Abstract
Purpose
Due to the aging population, an increasing proportion of elderly patients with soft tissue sarcoma are presenting to cancer centers. This population appears to have a worse prognosis but the reasons for this has not been studied in depth. The purpose of this study is to examine the effect of age on the outcome of patients with extremity and trunk soft tissue sarcoma.
Method
This is a multicenter study including 2071 patients with median age at operation of 57 years (1st quartile–3rd quartile: 42–70). The endpoints considered were local recurrence and metastasis with death as a competing event. Cox proportional hazards models were used to estimate hazard ratios across the age ranges with and without adjustment for known confounding factors.
Results
Older patients presented with tumors that were larger and of higher grade. The proportion of positive margins increased progressively as patients aged, but radiation therapy was relatively underused in patients over 60 years old. Age was strongly associated with both local recurrence and metastasis. The 5-year cumulative incidences of local recurrence were 7.6% (4.2%–12.2%) for patients 30 years or younger and 13.8% (9.8%–18.5%) for patients 75 years and older; corresponding 5-year cumulative incidences of metastasis were 21.5% (15.7%–28%) and 32.5% (27%–38.2%) for the same groups. Age showed a non linear effect with a dramatic increase in the risk of local recurrence and metastasis after 60 years old. The increased risk of metastasis for older patients was explained by disparities in tumor characteristics at presentation, and additionally for local recurrence, by disparities in treatment.
Conclusion
Age is associated with worse outcomes after resection of soft tissue sarcoma. Older patients have worse outcomes because they tend to present with tumors having more adverse prognostic features and they are also treated less aggressively. A significant effect of age that is not explained by known confounders remains.
