Age-related differences of oncological outcomes in primary extremity soft tissue sarcoma: a multistate model including 6260 patients

Ibtissam Acem*, Cornelis Verhoef, PERSARC study group, Anja J Rueten-Budde, Dirk J Grünhagen, Winan J van Houdt, Michiel A J van de Sande

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

13 Citations (Scopus)
11 Downloads (Pure)


PURPOSE: No studies extensively compared the young adults (YA, 18-39 years), middle-aged (40-69 years), and elderly (≥70 years) population with primary high-grade extremity soft tissue sarcoma (eSTS). This study aimed to determine whether the known effect of age on overall survival (OS) and disease progression can be explained by differences in tumour characteristics and treatment protocol among the YA, middle-aged and elderly population in patients with primary high-grade eSTS treated with curative intent.

METHODS: In this retrospective multicentre study, inclusion criteria were patients with primary high-grade eSTS of 18 years and older, surgically treated with curative intent between 2000 and 2016. Cox proportional hazard models and a multistate model were used to determine the association of age on OS and disease progression.

RESULTS: A total of 6260 patients were included in this study. YA presented more often after 'whoops'-surgery or for reresection due to residual disease, and with more deep-seated tumours. Elderly patients presented more often with grade III and larger (≥10 cm) tumours. After adjustment for the imbalance in tumour and treatment characteristics the hazard ratio for OS of the middle-aged population is 1.47 (95% confidence interval [CI]: 1.23-1.76) and 3.13 (95% CI: 2.59-3.78) in the elderly population, compared with YA.

DISCUSSION: The effect of age on OS could only partially be explained by the imbalance in the tumour characteristics and treatment variables. The threefold higher risk of elderly could, at least partially, be explained by a higher other-cause mortality. The results might also be explained by a different tumour behaviour or suboptimal treatment in elderly compared with the younger population.

Original languageEnglish
Pages (from-to)128-136
Number of pages9
JournalEuropean Journal of Cancer
Early online date30 Oct 2020
Publication statusPublished - 1 Dec 2020

Bibliographical note

Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.

Research programs

  • EMC MM-04-20-01


Dive into the research topics of 'Age-related differences of oncological outcomes in primary extremity soft tissue sarcoma: a multistate model including 6260 patients'. Together they form a unique fingerprint.

Cite this