Annals of Surgical Oncology

, Volume 16, Issue 9, pp 2579–2586 | Cite as

Complete Soft Tissue Sarcoma Resection is a Viable Treatment Option for Select Elderly Patients

  • G. Lahat
  • A. R. Dhuka
  • S. Lahat
  • A. J. Lazar
  • V. O. Lewis
  • P. P. Lin
  • B. Feig
  • J. N. Cormier
  • K. K. Hunt
  • P. W. T. Pisters
  • R. E. Pollock
  • D. Lev
Bone and Soft Tissue Sarcomas

Abstract

Background

Decreased performance status, comorbidities, and disease natural history may erode enthusiasm for soft tissue sarcoma (STS) resection in elderly patients. Consequently, we evaluated the outcome of elderly patients amenable to complete surgical resection treated at a single institution.

Methods

Prospectively accrued data were used to identify patients with primary STS age ≥65 years (n = 325) who underwent complete macroscopic resection at our institution (1996–2007). Univariable and multivariable analyses were performed to identify prognostic factors.

Results

Median age at presentation was 72 years; 179 patients (55.1%) had associated comorbidities with an ASA score of ≥3. Extremity was the most common site (57.1%; n = 186), undifferentiated pleomorphic sarcoma the most common histology (60.4%; n = 197); 232 (71.2%) were high grade, 222 (68.3%) were >5 cm. Thirty-day postoperative mortality was 0.9% (n = 3); overall complication rate was 30.7% (n = 100), and mean postoperative hospital stay was 9 days (range, 1–84). Estimated median survival was 96 months, 5-year disease-specific survival (DSS) was 63%. Multivariable analysis identified age ≥75 year (HR = 2.03), tumor size: 5–15 vs <5 cm (HR = 3.54), or >15 vs <5 cm (HR = 10.33), and high-grade (HR = 5.53) as significant independent adverse prognostic factors. Compared with patients aged 65–74 years, older patients had more high grade tumors (P = .04), received chemotherapy less often (P < .0001), developed different patterns of recurrence (P < .05), and exhibited a shorter median survival (70 months; P = .05).

Conclusions

Properly selected elderly patients can safely undergo extensive STS resections. Until more effective therapies become available, surgery in the elderly is indicated and remains the best means for STS control.

Keywords

Soft Tissue Sarcoma Young Cohort Undifferentiated Pleomorphic Sarcoma Soft Tissue Sarcoma Patient Complete Macroscopic Resection 

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Copyright information

© Society of Surgical Oncology 2009

Authors and Affiliations

  • G. Lahat
    • 1
    • 2
  • A. R. Dhuka
    • 1
    • 2
  • S. Lahat
    • 2
  • A. J. Lazar
    • 2
    • 3
  • V. O. Lewis
    • 1
  • P. P. Lin
    • 1
  • B. Feig
    • 1
  • J. N. Cormier
    • 1
  • K. K. Hunt
    • 1
  • P. W. T. Pisters
    • 1
  • R. E. Pollock
    • 1
    • 2
  • D. Lev
    • 2
    • 4
  1. 1.Department of Surgical OncologyUniversity of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Sarcoma Research CenterUniversity of Texas MD Anderson Cancer CenterHoustonUSA
  3. 3.Department of PathologyUniversity of Texas MD Anderson Cancer CenterHoustonUSA
  4. 4.Department of Cancer BiologyUniversity of Texas MD Anderson Cancer CenterHoustonUSA

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