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Infants in non-rhabdomyosarcoma soft tissue sarcoma

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Infants in non-rhabdomyosarcoma soft tissue sarcoma

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Content 1

INFANTS IN NON-RHABDOMYOSARCOMA SOFT TISSUE SARCOMA

by
Nelson Lam

M.S. Biostatistics
University of Southern California

May 2019

2

Table of Contents

Abstract ......................................................................................................................................................... 3
Introduction .................................................................................................................................................. 3
Methods ........................................................................................................................................................ 4
Results ........................................................................................................................................................... 6
Discussion.................................................................................................................................................... 13
References .................................................................................................................................................. 14

3

Abstract

Non-Rhabdomyosarcoma Soft Tissue Sarcomas (NRSTS) are disproportionally represented in the
pediatric patient population with relatively poor long-term survival for patients with metastatic
disease. Analyses were performed on data from ARST0332, a prospective phase 3 risk-based
study for NRSTS for patients under 30 years of age by the Children’s Oncology Group (COG), to
compare prognostic factors between infant (age≤2) and non-infant patients. A total of 12
characteristics of interests were tested for associations between the two groups and pairwise
interactions were tested among infant patients. Event-free Survival (EFS) and Overall Survival (OS)
were examined on univariate and multivariate level. Survival estimates stratified on risk groups
were visualized by Kaplan-Meier (KM) plots with 95% Confidence Interval (CI) figures and
compared using the log-rank test. Variables with p-value less than 0.2 were subsequently
selected as candidates for a multivariate stepwise Cox proportional hazard model, which yielded
no variables at the end for either OS or EFS significant at α = 0.05 with risk group already in the
model. Considering EFS events, the 5-year survival for intermediate-risk infants and
intermediate-risk non-infants were 0.76 (95% CI: 0.33, 0.92) and 0.68 (95% CI: 0.60, 0.74)
respectively. Considering OS events, the 5-year survival for intermediate-risk infants and
intermediate-risk non-infants were 0.87 (95% CI: 0.42, 0.97) and 0.78 (95% CI: 0.71, 0.83)
respectively. It was found that infant patients had a higher FNCLCC grade than that of non-infant
patients (p = 0.044). FNCLCC grade was also found to be correlated with invasiveness among
infant patients (p = 0.0294). No significant risk factors for either EFS or OS were found,
presumably due to a small sample size (N=17) with only 6 events.

Introduction

Non-Rhabdomyosarcoma Soft Tissue Sarcomas (NRSTS) are disproportionally represented in the
pediatric patient population, comprising nearly 3.5% of all childhood cancers, compared to the
national average of 0.7% of all new cancers in the United States in 2016.
1-2
In fact, there are only
500 to 550 children and adolescents diagnosed annually.
3
The estimated 5-year survival of
children and adolescents with non-metastatic NRSTS is approximately 80%, and only 50% of the
same group with high-risk features (large, high-grade tumors or unresectable disease) were able
to survive long (more than 10 years since original diagnosis) nonetheless.
4-5
On the other hand,
patients with metastatic disease had less than 20% for long-term survival.
2

In light of this, the Children’s Oncology Group (COG) conducted ARST0332, a prospective phase
3 risk-based study for NRSTS, the largest national study targeted for patients under 30 years of
age. Based on data analyzed from ARST0332, we outline the demographics and clinical features
for all patients. In addition, potential risk factors that predict event-free survival and overall
survival among the infant patients are presented.
4

