Treatment patterns, and survival of patients with metastatic undifferentiated pleomorphic sarcoma: A National Cancer Database (NCDB) study.
Authors: Hussain I Rangoonwala, Mary Elizabeth Dahl, Jonathan Gootee, Sai Giridhar Gundepalli, Sarah J Aurit, Peter T. Silberstein
Journal: Journal of Clinical Oncology (2021)

11561 Background: Undifferentiated Pleomorphic Sarcoma (UPS) is regarded as one of the most common types of soft tissue sarcoma. Although prior studies have highlighted its metastatic potential, there have been no database studies that delineate the clinical/social characteristics and outcomes in UPS patients with metastatic disease. Utilizing the National Cancer Database (NCDB), we want to observe the complex interplay between treatment approaches and non-biologic modifiers. Methods: 737 patients diagnosed with metastatic UPS above the age of 17 years between 2004 and 2015 were identified utilizing the NCDB. Patients were identified with ICD-O-3 morphologic code 8830/3. Demographic factors (Race/ethnicity, biological sex, Median household income/education at zip code level, facility type, insurance) were studied in relation to the type of treatment they received: No treatment; chemotherapy only; chemotherapy and radiation therapy; chemotherapy and surgery; chemotherapy, surgery, and radiation; radiation therapy and/or surgery; and other treatments. Survival tables were utilized to generate 1-year and 3-year survival rates, and Kaplan-Meier method with associated log-rank list was used to examine the differences in unadjusted survival. Results: Approximately 17% of our cohort were left untreated, whereas 83% received treatment. Patients who were untreated were likely to be older, on Medicare, and had a Charlson-Deyo (CD) score of 2 or above. Patients who were more likely to receive treatment were younger educated males with private insurance, residing in areas of higher income, and receiving care at an academic program. Patients who only received chemotherapy were more likely to belong to areas with lower income and had a CD score of 0. Patients who received a combination of chemotherapy, surgery, and radiation therapy were more likely to belong to areas of high income, private insurance owners, and received care at an academic facility. Patients who received chemotherapy with surgery and without radiation therapy were more likely to be younger males from areas of highest income, and received care at an academic facility. Patients who had better unadjusted survival were younger educated patients on private insurance or Medicaid, with distant lymph nodes metastases at diagnosis, who received a combination of chemotherapy, radiation therapy and surgery at an academic program. Patients who had poorer unadjusted survival were untreated older patients on Medicare, and with bone metastases. Conclusions: This is one of the most comprehensive studies involving patients with metastatic UPS that analyzes demographic variables in relation to the treatment approach. Some of the major determinants that influence outcomes in these patients included age, insurance status, treatment at academic facility, CD score, and type of metastases at diagnoses.