title: Adverse effect of older age on the recurrence of soft tissue sarcoma of the extremities and trunk.
abstract: OBJECTIVE
  To examine the effect of age on the recurrence of soft tissue sarcoma in the extremities and trunk.
  
  
  METHODS
  This was a multicenter study that included 2,385 patients with median age at surgery of 57 years. The end points considered were local recurrence and metastasis. Cox proportional hazards models were used to estimate hazard ratios across the age ranges with and without adjustment for known confounding factors.
  
  
  RESULTS
  Older patients presented with tumors that were larger (P < .001) and of higher grade (P < .001). The proportion of positive margins increased significantly as patients age (P < .001), but radiation therapy was relatively underused in patients older than age 60 years. The 5-year cumulative incidences of local recurrence were 7.2% (95% CI, 4% to 11.7%) for patients age 30 years or younger and 12.9% (95% CI, 9.1% to 17.5%) for patients age 75 years or older. The corresponding 5-year cumulative incidences of metastasis were 17.5% (95% CI, 12.1% to 23.7%) and 33.9% (95% CI, 28.1% to 39.8%) for the same groups. Regression models showed that age was significantly associated with local recurrence (P < .001) and metastasis (P < .001) in nonadjusted models. After adjusting for imbalance in presentation and treatment variables, age remained significantly associated with local recurrence (P = .031) and metastasis (P = .019).
  
  
  CONCLUSIONS
  Older patients have worse outcomes because they tend to present with worse tumors and are treated less aggressively. However, there remained a significant increase in the risk of both local and systemic recurrence associated with increasing age that could not be explained by tumor or treatment characteristics.
authors.affiliation: Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: David J
authors.initials: DJ
authors.lastname: Biau
authors.forename: Peter C
authors.initials: PC
authors.lastname: Ferguson
authors.forename: Robert E
authors.initials: RE
authors.lastname: Turcotte
authors.forename: Peter
authors.initials: P
authors.lastname: Chung
authors.forename: Marc H
authors.initials: MH
authors.lastname: Isler
authors.forename: Soha
authors.initials: S
authors.lastname: Riad
authors.forename: Anthony M
authors.initials: AM
authors.lastname: Griffin
authors.forename: Charles N
authors.initials: CN
authors.lastname: Catton
authors.forename: Brian
authors.initials: B
authors.lastname: O'Sullivan
authors.forename: Jay S
authors.initials: JS
authors.lastname: Wunder
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002170:Canada / Q000453:epidemiology; D005121:Extremities; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000473:pathology; D016016:Proportional Hazards Models; D012509:Sarcoma / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery; D012983:Soft Tissue Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery; D060726:Torso