Methods

The analytic data set was created from the Case Report Forms (CRFs) submitted through the
electronic Remote Data Entry System (eRDES) of the COG. There were three sources of the CRFs:
the individual treatment hospitals of the patients, a surgical central review team, and a pathology
central review team. Variables of interest were gender, race, ethnicity, primary tumor size, the
Pediatric Oncology Group (POG) and the French Federation of Cancer Centers (FNCLCC) tumor
histologic grades, risk group, primary tumor depth, primary tumor invasiveness, primary tumor
site, treatment arm and unresected tumor.
6-7
The variables were grouped into patient-related
and tumor-related accordingly.
The POG NRSTS grading system was used to categorize tumor histology in our sample, which was
based on previous systems developed for adults but accounts for pediatric pathologic entities as
well. Another grading system used was the FNCLCC Sarcoma Group. For both grading systems, a
grade of 1 or 2 was further categorized as ‘Low grade’, while a grade of 3 was categorized as ‘High
grade’.
Primary tumor depth was defined in accordance with the 6
th
edition of the AJCC Cancer Staging
Manual.
8
Tumors that were superficial to and did not involve the superficial fascia were
categorized as ‘Superficial’, while tumors that were deep or invaded the superficial fascia were
categorized as ‘Deep’. In determining tumor invasiveness, tumors that did not touch or invade
neurovascular structures or bones were categorized as ‘Non-invasive’ while others were
categorized as ‘Invasive’.
The low risk group was defined to be patients with grossly resected non-metastatic tumors
except those who had tumors that were both high grade and > 5 cm in maximal diameter.
Intermediate risk group was defined to be patients with initially unresected non-metastatic
tumors. Patients with metastatic tumors fell under high risk group. Figure 1 illustrates the overall
experimental design schema, which outlines the risk group classification.
Data on size, depth and invasiveness of primary tumors were collected from the three
aforementioned sources in the following hierarchy with decreasing reliability: Pathology Central
Review Baseline > Surgical Central Review Baseline > Individual treatment hospital records. For
example, only if data was unavailable or unknown in Pathology Central Review would data in
Surgical Central Review Baseline be used, and henceforward.
Event-free Survival (EFS) was defined to be the time from date of enrollment until date of relapse
or progression, second malignancy (SMN), death or last follow-up, whichever took place first. EFS
events were indicated by one of the three aforementioned events, the rest were considered
censored at the end of follow-up. Overall Survival (OS) was defined to be the time from date of
enrollment until date of death or last follow-up, whichever took place first. Similarly, OS events
were indicated by death, with the rest considered censored at the end of follow-up.
5

Figure 1 Overall Experimental Design Schema
9

6

Among 529 evaluable patients, associations between all demographic characteristics of interest
and infant status were checked using Fisher’s Exact Test. Pairwise associations among the
variables of interest were also examined for infants in the same manner.
10

Probability estimates of EFS and OS were calculated by Kaplan-Meier (KM) method with 95%
Confidence Intervals (CIs) using the complementary log-log transformation and compared using
the log-rank test stratified by risk group, which is known to be a strong prognostic factor in NRSTS.
11
We also performed proportional hazards regression models on EFS and OS events on univariate
level and multivariate level respectively.
11

All variables of interest were tested for univariate association with EFS and OS events stratified
by risk group. Variables with p-values under a selection threshold of 0.20 from the univariate
models and risk group were selected as candidates for the multivariate stepwise Cox proportional
hazard model, with both entry and exit threshold set to 0.05. We assumed the Cox proportional
hazard assumptions hold for all variables in the regression models.
11

All analyses were performed with SAS
®
9.4, using two-sided tests with α = 0.05.
12

Results

Descriptive statistics for all patients (N = 529), significant interactions, site of primary tumor and
histologic diagnosis among infant patients were displayed in Tables 1 through 4, respectively.
Tumor depth distribution among infants was rather extreme (N=15 for deep and N=2 for
superficial) and thus was excluded from the univariate analysis. There was no significant
difference in the distribution of variables except for FNCLCC tumor histologic grade, among infant
and non-infant patients.

7

Table 1 Descriptive Characteristics Among Infant and Non-infant Patients

Characteristics Infants (N=17), % Non-infants (N=512), % p-value

Patient-Related

Sex 0.217
Male 5 (29.4) 240 (46.9)
Female 12 (70.6) 272 (53.1)
Race 0.745
White 12 (70.6) 363 (70.9)
Black 4 (23.5) 76 (14.8)
Others 0 24 (4.7)
Unknown 1 (5.9) 49 (9.6)
Ethnicity 0.544
Hispanic or Latino 4 (23.5) 76 (14.8)
Not Hispanic or Latino 13 (76.5) 417 (81.5)
Unknown 0 19 (3.7)

