Prognostic factors for elderly patients with primary malignant bone and soft tissue tumors

Iwai,Tadashi; Hoshi,Manabu; Takada,Jun; Oebisu,Naoto; Aono,Masanari; Takami,Masatsugu; Ieguchi,Makoto; Nakamura,Hiroaki

doi:10.3892/ol.2015.3432

Prognostic factors for elderly patients with primary malignant bone and soft tissue tumors

Authors:
- Tadashi Iwai
- Manabu Hoshi
- Jun Takada
- Naoto Oebisu
- Masanari Aono
- Masatsugu Takami
- Makoto Ieguchi
- Hiroaki Nakamura
View Affiliations

Affiliations: Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Abeno‑Ku, Osaka 545‑8585, Japan
Published online on: June 29, 2015 https://doi.org/10.3892/ol.2015.3432
Pages: 1799-1804

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

The number of patients with primary malignant bone and soft tissue tumors in Japan is increasing in line with the increasing size of the elderly population. The aim of the present study was to determine the prognostic factors of primary malignant bone or soft tissue tumors in elderly patients. Clinical data was obtained from 90 patients, aged ≥65 years, with primary malignant bone or soft tissue tumors (bone, 20 cases; and soft tissue, 70 cases), treated at the Osaka City University Hospital between 1993 and 2013. Clinical information prior to treatment and tumor type, location, size, depth, grade and American Society of Anesthesiologists‑Physical Status (ASA‑PS) score were evaluated in order to identify prognostic factors using the Cox proportional hazards regression model. In addition, 5‑year survival rates were evaluated using the Kaplan‑Meier method. The average follow‑up period was 44.8 months and the 5‑year overall survival rate was 77.5%. In the multivariate analysis, ASA‑PS score and high‑grade sarcoma were found to be associated with a poorer overall survival. No significant differences were observed between the patient group aged 65‑74 years and that aged ≥75 years. In general, aging is associated with physically reduced function and an increased prevalence of comorbidities. It was therefore expected that increasing age may be a predictive factor for poor prognosis. However, the results of the present study suggested that ASA‑PS score and tumor grade were significant factors associated with poor prognosis, whereas increasing age was not. Therefore, the treatment of elderly patients with primary bone and soft tissue tumors should not be based on age.

