Benefits and adverse events in younger versus older patients receiving neoadjuvant chemotherapy for osteosarcoma: findings from a meta-analysis
The LIVESTRONG Young Adult Alliance has conducted a meta-analysis of individual patient data from prospective neoadjuvant chemotherapy osteosarcoma studies and registries to examine the relationships of sex, age, and toxicity on survival. Suitable data sets were identified by a survey of published d...
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| Published in: | Journal of clinical oncology Vol. 31; no. 18; p. 2303 |
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| Main Authors: | , , , , , , , , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
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20.06.2013
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| ISSN: | 1527-7755, 1527-7755 |
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| Abstract | The LIVESTRONG Young Adult Alliance has conducted a meta-analysis of individual patient data from prospective neoadjuvant chemotherapy osteosarcoma studies and registries to examine the relationships of sex, age, and toxicity on survival.
Suitable data sets were identified by a survey of published data reported in PubMed. The final pooled data set comprised 4,838 patients from five international cooperative groups.
After accounting for important variables known at study entry such as tumor location and histology, females experienced higher overall survival rates than males (P = .005) and children fared better than adolescents and adults (P = .002). Multivariate landmark analysis following surgery indicated that a higher rate of chemotherapy-induced tumor necrosis was associated with longer survival (P < .001), as was female sex (P = .004) and the incidence of grade 3 or 4 mucositis (P = .03). Age group was not statistically significant in this landmark analysis (P = .12). Females reported higher rates of grade 3 or 4 thrombocytopenia relative to males (P < .001). Children reported the highest rates of grade 3 or 4 neutropenia (P < .001) and thrombocytopenia (P < .001). The achievement of good tumor necrosis was higher for females than for males (P = .002) and for children than for adults (P < .001).
These results suggest fundamental differences in the way chemotherapy is handled by females compared with males and by children compared with older populations. These differences may influence survival in a disease in which chemotherapy is critical to overall outcomes. |
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| AbstractList | The LIVESTRONG Young Adult Alliance has conducted a meta-analysis of individual patient data from prospective neoadjuvant chemotherapy osteosarcoma studies and registries to examine the relationships of sex, age, and toxicity on survival.
Suitable data sets were identified by a survey of published data reported in PubMed. The final pooled data set comprised 4,838 patients from five international cooperative groups.
After accounting for important variables known at study entry such as tumor location and histology, females experienced higher overall survival rates than males (P = .005) and children fared better than adolescents and adults (P = .002). Multivariate landmark analysis following surgery indicated that a higher rate of chemotherapy-induced tumor necrosis was associated with longer survival (P < .001), as was female sex (P = .004) and the incidence of grade 3 or 4 mucositis (P = .03). Age group was not statistically significant in this landmark analysis (P = .12). Females reported higher rates of grade 3 or 4 thrombocytopenia relative to males (P < .001). Children reported the highest rates of grade 3 or 4 neutropenia (P < .001) and thrombocytopenia (P < .001). The achievement of good tumor necrosis was higher for females than for males (P = .002) and for children than for adults (P < .001).
These results suggest fundamental differences in the way chemotherapy is handled by females compared with males and by children compared with older populations. These differences may influence survival in a disease in which chemotherapy is critical to overall outcomes. The LIVESTRONG Young Adult Alliance has conducted a meta-analysis of individual patient data from prospective neoadjuvant chemotherapy osteosarcoma studies and registries to examine the relationships of sex, age, and toxicity on survival.PURPOSEThe LIVESTRONG Young Adult Alliance has conducted a meta-analysis of individual patient data from prospective neoadjuvant chemotherapy osteosarcoma studies and registries to examine the relationships of sex, age, and toxicity on survival.Suitable data sets were identified by a survey of published data reported in PubMed. The final pooled data set comprised 4,838 patients from five international cooperative groups.PATIENTS AND METHODSSuitable data sets were identified by a survey of published data reported in PubMed. The final pooled data set comprised 