Tumor-Related

Primary Tumor Size (cm) 0.667
0-5 7 (41.2) 188 (36.7)
5.1-10 5 (29.4) 163 (31.8)
10.1-15 2 (11.8) 104 (20.3)
>15 3 (17.7) 57 (11.1)
POG Tumor Histologic Grade 1.000
High 13 (76.5) 370 (72.3)
Low 4 (23.5) 142 (27.7)
FNCLCC Tumor Histologic Grade 0.044
High 12 (70.6) 224 (43.8)
Low 5 (29.4) 287 (56.1)
Indeterminate 0 1 (0.1)
Risk Group 0.842
High 3 (17.7) 77 (15.0)
Intermediate 8 (47.1) 219 (42.8)
Low 6 (35.3) 216 (42.2)
Primary Tumor Depth 0.749
Deep 15 (88.2) 422 (82.4)
Superficial 2 (11.8) 90 (17.6)
Invasiveness 0.462
Invasive 8 (47.1) 292 (57.0)
Non-invasive 9 (52.9) 220 (43.0)
8

Table 2 Pairwise Comparison of Variables Among Infant Patients with Significant and Informative P-values
FNCLCC Tumor Histologic Grade p-value
Invasiveness High Low 0.0294
Invasive 8 0
Non-invasive 4 5

Table 3 Specific Sites of Primary Tumor of Infant Patients
Site Frequency, %
Head 1 (5.9)
Neck 1 (5.9)
Paraspinal 1 (5.9)
Abdominal Wall 2 (11.8)
Intraperitoneal 2 (11.8)
Retroperitoneal 2 (11.8)
Pelvis 1 (5.9)
Perineum 1 (5.9)
Shoulder 1 (5.9)
Upper Arm 1 (5.9)
Thigh 2 (11.8)
Leg 1 (5.9)
Breast 1 (5.9)

Characteristics Infants (N=17), % Non-infants (N=512), % p-value
Primary Tumor Site 0.111
Body Wall 4 (23.5) 71 (13.9)
Extremity 5 (29.4) 284 (55.5)
Head and Neck 2 (11.8) 52 (10.2)
Visceral 6 (35.3) 105 (20.5)
Treatment Arm 0.597
A: No Adjuvant Treatment 5 (29.4) 200 (39.1)
B: Adjuvant Treatment 1 (5.9) 16 (3.1)
C: Adjuvant Treatment +
radiotherapy
4 (23.5) 107 (20.9)
D: Neoadjuvant chemo-
radiotherapy
7 (41.2) 189 (36.9)
Un-resected Tumor 0.615
No 10 (58.8) 331 (64.7)
Yes 7 (41.2) 181 (35.3)
9

Table 4 Histologic Diagnoses of Infant Patients
Diagnosis Frequency, %
Synovial Sarcoma 1 (5.9)
Malignant Peripheral Nerve Sheath Tumor 2 (11.8)
Dermatofibrosarcoma Protuberans 2 (11.8)
Low Grade Myofibroblastic Sarcoma 1 (5.9)
Myoepithelial Carcinoma 1 (5.9)
Unclassified Soft Tissue Sarcoma 4 (23.5)
Undifferentiated Sarcoma, Epithelioid Cell Type 2 (11.8)
Undifferentiated Sarcoma, Round Cell Type 2 (11.8)
Undifferentiated Sarcoma, Spindle Cell Type 2 (11.8)

Figure 2 Kaplan-Meier Plot of Event-free Survival for All Patients Stratified by Risk Groups
Test χ2 df P-value
Stratified Log-Rank 0.1401 1 0.7082
77 20 14 10 5 1
3 2 1 1 1 0
219 157 129 98 41 8
8 6 5 2 2 0
216 182 147 104 39 5
6 3 3 3 2 0
0 2 4 6 8 10
EFS Time
0.0
0.2
0.4
0.6
0.8
1.0
Survival Probability
1
2
3
4
5
6
6: Risk Group=Low Infant=Yes 5: Risk Group=Low Infant=No
4: Risk Group=Intermediate Infant=Yes 3: Risk Group=Intermediate Infant=No
2: Risk Group=High Infant=Yes 1: Risk Group=High Infant=No
Product-Limit Survival Estimates
With Number of Subjects at Risk
EFS Time (Year)
10

Figure 3 Kaplan-Meier Plot of Overall Survival for All Patients Stratified by Risk Groups
Test χ2 df P-value
Stratified Log-Rank 0.1382 1 0.7101

