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 Graaf Medical 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

Adults

35-64years

AYAs

18-34years

Elderly

≥65years

Patient cohort Patients histologically diagnosed with SS: 1989-2012

102 (17%) 46 (8%) 438 (75%) Localized disease Metastatic disease Unknown Total: 586 patients

Overall survival: stage at diagnosis

• Median follow up: 42 months (range 0-300 months) No metastasis 5yr OS: 64±2% Unknown stage Metastases median survival: 11±1months

Survival time (months)

Localised disease

Patient characteristics Variable

Age Sex Histology Hospital of surgery o o o o o o o o o o o o <18 years 18-34 years 35-64 years ≥65 years Male Female Monophasic Biphasic

Not specified

General hospital Academic hospital

Unknown

n = 438

51 143 192 52 236 202 95 98 245 108 196 134

(100%)

(12%) (33%) (44%) (12%) (54%) (46%) (22%) (22%) (56%) (25%) (45%) (31%)

Patient characteristics Variable

Site of origin Therapy Resection status o o o o o o o o o o o Extremities Head and neck Trunk Other Surgery alone Surgery + RT (+CT) Surgery + CT No surgery R0 R1 / R2

R status unknown

n = 438

294 36 78 30 151 206 38 43 135 51 252

(100%)

(67%) (8%) (18%) (7%) (35%) (47%) (9%) (10%) (31%) (12%) (58%)

Overall survival: age groups

5yr OS: 91±4% Children 5yr OS: 72±4% 5yr OS: 57±4% 5yr OS: 43±7% AYAs Adults Elderly

Survival time (months)

Relative survival: age groups

5yr OS: 91%

5yr RS: 91%

5yr OS: 72%

5yr RS: 72%

5yr OS: 57%

5yr RS: 58%

5yr OS: 43%

5yr RS: 53%

Children AYAs Adults Elderly RS: Corrected for age, sex and year

Age as a continous variable Age (years)

Cox regression: Univariate analyses Variables

Age groups Sex Histology Hospital of surgery Site of origin Therapy Resection status

Cox regression: Univariate analyses Variables

Age groups Sex Histology Hospital of surgery Site of origin Therapy Resection status p < 0.10

Cox regression: Univariate analyses Variables

Age groups Sex Histology Hospital of surgery Site of origin Therapy Resection status p < 0.10

Cox regression: Univariate analyses Variables

Age groups Sex Histology Hospital of surgery Site of origin Therapy Resection status p < 0.10

Treatment modalities

*Chi-square: p<0.05

* 100% Surgery + CT 80% 60% 40% 20% 0% Surgery + RT (+CT) Surgery alone Total Children AYAs Adults Elderly 43 patients received no surgery  left out of multivariate analysis

Cox regression: Multivariate analysis Age groups

Children AYAs Adults Elderly

Treatment

Surgery alone Surgery + (neo)adj radiotherapy* Surgery + (neo)adj chemotherapy

Primary localisation

Extremities Head and neck Trunk Other 0,1 1,0 10,0 49 1 136 2.26

171 3.81

39 6.52

151 1 206 0.93

38 1.75

n HR 279 1 33 1.05

60 1.97

23 2.04

Cox regression: Multivariate analysis Age groups

Children AYAs Adults Elderly

Treatment

Surgery alone Surgery + RT (+CT) Surgery + CT

Primary localisation

Extremities Head and neck Trunk Other 0,1 1,0 10,0 49 1 136 2.26

171 3.81

39 6.52

n HR 151 1 206 0.93

38 1.75

279 1 33 1.05

60 1.97

23 2.04

Cox regression: Multivariate analysis

n HR

Age groups

Children AYAs Adults Elderly 49 1 136 2.26

171 3.81

39 6.52

Treatment

Surgery alone Surgery + RT (+CT) Surgery + CT

Primary localisation

Extremities Head and neck Trunk Other 151 1 206 0.93

38 1.75

279 1 33 1.05

60 1.97

23 2.04

0,1 1,0 10,0

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