Sarcomas in patients over 90: Natural history and treatment—A nationwide study over 6 years

Abstract

Soft tissue sarcomas (STS) are rare tumors accounting for less than 1% of human cancers. While the highest incidence of sarcomas is observed in elderly, this population is often excluded or poorly represented in clinical trials. The present study reports on clinicopathological presentation, and outcome of sarcoma patients over 90 recorded in the http://netsarc.org French national database. NETSARC (http://netsarc.org) is a network of 26 reference sarcoma centers with specialized multidisciplinary tumor board (MDTB), funded by the French National Cancer Institute to improve the outcome of sarcoma patients. Since 2010, presentation to an MDTB, second pathological review, and collection of sarcoma patient characteristics and follow‐up are collected in a database Information of patients registered from January 1, 2010, to December 31, 2016, in NETSARC were collected, analyzed and compared to the younger population. Patients with sarcomas aged >90 have almost exclusively sarcomas with complex genomics (92.0% vs. 66.3%), are less frequently metastatic (5.3% vs. 14·7%) at diagnosis, have more often superficial tumors (39.8% vs. 14.7%), as well as limbs and head and neck sites (75.2% vs. 38.7%) (all p < 0.001). Optimal diagnostic procedures and surgery were less frequently performed in patients over 90 (p < 0.001). These patients were less frequently operated in NETSARC centers, as compared to those of younger age groups including aged 80–90. However, local relapse‐free survival, metastatic relapse‐free survival and relapse‐free survival were not significantly different from those of younger patients, in the whole cohort, as well as in the subgroup of operated patients. As expected overall survival was worse in patients over 90 (p < 0.001). Patients over 90 who were not operated had worse overall survival than younger patients (9.9 vs. 27.3 months, p < 0.001). Patients with STS diagnosed after 90 have distinct clinicopathological features, but comparable relapse‐free survival, unless clinical practice guidelines recommendations are not applied. Standard management should be proposed to these patients if oncogeriatric status allows.

Angiosarcoma: A population-based cancer registry descriptive study of 45 consecutive cases diagnosed between 1979 and 2016

“…When considering cutaneous AS, 10 5-year OS was even higher, superior to 90% for patients with dermatofibrosarcoma protuberans, leiomyosarcoma or malignant fibrous histiocytoma. As previously expected, 3 , 6 – 8 visceral AS, distant metastases at diagnosis and age ⩾ to 70 years were predictive of worse OS in our cohort ( Figure 1 ). In contrast, a French retrospective multicenter study (June 1980 to October 2009) of 107 patients with localized AS revealed higher 1-year and 5-year OS rates at 74.8% (95% CI: 70.7–78.9) and 39.8% (95% CI: 30.6–43.2), respectively.…”

“…Factors including age ⩾ to 70 years, male gender, unmarried status, pre-existing lymphedema, primary site of AS (cutaneous versus visceral), tumor size ⩾5 cm, tumor depth, distant metastases at diagnosis and non-surgery were reported to be independently associated with poor survival on prognosis. 3,7,8 In a previous prospective French study 9 including 658 patients with soft tissue sarcomas, 28 AS were identified. Among them, radiation-induced AS represented 18% out of all cases and only one case of Stewart-Treves syndrome was identified.…”

“…Factors including age ⩾ to 70 years, male gender, unmarried status, pre-existing lymphedema, primary site of AS (cutaneous versus visceral), tumor size ⩾5 cm, tumor depth, distant metastases at diagnosis and non-surgery were reported to be independently associated with poor survival on prognosis. 3 , 7 , 8 …”

Aberrant PTEN, PIK3CA, pMAPK, and TP53 expression in human scalp and face angiosarcoma

“…Angiosarcomas are very rare, accounting for approximately 1% to 2% of soft tissue sarcomas, [ 35 ] which represent only 1% to 2% of all tumors. [ 36 ] We included all cases that were identified at our hospital. In addition, the possibility of differential diagnoses in angiosarcoma patients could not be ruled out; thus, some cases were not identified in this database.…”

Outcomes of soft-tissue sarcoma in nonagenarians

“…2,3 In 2010, approximately 40% of patients with limb STS were diagnosed in those aged over 65 years, 1 but historically the elderly age group are under-represented in clinical trials. [4][5][6] Better strategies for the management of long-term conditions mean that the population is progressively ageing, and the NHS is seeing an increasing number of patients presenting with symptoms and signs of STS in the very elderly age range (over 90 years cohort). 1 The management, local recurrence, and overall survival rates in the middle-aged and elderly population are well documented, 3,7 but insufficient evidence exists to guide treatment in the very elderly age group.…”