THE EFFECT OF AGE ON OUTCOME OF SYNOVIAL SARCOMA PATIENTS

A DUTCH POPULATION BASED STUDY

Myrella Vlenterie, SEJ Kaal, VKY Ho, R Vlenterie, WTA van der GraafMedical Oncology, Radboud University Medical Centre, Nijmegen

Literature

Literature

Research question• Is age an independent prognostic factor for overall

and relative survival in synovial sarcoma patients?

Research question• Is age an independent prognostic factor for overall

and relative survival in synovial sarcoma patients?

• Do treatment modalities explain the differences between variant age groups?

Materials & Methods• The Netherlands Cancer Registry:

• >95% coverage• Information at diagnosis• Tumour and patient characteristics, diagnostics and therapy • Sources: Dutch pathology network (PALGA) & hospital records

Materials & Methods• The Netherlands Cancer Registry:

• >95% coverage• Information at diagnosis• Tumour and patient characteristics, diagnostics and therapy • Sources: Dutch pathology network (PALGA) & hospital records

• Cancer care in the Netherlands• Sarcoma care centralised in recent years

Materials & Methods• The Netherlands Cancer Registry:

• >95% coverage• Information at diagnosis• Tumour and patient characteristics, diagnostics and therapy • Sources: Dutch pathology network (PALGA) & hospital records

• Cancer care in the Netherlands• Sarcoma care centralised in recent years

• Statistics: • Kaplan Meier for Overall survival (OS) • Relative survival (RS)• Univariate analyses• Multivariate Cox regression analyses

Age groups

Children < 18years

Adults35-64years

AYAs18-34years

Elderly≥65years

Patient cohort

438 (75%)

102 (17%)

46 (8%)

Patients histologically diagnosed with SS: 1989-2012

Localized diseaseMetastatic diseaseUnknown

Total: 586 patients

Overall survival: stage at diagnosis

No metastasis 5yr OS: 64±2%

Unknown stage

Metastasesmedian survival: 11±1months

• Median follow up: 42 months (range 0-300 months)

Cum

ulati

ve s

urvi

val

Survival time (months)

Localised disease

Patient characteristicsVariable n = 438 (100%)

Age o <18 yearso 18-34 yearso 35-64 yearso ≥65 years

5114319252

(12%)(33%)(44%)(12%)

Sex o Maleo Female

236202

(54%)(46%)

Histology o Monophasico Biphasico Not specified

9598

245

(22%)(22%)(56%)

Hospital of surgery o General hospitalo Academic hospitalo Unknown

108196134

(25%)(45%)(31%)

Patient characteristicsVariable n = 438 (100%)

Site of origin o Extremitieso Head and necko Trunko Other

294367830

(67%)(8%)

(18%)(7%)

Therapy o Surgery aloneo Surgery + RT (+CT)o Surgery + CTo No surgery

1512063843

(35%)(47%)(9%)

(10%)

Resection status

o R0o R1 / R2o R status unknown

13551

252

(31%)(12%)(58%)

Overall survival: age groups

5yr OS: 91±4% Children

5yr OS: 72±4% AYAs

5yr OS: 57±4% Adults

5yr OS: 43±7% Elderly

Cum

ulati

ve s

urvi

val

Survival time (months)

Relative survival: age groups5yr OS: 91%5yr RS: 91% Children

5yr OS: 72%5yr RS: 72% AYAs

5yr OS: 57%5yr RS: 58% Adults

5yr OS: 43%5yr RS: 53% Elderly

RS: Corrected for age, sex and year

Age as a continous variable

Age (years)

Surv

ival

tim

e (m

onth

s)

Cox regression: Univariate analyses

VariablesAge groups

SexHistology

Hospital of surgerySite of origin

TherapyResection status

Cox regression: Univariate analyses

VariablesAge groups

SexHistology

Hospital of surgerySite of origin

TherapyResection status

p < 0.10

Cox regression: Univariate analyses

VariablesAge groups

SexHistology

Hospital of surgerySite of origin

TherapyResection status

p < 0.10

Cox regression: Univariate analyses

VariablesAge groups

SexHistology

Hospital of surgerySite of origin

TherapyResection status

p < 0.10

Total Children AYAs Adults Elderly0%

10%20%30%40%50%60%70%80%90%

100%

Surgery + CT

Surgery + RT (+CT)

Surgery alone

Treatment modalities*Chi-square: p<0.05

*

43 patients received no surgery left out of multivariate analysis

Cox regression: Multivariate analysis

n HR

Children

AYAsAdults

Elderly

Surgery alone

Surgery + (neo)adj radiotherapy*

Surgery + (neo)adj chemotherapy

Extremities

Head and neck

Trunk

Other

Primary localisation

136 2.26

171 3.81

39 6.52

151 1

206 0.93

38 1.75

279 1

33 1.05

60 1.97

Age groups

Treatment

49 1

23 2.04

Cox regression: Multivariate analysis

Children

AYAsAdults

Elderly

Surgery alone

Surgery + RT (+CT)

Surgery + CT

Extremities

Head and neck

Trunk

Other

Primary localisation

136 2.26

171 3.81

39 6.52

151 1

206 0.93

38 1.75

279 1

33 1.05

60 1.97

Age groups

Treatment

49 1

23 2.04

n HR

Cox regression: Multivariate analysisn HR

ChildrenAYAs

Adults

Elderly

Surgery alone

Surgery + RT (+CT)

Surgery + CT

Extremities

Head and neck

Trunk

Other

Primary localisation

136 2.26

171 3.81

39 6.52

151 1

206 0.93

38 1.75

279 1

33 1.05

60 1.97

Age groups

Treatment

49 1

23 2.04

Take home messages

1. Age at diagnosis is an independent prognostic factor for overall and relative survival

2. Survival differences can not be explained by treatment modalities

Future research

• Further research in tumor biology is necessary

to explain the survival differences