View Figures

View References

1	Ministry of Health, Labor and Welfare of Japan, . 2014 Statistics. Elderly people, natality, life expectancy. http://www.mhlw.go.jp/toukei/saikin/hw/jinkou/geppo/nengai14/index.htmlAccessed. 30–April. 2014
2	World Health Organization, . Health statistics and information systems definition of an older or elderly person. http://www.who.int/healthinfo/en/Accessed. 30–April. 2014
3	Office for Policies on Cohesive Society, . Cabinet Office, Government of Japan. http://www8.cao.go.jp/souki/index-eng.htmlAccessed. 30–April. 2014
4	Japanese Orthopedic Association Musculoskeletal Tumor Committee, . Bone Tumor Registry and Malignant Soft Tissue Tumor Registry in JapanJapanese Musculoskeletal Oncology Group; Tokyo: 2008
5	Anisimov VN: The relationship between aging and carcinogenesis: A critical appraisal. Crit Rev Oncol Hematol. 45:277–304. 2003. View Article : Google Scholar : PubMed/NCBI
6	Balducci L and Erchler WB: Cancer and aging: A nexus at several levels. Nat Rev Cancer. 5:655–662. 2005. View Article : Google Scholar : PubMed/NCBI
7	Al-Refaie WB, Habermann EB, Dudeja V, Vickers SM, Tuttle TM, Jensen EH and Virnig BA: Extremity soft tissue sarcoma care in the elderly: Insights into the generalizability of NCI Cancer Trials. Ann Surg Oncol. 17:1732–1738. 2010. View Article : Google Scholar : PubMed/NCBI
8	Osaka S, Sugita H, Osaka E, Yoshida Y and Ryu J: Surgical management of malignant soft tissue tumours in patients aged 65 years or older. J Orthop Surg (Hong Kong). 11:28–33. 2003.PubMed/NCBI
9	Lahat G, Dhuka AR, Lahat S, Lazar AJ, Lewis VO, Lin PP, Feig B, Cormier JN, Hunt KK, Pisters PW, et al: Complete soft tissue sarcoma resection is a viable treatment option for select elderly patients. Ann Surg Oncol. 16:2579–2586. 2009. View Article : Google Scholar : PubMed/NCBI
10	Boden RA, Clark MA, Neuhaus SJ, A'hern JR, Thomas JM and Hayes AJ: Surgical management of soft tissue sarcoma in patients over 80 years. Eur J Surg Oncol. 32:1154–1158. 2006. View Article : Google Scholar : PubMed/NCBI
11	Torigoe T, Terakado A, Suehara Y, Kurosawa H, Yazawa Y and Takagi T: Bone versus soft-tissue sarcomas in the elderly. J Orthop Surg. 18:58–62. 2010.
12	Kozawa E, Sugiura H, Tsukushi S, et al: Multiple primary malignancies in elderly patients with high-grade soft tissue sarcoma. Int J Clin Oncol. 19:384–390. 2014. View Article : Google Scholar : PubMed/NCBI
13	Yoneda Y, Kunisada T, Naka N, Nishida Y, Kawai A, Morii T, Takeda K, Hasei J, Yamakawa Y and Ozaki TJapanese Musculoskeletal Oncology Group: Favorable outcome after complete resection in elderly soft tissue sarcoma patients: Japanese Musculoskeletal Oncology Group study. Eur J Surg Oncol. 40:49–54. 2014. View Article : Google Scholar : PubMed/NCBI
14	Flecher C, Unni K and Mertens F: Pathology and genetics of tumours of soft tissue and boneWorld Health Organization Classification of Tumours. Kleihues P and Sobin LH: International Agency for Research on Cancer Press; Lyon: pp. 10–18. 2002
15	Broders AC: Squamous cell epithelioma of the lip. A study of 537 cases. JAMA. 74:656–664. 1920. View Article : Google Scholar
16	Trojani M, Contesso G, Coindre JM, Rouesse J, Bui NB, de Mascarel A, Goussot JF, David M, Bonichon F and Lagarde C: Soft-tissue sarcomas of adults; study of pathological prognostic variables and definition of a histopathological grading system. Int J Cancer. 33:37–42. 1984. View Article : Google Scholar : PubMed/NCBI
17	Edge SB, Byrd DR, Compton CC, et al: American Joint Committee on Cancer (AJCC): Soft tissue sarcomaAJCC cancer staging manual. 7th. Springer; New York, NY: pp. 291–296. 2010
18	Edge SB, Byrd DR, Compton CC, et al: AJCC boneAJCC cancer staging manual. 7th. Springer; New York, NY: pp. 281–290. 2010
19	Hosking MP, Warner MA, Lobdell CM, Offord KP and Melton LJ III: Outcomes of surgery in patients 90 years of age and older. JAMA. 261:1909–1915. 1989. View Article : Google Scholar : PubMed/NCBI
20	Kawaguchi N, Ahmed AR, Matsumoto S, Manabe J and Matsushita Y: The concept of curative margin in surgery for bone and soft tissue sarcoma. Clin Orthop Relat Res. 419:165–172. 2004. View Article : Google Scholar : PubMed/NCBI
21	Kaplan EL and Meier P: Nonparametric estimation from incomplete observation. J Am Stat Assoc. 53:448–457. 1958. View Article : Google Scholar
22	Mantel N: Evaluation of survival data and two new rank order statistics arising in its consideration. Cancer Chemother Rep. 50:163–170. 1966.PubMed/NCBI
23	Cox DR: Regression models and life-tables. J R Stat Soc. 34:187–220. 1972.
24	Takano S, Watanabe Y, Ohishi H, Kono S, Nakamura M, Kubota N and Iwai S: Multimodality treatment for patients with hepatocellular carcinoma: A single institution retrospective series. Eur J Surg Oncol. 26:67–72. 2000. View Article : Google Scholar : PubMed/NCBI
25	Suemitsu R, Yamaguchi M, Takeo S, Ondo K, Ueda H, Yoshino I and Maehara Y: Favorable surgical results for patients with nonsmall cell lung cancer over 80 years old: A multicenter survey. Ann Thorac Cardiovasc Surg. 14:154–160. 2008.PubMed/NCBI
26	ESMO/European Sarcoma, Network Working Group, . Soft tissue, visceral sarcomas: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 23 (Suppl 7):vii92–vii99. 2012.PubMed/NCBI
27	Linch M, Miah AB, Thway K, Judson IR and Benson C: Systemic treatment of soft-tissue sarcoma-gold standard and novel therapies. Nat Rev Clin Oncol. 11:187–202. 2014. View Article : Google Scholar : PubMed/NCBI
28	Farry JK, Flombaum CD and Latcha S: Long term renal toxicity of ifosfamide in adult patients - 5 year data. Eur J Cancer. 48:1326–1331. 2012. View Article : Google Scholar : PubMed/NCBI
29	Matushansky I, Dela Cruz F, Insel BJ, Hershman DL and Neugut AI: Chemotherapy use in elderly patients with soft tissue sarcoma: A population-based study. Cancer Invest. 31:83–91. 2013. View Article : Google Scholar : PubMed/NCBI
30	Vigorito C and Giallauria F: Effects of exercise on cardiovascular performance in the elderly. Front Physiol. 5:512014. View Article : Google Scholar : PubMed/NCBI