Kaplan-Meier plots for EFS and OS are shown in Figures 2 and 3, respectively, comparing infant
and non-infant survivals stratified by risk groups. Considering EFS events, the 5-year survival for
intermediate-risk infants and intermediate-risk non-infants were 0.76 (95% CI: 0.33, 0.92) and
0.68 (95% CI: 0.60, 0.74) respectively. Considering OS events, the 5-year survival for
intermediate-risk infants and intermediate-risk non-infants were 0.87 (95% CI: 0.42, 0.97) and
0.78 (95% CI: 0.71, 0.83) respectively.
Log-rank tests stratified by risk group were performed for EFS (χ2 = 0.1401, df = 1, p = 0.7082)
and OS (χ2 = 0.1382, df = 1, p = 0.7101) to test for differences between infants and non-infant
patients. The two p-values indicated that there were no statistically significant differences
whether patients were infant or not for either EFS or OS. Interestingly, note that in Figure 2, all
infant event-free survival curves, regardless of risk groups, condensed to the curve for
77 41 23 16 6 1
3 2 1 1 1 0
219 187 159 118 48 8
8 7 6 4 2 0
216 197 159 117 42 6
6 5 4 4 3 0
0 2 4 6 8 10
death_time
0.0
0.2
0.4
0.6
0.8
1.0
Survival Probability
1
2
3
4
5
6
6: Risk Group=Low Infant=Yes 5: Risk Group=Low Infant=No
4: Risk Group=Intermediate Infant=Yes 3: Risk Group=Intermediate Infant=No
2: Risk Group=High Infant=Yes 1: Risk Group=High Infant=No
Product-Limit Survival Estimates
With Number of Subjects at Risk
Death Time (Year)
11

intermediate risk of the non-infant patients. Figure 3 shows similar patterns, although less
obvious.
Table 5 Univariate Cox Proportional Hazard Model for EFS Among Infant Patients
Variables N Parameter
Estimate (SE)
Hazard Ratio
(95% CI)
Wald
χ2
df p-
value

Patient-Related
Sex Male (ref.) 5 0 1 0.04 1 0.84
Female 12 -0.17 (0.88) 0.84 (0.15, 4.68)
Race White (ref.) 12 0 1 2.96 2 0.23
Black 4 1.42 (0.83) 4.14 (0.82, 20.86)
**Unknown 1 — —
Ethnicity Not Hispanic or
Latino (ref.)
13 0 1 0.05 1 0.83
Hispanic or
Latino
4 -0.24 (1.10) 0.79 (0.09, 6.81)

Tumor-Related
Primary
Tumor Size
(cm)
<5 (ref.) 7 0 1 1.47 3 0.69
5.1 – 10 5 -0.58 (1.16) 0.56 (0.06, 5.46)
10.1 – 15 2 0.81 (0.92) 2.27 (0.38, 13.67)
**>15 3 — —
POG Grade Low (ref.) 4 0 1 0.62 1 0.43
High 13 -0.69 (0.88) 0.50 (0.09, 2.79)
FNCLCC
Grade
Low (ref.) 5 0 1 0.07 1 0.79
High 12 -0.23 (0.87) 0.79 (0.14, 4.36)
Invasiveness Invasive (ref.) 8 0 1 0.46 1 0.50
Non-invasive 9 0.59 (0.87) 1.81 (0.33, 9.90)
Primary
Tumor Site
Body Wall (ref.) 4 0 1 1.03 3 0.79
Extremity 5 -1.16 (1.24) 0.32 (0.03, 3.57)
Head and Neck 2 -0.10 (1.23) 0.90 (0.08, 10.00)
Visceral 6 -0.60 (1.00) 0.55 (0.08, 3.93)
*Treatment
Arm
A (ref.) 5 0 1 0.57 3 0.90
**B 1 — —
C 4 0.93 (1.23) 2.53 (0.23, 27.99)
D 7 0.58 (1.23) 1.79 (0.16, 19.97)
Unresected
Tumor
Yes (ref.) 7 0 1
No 10 0.25 (0.87) 1.28 (0.23, 7.03) 0.08 1 0.78
* Treatment Arm A, B, C, D indicates no adjuvant treatment, adjuvant treatment, adjuvant treatment +
radiotherapy and neoadjuvant chemo-radiotherapy respectively.
** Estimates are unstable due to lack of events.
#
The reference groups were indicated by parameter estimates and hazard ratios of 1s.
12

