(P 223) OUTCOMES OF GERIATRIC PATIENTS WITH DE NOVO SARCOMA AND LUNG METASTASES: ROLE OF TUMOR CHARACTERISTICS AND TREATMENT STRATEGY

Objective: This study aimed to assess the impact of clinicopathological characteristics and treatment strategies on survival in geriatric patients presenting sarcoma with lung metastases.

Methods: We retrospectively analyzed patients aged ≥80 years with de novo sarcoma diagnosis and lung metastasis in the Surveillance, Epidemiology, and End Results (SEER) database (2000-2020). Kaplan-Meier analysis and log-rank tests were used to assess differences in overall survival (OS). Cox regression analysis was used to assess prognostic factors for this group of patients.

Results: A total of 406 patients were included with median OS (mOS) of 3 mo (3-4 mo), reflecting the aggressive nature of metastatic sarcoma in this population. Sarcoma with higher grade (P=0.0078), bone metastasis (P=0.036), and distant lymph node metastases (P=0.019) were associated with a poorer prognosis of patients. Cox analysis further identified bone metastasis as an independent factor associated with a worse OS (HR 1.33, 95%CI 1.00-1.76, P=0.049), whereas female sex was associated with an improved OS (HR 0.075, 95%CI 0.60-0.95, P=0.017). Treatments of the primary disease with surgery (HR 0.47, 95%CI 0.36-0.61, P< 0.001), RT (HR 0.54, 95%CI 0.42-0.70, P< 0.001), or CT (HR 0.41, 95%CI 0.31-0.56, P< 0.001) were each independently correlated to improved OS. Patients receiving multimodal therapy had better outcomes compared to those receiving monotherapy. Comparable prognoses were observed in patients with surgery plus RT/CT or triplet therapies. Radiotherapy timing relative to surgery did not significantly impact survival (P=0.11).

Conclusion: Among geriatric patients with de novo sarcoma and lung metastases, synchronous bone and lymph node involvement and high-grade histology are negative prognostic indicators. Multimodal treatments improved survival, despite of patients’ advanced age. Personalized treatment plans incorporating surgery, chemotherapy or radiotherapy when feasible may offer survival benefit in this vulnerable population.