Limb‐sparing surgery plus radiotherapy results in superior survival: an analysis of patients with high‐grade extremity soft‐tissue sarcoma from the NCDB and SEER

摘要

Small randomized trials have not shown an overall survival (OS) difference among local treatment modalities for patients with extremity soft‐tissue sarcomas (E‐STS) but were underpowered for OS. We examine the impact of local treatment modalities on OS and sarcoma mortality (SM) using two national registries. The National Cancer Database (NCDB) and the Surveillance, Epidemiology, and End Results (SEER) Program were analyzed separately to identify patients with stage II‐III, high‐grade E‐STS diagnosed between 2004 and 2013 and treated with (1) amputation alone, (2) limb‐sparing surgery (LSS) alone, (3) preoperative radiation therapy (RT) and LSS, or (4) LSS and postoperative RT. Multivariable analyses (MVAs) and 1:1 matched pair analyses ( style="fixed-case">MPAs) examined treatment impacts on style="fixed-case">OS (both databases) and style="fixed-case">SM ( style="fixed-case">SEER only). From the style="fixed-case">NCDB and style="fixed-case">SEER, 7828 and 2937 patients were included. On style="fixed-case">MVAs, amputation was associated with inferior style="fixed-case">OS and style="fixed-case">SM. Relative to style="fixed-case">LSS alone, both preoperative style="fixed-case">RT and style="fixed-case">LSS ( style="fixed-case">HR, 0.70; 95% style="fixed-case">CI: 0.62‐0.78) and style="fixed-case">LSS and postoperative style="fixed-case">RT ( style="fixed-case">HR, 0.69; 95% style="fixed-case">CI: 0.63‐0.75) improved style="fixed-case">OS in style="fixed-case">NCDB analyses with confirmation by style="fixed-case">SEER. Estimated median survivals from style="fixed-case">MPA utilizing style="fixed-case">NCDB data were 7.2 years with style="fixed-case">LSS alone (95% style="fixed-case">CI: 6.5‐8.9 years) vs 9.8 years (95% style="fixed-case">CI: 9.0‐11.2 years) with style="fixed-case">LSS and postoperative style="fixed-case">RT. A style="fixed-case">MPA comparing preoperative style="fixed-case">RT and style="fixed-case">LSS to style="fixed-case">LSS alone found median survivals of 8.9 years (95% style="fixed-case">CI: 7.9‐not estimable) and 6.6 years (95% style="fixed-case">CI: 5.4‐7.8 years). Optimal high‐grade E‐ style="fixed-case">STS management includes style="fixed-case">LSS with preoperative or postoperative style="fixed-case">RT as evidenced by superior style="fixed-case">OS and style="fixed-case">SM.