Table 6 Univariate Cox Proportional Hazard Model for OS Among Infant Patients
Variables N Parameter
Estimate, SE
Hazard Ratio,
95% CI
Wald
χ2
df p-
value

Patient-Related
Sex Male (ref.) 5 0 1 0.05 1 0.82
Female 12 0.20 (0.88) 1.23 (0.22, 6.81)
Race White (ref.) 12 0 1 3.85 1 0.06
Black 4 1.81 (0.93) 6.17 (1.00, 38.01)
**Unknown 1 — —
Ethnicity Not Hispanic or
Latino (ref.)
13 0 1 0.85 1 0.77
Hispanic or
Latino
4 -0.34 (1.15) 0.72 (0.08, 6.83)

Tumor-Related
Primary
Tumor Size
(cm)
<5 (ref.) 7 0 1 3.12 3 0.37
5.1 – 10 5 -0.52 (1.17) 0.60 (0.06, 5.96)
10.1 – 15 2 1.46 (0.95) 4.33 (0.67, 27.9)
**>15 3 — —
POG Grade Low (ref.) 4 0 1 0.22 1 0.64
High 13 -0.42 (0.90) 0.65 (0.11, 3.81)
FNCLCC
Grade
Low (ref.) 5 0 1 0.002 1 0.97
High 12 -0.03 (0.88) 0.97 (0.17, 5.46)
Invasiveness Invasive (ref.) 8 0 1 0.27 1 0.60
Non-invasive 9 0.46 (0.87) 1.58 (0.29, 8.72)
Primary
Tumor Site
Body Wall (ref.) 4 0 1 1.56 3 0.67
Extremity 5 -1.44 (1.31) 0.24 (0.02, 3.10)
Head and Neck 2 -0.05 (1.23) 0.95 (0.09, 10.62)
Visceral 6 -0.94 (1.07) 0.39 (0.05, 3.20)
*Treatment
Arm
A (ref.) 5 0 1 3.09 3 0.38
B 1 2.75 (1.59) 15.6 (0.70, 350.2)
C 4 1.03 (1.23) 2.80 (0.25, 31.44)
D 7 1.06 (1.29) 2.87 (0.23, 35.79)
Un-resected
Tumor
Yes (ref.) 7 0 1 0.01 1 0.90
No 10 -0.11 (0.93) 0.90 (0.15, 5.49)
* Treatment Arm A, B, C, D indicates no adjuvant treatment, adjuvant treatment, adjuvant treatment +
radiotherapy and neoadjuvant chemo-radiotherapy respectively.
** Estimates are unstable due to lack of events.
#
The reference groups were indicated by parameter estimates and hazard ratios of 1s.

13

Race was the only selected variable for multivariate analysis with risk group forced in the
model. The proportional hazards regression stepwise selection process yielded no variables that
were statistically significant in the presence of risk group at the end for both OS and EFS events.

Discussion

Our results indicated that infant patients did not show any significant difference in sex, race,
ethnicity, primary tumor size, POG grade, risk group, primary tumor depth, tumor invasiveness,
primary tumor site, treatment arm and unresected tumor compared to non-infant patients. The
only statistically significant difference was that infant patients had a higher FNCLCC grade than
that of non-infant patients (p = 0.044). The only statistically significant difference in the pairwise
comparisons among variables within the 17 infants was that FNCLCC grade was found to be
correlated with invasiveness among infant patients (p = 0.0294), such that a high FNCLCC grade
might indicate more invasive tumors, or vice versa.
Several significant interactions were not reported due to the nature of sample classification in
this cohort. To illustrate, ethnicity vs. race would not be informative because the small p-value
would be caused by the fact that most Hispanic/Latinos were listed as White in this cohort.
Similarly, variables that were defined in terms of one another (for example, tumor grades vs. risk
group) were not reported.
The most common histology types among infant patients were unclassified soft tissue sarcoma,
followed by undifferentiated sarcoma of various cell type.
There were no significant risk factors for either EFS or OS after accounting for risk group among
infant patients. This was not surprising considering our small sample size of infant patients
(N=17), coupled with low number of events (6 out of 17). It would require huge effects for them
to become significant with such limited number of events. In future studies, investigators could
try a larger study, although the rare nature of such disease in young patients would make such
attempt difficult. To tackle this, one might consider aggregating the sample through
international collaboration.