4,838 patients from five international cooperative groups.After accounting for important variables known at study entry such as tumor location and histology, females experienced higher overall survival rates than males (P = .005) and children fared better than adolescents and adults (P = .002). Multivariate landmark analysis following surgery indicated that a higher rate of chemotherapy-induced tumor necrosis was associated with longer survival (P < .001), as was female sex (P = .004) and the incidence of grade 3 or 4 mucositis (P = .03). Age group was not statistically significant in this landmark analysis (P = .12). Females reported higher rates of grade 3 or 4 thrombocytopenia relative to males (P < .001). Children reported the highest rates of grade 3 or 4 neutropenia (P < .001) and thrombocytopenia (P < .001). The achievement of good tumor necrosis was higher for females than for males (P = .002) and for children than for adults (P < .001).RESULTSAfter accounting for important variables known at study entry such as tumor location and histology, females experienced higher overall survival rates than males (P = .005) and children fared better than adolescents and adults (P = .002). Multivariate landmark analysis following surgery indicated that a higher rate of chemotherapy-induced tumor necrosis was associated with longer survival (P < .001), as was female sex (P = .004) and the incidence of grade 3 or 4 mucositis (P = .03). Age group was not statistically significant in this landmark analysis (P = .12). Females reported higher rates of grade 3 or 4 thrombocytopenia relative to males (P < .001). Children reported the highest rates of grade 3 or 4 neutropenia (P < .001) and thrombocytopenia (P < .001). The achievement of good tumor necrosis was higher for females than for males (P = .002) and for children than for adults (P < .001).These results suggest fundamental differences in the way chemotherapy is handled by females compared with males and by children compared with older populations. These differences may influence survival in a disease in which chemotherapy is critical to overall outcomes.CONCLUSIONThese results suggest fundamental differences in the way chemotherapy is handled by females compared with males and by children compared with older populations. These differences may influence survival in a disease in which chemotherapy is critical to overall outcomes. |
| Author | Kager, Leo Bleyer, Archie Ferrari, Stefano Picci, Piero Conyers, Rachel Gelderblom, Hans Thomas, David M Collins, Marnie Herschtal, Alan Wilhelm, Miriam Bielack, Stefan Petrilli, Antonio Sérgio Sydes, Matthew Smeland, Sigbjørn Whelan, Jeremy Kühne, Thomas Eriksson, Mikael |
| Author_xml | – sequence: 1 givenname: Marnie surname: Collins fullname: Collins, Marnie organization: Peter MacCallum Cancer Centre and Australasian Sarcoma Study Group, Melbourne, Australia – sequence: 2 givenname: Miriam surname: Wilhelm fullname: Wilhelm, Miriam – sequence: 3 givenname: Rachel surname: Conyers fullname: Conyers, Rachel – sequence: 4 givenname: Alan surname: Herschtal fullname: Herschtal, Alan – sequence: 5 givenname: Jeremy surname: Whelan fullname: Whelan, Jeremy – sequence: 6 givenname: Stefan surname: Bielack fullname: Bielack, Stefan – sequence: 7 givenname: Leo surname: Kager fullname: Kager, Leo – sequence: 8 givenname: Thomas surname: Kühne fullname: Kühne, Thomas – sequence: 9 givenname: Matthew surname: Sydes fullname: Sydes, Matthew – sequence: 10 givenname: Hans surname: Gelderblom fullname: Gelderblom, Hans – sequence: 11 givenname: Stefano surname: Ferrari fullname: Ferrari, Stefano – sequence: 12 givenname: Piero surname: Picci fullname: Picci, Piero – sequence: 13 givenname: Sigbjørn surname: Smeland fullname: Smeland, Sigbjørn – sequence: 14 givenname: Mikael surname: Eriksson fullname: Eriksson, Mikael – sequence: 15 givenname: Antonio Sérgio surname: Petrilli fullname: Petrilli, Antonio Sérgio – sequence: 16 givenname: Archie surname: Bleyer fullname: Bleyer, Archie – sequence: 17 givenname: David M surname: Thomas fullname: Thomas, David M |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/23669227$$D View this record in MEDLINE/PubMed |
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| SubjectTerms | Adolescent Adult Age Factors Bone Neoplasms - drug therapy Bone Neoplasms - surgery Chemotherapy, Adjuvant - adverse effects Child Combined Modality Therapy Humans Kaplan-Meier Estimate Multivariate Analysis Neoadjuvant Therapy - adverse effects Neutropenia - chemically induced Osteosarcoma - drug therapy Osteosarcoma - surgery Outcome Assessment, Health Care - statistics & numerical data Prospective Studies Regression Analysis Sex Factors Thrombocytopenia - chemically induced Young Adult |
| Title | Benefits and adverse events in younger versus older patients receiving neoadjuvant chemotherapy for osteosarcoma: findings from a meta-analysis |
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