Low Rates of Chemotherapy Use for Primary, High-Grade Soft Tissue Sarcoma: A National Cancer Database Analysis
Background: There is conflicting evidence regarding the role of chemotherapy for high-grade soft tissue sarcoma (STS) in adults. We sought to characterize patterns of chemotherapy use, including multiagent and neoadjuvant chemotherapy, in the United States. Patients and Methods: Using the National Cancer Database, we identified 19,969 adult patients who underwent surgical resection for primary high-grade STS from 2004 to 2016. Using logistic regression, we examined factors associated with overall, multiagent, and neoadjuvant chemotherapy use. Results: Chemotherapy was administered to 22% (n=4,377) of the study population. Among patients treated using chemotherapy, 85% received multiagent treatment and 47% received neoadjuvant treatment. On multivariate analysis, factors associated with chemotherapy use included tumor size, depth, histology, and primary site; receipt of radiation treatment; younger age; higher patient income; and academic treatment facility. Factors associated with multiagent chemotherapy use included tumor histology, tumor primary site, and younger age. Factors associated with neoadjuvant chemotherapy use included tumor size, depth, margin status, and primary site; receipt of radiation treatment; higher patient income; academic treatment facility type; and distance to treatment facility. Treatment at a high-volume facility was the only factor associated with overall, multiagent, and neoadjuvant chemotherapy use. No significant temporal trend was seen in overall, multiagent, or neoadjuvant chemotherapy use. Conclusions: Overall chemotherapy use was low (22%). The variability in chemotherapy use was driven by clinical, patient, demographic, and facility factors. Among patients treated with chemotherapy, the use of multiagent chemotherapy was high (85%), and nearly half received neoadjuvant therapy. There was a discrepancy in the use of chemotherapy—including neoadjuvant and multiagent chemotherapy—between high- and low-volume treatment centers.
Submitted August 26, 2019; accepted for publication February 19, 2020.
Author contributions: Study design: Graham, Onyshchenko, Kalbasi. Data acquisition, analysis, and interpretation, including statistical analysis: Graham, Kalbasi. Manuscript draft: Graham, Kalbasi. Critical review and edit of final draft: All authors. Project supervision: Eilber, Kalbasi.
Disclosures: Dr. Onyshchenko has disclosed that he is a scientific advisor for Bayer. Dr. Singh has disclosed that he is a scientific advisor for Eli Lilly, Roche, and Blueprints; has received honoraria/consulting fees from Daiichi Sankyo, Deciphera, Eisai, Eli Lilly, Novartis, Expert Perspectives, and OncLive; a consultant for Daiichi Sankyo and Eisai; a member of the board of directors of and shareholder in Certis Oncology Solutions; and receives grant/research support from Eli Lilly, Deciphera, Nanocarrier, and Blueprints. Dr. Eilber has disclosed that he is a scientific advisor for Certis Oncology Solutions. The remaining authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.
Funding: This work was supported by funding from the Department of Radiation Oncology, UCLA Health System (ID0EQJAG3359), the Division of Surgical Oncology, Department of Surgery, UCLA Health System (ID0E6JAG3360), and the Jonsson Comprehensive Cancer Center, UCLA Health System (ID0EOKAG3361).
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