OBJECTIVE: Sarcomas of the genitourinary (GU) tract are rare. We hypothesized that the biology of tumors, treatment modalities received, and survival would differ between adults and children.METHODS: The 1998-2012 National... [ view full abstract ]
OBJECTIVE: Sarcomas of the genitourinary (GU) tract are rare. We hypothesized that the biology of tumors, treatment modalities received, and survival would differ between adults and children.
METHODS: The 1998-2012 National Cancer Database was queried for GU tract sarcomas. Demographics, diagnosis, tumor stage and histology, treatment types, and survival were compared between children (<21y) and adults (>=21y). Subgroup analyses were performed based on gender and anatomic sites: urinary tract (UT), female reproductive tract (FemRep), and male reproductive tract (MaleRep).
RESULTS: 3559 patients were identified (941 pediatric, 2618 adult). UT and MaleRep primaries were more common in children, and FemRep more common in adults (p<0.0001). The most common histologic subtype was embryonal rhabdomyosarcoma in children (62.2%) and leiomyosarcoma in adults (28.2%). Adult tumors were more likely to be moderately differentiated (p<0.0001). Children were more likely to travel farther for therapy (p<0.0001), begin therapy within 30 days (p<0.0002), and receive chemotherapy (p<0.0001). Children were less likely to receive surgery (p<0.0001). Children were more likely to have public insurance (p<0.0001), although patients with private insurance had improved survival (p<0.0001). Controlling for tumor site and stage, there were no survival differences in children versus adults.
CONCLUSIONS: GU tract sarcomas occur in a different anatomic and histologic distribution in children versus adults. Similar survival in the face of discordant treatment strategies in children versus adults suggests differences in the biology of these tumors. Identification of sub-groups at risk for poor survival, including insurance status, may allow focused development of novel treatment strategies.
