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Updated: Oct 4, 2025
A Mouse Model of Incompletely Resected Soft Tissue Sarcoma for Testing Neoadjuvant Therapies
Published on: July 28, 2020
National evaluation of patterns and predictors of underuse of multimodal therapy for high-risk extremity soft tissue
Aradhya Nigam1, Nathan Aminpour2, Alexander Zeymo3
1MedStar-Georgetown Surgical Outcomes Research Center, Washington, DC; Department of Surgery, MedStar-Georgetown University Hospital, Washington, DC.
Background:
Treatment of high-risk extremity soft tissue sarcomas remains widely varied. Despite growing support for a multimodal approach for treatment of these rare and aggressive neoplasms, its dissemination remains underused. This national study aimed to evaluate variations in treatment patterns and uncover factors predictive of underuse of multimodal therapy in high-risk extremity soft tissue sarcomas.
Methods:
The 2010 to 2015 National Cancer Database was used to evaluate trends in 3 common treatment patterns: surgery alone, surgery + adjuvant therapy, and neoadjuvant therapy + surgery. Demographic-, sarcoma-, hospital-, and treatment-level factors of 6,725 surgically treated patients with stage II or III intermediate- to high-grade extremity soft tissue sarcomas were evaluated by types of treatment modality. Stepwise multivariable logistic regression was performed to identify factors predictive of each treatment modality.
Results:
When compared to surgery alone (34.6%) and adjuvant therapy (41.2%), use of neoadjuvant therapy + surgery for high-risk extremity soft tissue sarcomas remained low (25.3%). However, time trend analysis demonstrated that neoadjuvant therapy + surgery has significantly increased by 7% per year, whereas surgery alone decreased by 4% every year (P < .05 for both). Factors predictive of surgery alone were older age, nonprivate insurance, increasing travel distance, and multimorbidity (P < .05). Conversely, factors associated with neoadjuvant therapy + surgery were private insurance, higher education, and care at academic or high-volume institutions (for all, P < .05). Tumor-related factors predictive for neoadjuvant therapy + surgery included size <5 cm and higher-grade tumors (P < .05).
Conclusion:
Adoption of multimodality therapy for high-risk extremity soft tissue sarcomas remains low and gradual in the United States. Dissemination of multimodality therapy will require attention to access and hospital factors to maximize these therapies for high-risk extremity soft tissue sarcomas.
Insights
Multimodal therapy for high-risk extremity soft tissue sarcomas is underused but increasing. Factors like insurance and institution type influence treatment choices for these rare cancers.
Area of Science:
- Oncology
- Surgical Oncology
- Cancer Research
Background:
- Treatment for high-risk extremity soft tissue sarcomas is highly variable.
- Multimodal approaches are increasingly supported but underutilized for these rare, aggressive cancers.
Purpose of the Study:
- To analyze treatment variations for high-risk extremity soft tissue sarcomas.
- To identify factors associated with the underuse of multimodal therapy.
Main Methods:
- Utilized the National Cancer Database (2010-2015) for 6,725 patients with stage II/III extremity soft tissue sarcomas.
- Evaluated trends in surgery alone, surgery + adjuvant therapy, and neoadjuvant therapy + surgery.
- Employed multivariable logistic regression to identify predictive factors for treatment modalities.
Main Results:
- Neoadjuvant therapy + surgery use was lowest (25.3%) but increased 7% annually; surgery alone decreased 4% annually.
- Factors for surgery alone included older age, non-private insurance, and multimorbidity.
- Neoadjuvant therapy + surgery was linked to private insurance, higher education, and academic/high-volume centers, with smaller (<5 cm) and higher-grade tumors.
Conclusions:
- Multimodality therapy adoption for high-risk extremity soft tissue sarcomas in the US is slow.
- Improving access and considering hospital factors are crucial for maximizing multimodal therapy use.
