords: Science & Technology; Life Sciences & Biomedicine; Oncology; Surgery; PULMONARY METASTASECTOMY; NEOADJUVANT CHEMOTHERAPY; RADIATION-THERAPY; IMPROVED SURVIVAL; HIGH-RISK; HIGH-GRADE; PHASE-II; RESECTION; RADIOTHERAPY; MULTICENTER

Abstract

Background: The optimal management of patients with stage IV soft tissue sarcoma of the extremity (STSE) with distant metastases at diagnosis is unclear due to limited evidence and heterogeneity of current practice patterns. National guidelines have recommended surgical management of the primary site (SP) with or without radiotherapy (R), chemotherapy (C), and metastasectomy (M). Methods: In the National Cancer Database (NCDB), patients with initially metastatic STSE who received definitive SP from 2004 to 2014 were identified. Survival distributions were estimated and compared using the Kaplan–Meier method and log-rank tests, and covariates were compared using Chi-square tests or analysis of variance (ANOVA). Propensity score analysis using inverse probability of treatment weighting was used. Results: Overall, 1124 patients were included, with a median age of 55 years (range 18–90). Utilization of SP+M increased over time from 18.8% in 2004–2006, to 33.3% in 2007–2009, to 47.9% in 2010–2014 (p = 0.024). The addition of M to SP was associated with superior 5-year overall survival (OS) at 30.8% (SP+M+/−C+/−R) compared with 18.2% for those treated with non-surgical adjuvant therapies (SP+/−C+/−R) and 12.6% for SP alone (p < 0.0001). Positive surgical margins were noted in 24.1% of patients and was associated with worse OS (hazard ratio 1.44, p < 0.001) on multivariable analysis. Conclusions: This is the first known study utilizing a large database to explore practice patterns and outcomes for patients with metastatic STSE receiving definitive SP. Utilization of metastasectomy increased in the study period and was associated with longer survival compared with SP alone. These hypothesis-generating data warrant additional study.