National survival trends of young adults with sarcoma: lack of progress is associated with lack of clinical trial participation.

Young adults with cancer in the U.S. have had less improvement in survival than either younger patients or older patients. The authors attempted to determine whether similar deficits have occurred in young adults with sarcomas and, if so, then why. In 38,144 young adults with sarcoma who were diagnosed during 1975-1998 and were followed by the National Cancer Institute's (NCI) Surveillance, Epidemiology, and End Results Program, the average annual percent change in 5-year survival was derived as a function of patient age. National sarcoma treatment trial data were obtained on 3242 patients who were entered onto NCI-sponsored trials during 1997-2002. 1) For patients with bone and soft-tissue sarcomas, except Kaposi sarcoma (KS), the least survival improvement occurred between age 15 years and age 45 years. For patients with KS, the pattern was reversed, with the greatest survival increase occurring among patients ages 30-44 years. 2) The lowest participation rate in NCI-sponsored sarcoma treatment trials occurred in patients ages 20-44 years. For patients with KS, the highest accrual rate occurred in patients ages 35-44 years. 3) The age-dependent survival improvement and clinical-trial accrual patterns were correlated directly (soft-tissue sarcomas, P < 0.005; bone sarcomas, P < 0.05; KS, P = 0.06), regardless of whether the accrual profile demonstrated a decline or a peak (KS) during early adulthood. The lack of survival prolongation in patients age 15-44 years in the U.S. with non-KS sarcomas may have been a result of their relative lack of participation in clinical trials. If this is true, then reversing the shortfall in survival among young adults with sarcomas, as was accomplished among patients with KS, should benefit from increased clinical trial availability, access, and participation.

Bleyer A ，Montello M ，Budd T ，Saxman S ... -  《CANCER》

Adolescents and young adults with cancer: the scope of the problem and criticality of clinical trials.

In the U.S., older adolescents and young adults with cancer have benefited less from therapeutic advances than did either younger or older patients. One factor that may explain this deficit is the relative lack of participation of patients in this age group on clinical trials of therapies that could improve their outcome. Comparisons were made of the participation of cancer patients on clinical trials in the U.S., as a function of patient age, with the change in national cancer mortality rate; and Surveillance, Epidemiology, End Results (SEER) cancer survival rate as a function of age. The participation rate in cancer treatment trials has been strikingly lower in 15-34-year-olds than in younger or older patients. The nadir has been apparent for both males and females in all of the major ethnic and racial groups. The national cancer mortality reduction and SEER survival improvement shows a similar age dependence. In the U.S., the age-dependence of cancer treatment trial participation, and of improvement in survival prolongation and cancer death rates, are correlated. Regardless of whether there is a causal relationship, the impact on the older adolescent and young adult U.S. population is substantial, adversely affecting the national cost of healthcare, the person-years of life lost, the loss of young people entering the job market, and the scientific knowledge and social implications of cancer during adolescence and early adulthood. National initiatives are underway to address these issues, with special emphasis on increasing the availability and access to clinical trials designed for older adolescents and young adults.

Bleyer A ，Budd T ，Montello M 《-》

Cutaneous soft tissue sarcoma incidence patterns in the U.S. : an analysis of 12,114 cases.

Cutaneous soft tissue sarcomas (CSTS) are a heterogeneous group of mesenchymal neoplasms. To the authors' knowledge, no prior large, population-based study has focused on CSTS. Surveillance, Epidemiology, and End Results (SEER) Program incidence and relative survival rates of CSTS were analyzed according to race, sex, and histologic type using the 2002 criteria of the World Health Organization classification. Among residents of the 13 SEER registries, 12,114 CSTS were diagnosed from 1992 through 2004. Overall age-adjusted CSTS incidence rates were highest among blacks (30.8 per 1,000,000 person-years) followed by whites (25 per 1,000,000 person-years), and American Indians/Alaska Natives (11.2 per 1,000,000 person-years) and were lowest among Asian/Pacific Islanders (7.7 per 1,000,000 person-years). Kaposi sarcoma (KS) accounted for 71.1% of cases, and the rates were similarly ranked. Dermatofibrosarcoma protuberans (DFSP) rates also were highest among blacks, whereas leiomyosarcoma (LS) and angiosarcoma (AS) rates were highest among whites. The rate ratio of men to women was 25.5 for KS, 4.7 for malignant fibrous histiocytoma (MFH), 3.7 for LS, 2.0 for AS, and 0.9 for DFSP. The 5-year relative survival rates were 99% for patients with DFSP, 89% for patients with MFH, 92% for patients with LS, and 45% for patients with AS. KS rates among men in the original 9 SEER registries increased more than 30-fold during the 1980s before they peaked around 1991 and subsequently declined rapidly because of human immunodeficiency virus-associated KS and highly active antiretroviral therapy. This KS pattern was evident not only among those ages 20 to 59 years but also among those ages 60 to 69 years. From 1978 through 2004, LS and AS rates among whites increased exponentially. CSTS rates varied markedly over time and by race, sex, and histologic type, supporting the notion that these histologic variants of CSTS areetiologically distinct.

Rouhani P ，Fletcher CD ，Devesa SS ，Toro JR ... -  《-》

Post-radiation sarcomas. Clinical outcome of 52 Patients.

Previous studies reported on post-radiation sarcomas. However, the incidence, latency from radiation therapy, treatment, and survival has been difficult to evaluate. We performed a retrospective, single-institutional study to determine these factors for post-radiation sarcomas. We retrospectively studied 52 patients with post-radiation sarcomas diagnosed and treated from 1985 to 2011. The mean age was 49 years; 45 patients had bone and 7 soft tissue sarcoma. The mean follow-up was 45 months. Survival was analyzed with respect to age at diagnosis, type (bone vs. soft tissue), histology, location (trunk vs. extremities), size, and surgical treatment (resection vs. amputation). The risk of post-radiation sarcoma was 0.06% at a mean latency of 15 years (3-50 years) after radiation therapy. The most common histology was osteosarcoma followed by malignant fibrous histiocytoma and fibrosarcoma; all sarcomas were high grade. Survival of the patients with post-radiation sarcomas was 85% at 1 year, 51% at 2 years, 48% at 3 years, and 45% at 5 years. Univariate predictor of survival was only the type of the sarcoma. No variable was significant in multivariate analysis. Prognosis of post-radiation sarcomas is poor; the type of the sarcomas is the only significant variable for survival.

Mavrogenis AF ，Pala E ，Guerra G ，Ruggieri P ... -  《-》

Trends in survival of patients diagnosed with cancers of the brain and nervous system, thyroid, eye, bone, and soft tissues in the Nordic countries 1964-2003 followed up until the end of 2006.

Bray F ，Engholm G ，Hakulinen T ，Gislum M ，Tryggvadóttir L ，Storm HH ，Klint A ... -  《-》