14

References

1. Ries LG, Smith MA, Gurney J, et al. Cancer incidence and survival among children and adolescents:
United States SEER Program 1975 –1995. National Cancer Institute; Bethesda, MD: 1999. Vol pub no.
99-4649.

2. Siegel RL, Miller KD, Jemal A. CA Cancer J Clin. 2016 Jan-Feb; 66(1):7-30. Cancer statistics, 2016.

3. Ferrari A, Sultan I, Huang TT, et al. Soft tissue sarcoma across the age spectrum: a population-based
study from the Surveillance Epidemiology and End Results database. Pediatric blood &
cancer. 2011;57(6):943 –949.

4. Pappo AS, Devidas M, Jenkins J, et al: Vincristine (V), ifosfamide (I), doxorubicin (D), and GCSF(G) for
pediatric unresected metastatic non-rhabdomyosarcomatous soft tissue sarcomas (NRSTS): A Pediatric
Oncology Group study. Proc Am Soc Clin Oncol 20:378a, 2001

5. Bleyer WA, Tejeda H, Murphy SB, et al: National cancer clinical trials: children have equal access;
adolescents do not. J Adolesc Health 21:366-73, 1997

6. Parham DM, Webber BL, Jenkins JJ r, et al: Nonrhabdomyosarcomatous soft tissue sarcomas
ofchildhood: formulation of a simplified system for grading. Mod Pathol 8:705-10, 1995

7. Coindre JM, Terrier P, Bui NB, et al: Prognostic factors in adult patients with locally controlledsoft
tissue sarcoma. A study of 546 patients from the French Federation of Cancer CentersSarcoma Group. J
Clin Oncol 14:869-77, 1996

8. Greene FL, Page DL, Fleming ID, et al: AJCC Cancer Staging Manual. New York, Springer-Verlag,
2002

9. Sheri L. Spunt, Lynn Million, James Robert Anderson, Cheryl M. Coffin, Beth McCarville, R. Lor
Randall, David Parham, Simon C Kao, Andrea Anita Hayes-Jordan, Suzanne L. Wolden, Stephanie Alicia
Terezakis, Jennifer Black, Fran Laurie, Ellen Kawashima, Rose Anne Speights, Stephen Skapek, William
H. Meyer, Douglas S. Hawkins, and Alberto S. Pappo.Risk-based treatment for nonrhabdomyosarcoma
soft tissue sarcomas (NRSTS) in patients under 30 years of age: Children ’s Oncology Group study
ARST0332. Journal of Clinical Oncology 2014 32:15_suppl, 10008-10008

10. Shi, J., Levinson, D. F., & Whittemore, A. S. (2008). Significance levels for studies with correlated test
statistics. Biostatistics, 9(3), 458-66.

11. P.Klein, J. and L.Moeschberger, M. (2003). Survival Analysis: Techniques for Cencored and
Truncated Data. 2nd ed. pp.91-133, 165-198, 243-287.

12. SAS [computer program]. Version 9.4. Cary, NC: SAS Institute Inc; 2016.

Abstract (if available)

Abstract Non-Rhabdomyosarcoma Soft Tissue Sarcomas (NRSTS) are disproportionally represented in the pediatric patient population with relatively poor long-term survival for patients with metastatic disease. Analyses were performed on data from ARST0332, a prospective phase 3 risk-based study for NRSTS for patients under 30 years of age by the Children’s Oncology Group (COG), to compare prognostic factors between infant (age≤2) and non-infant patients. A total of 12 characteristics of interests were tested for associations between the two groups and pairwise interactions were tested among infant patients. Event-free Survival (EFS) and Overall Survival (OS) were examined on univariate and multivariate level. Survival estimates stratified on risk groups were visualized by Kaplan-Meier (KM) plots with 95% Confidence Interval (CI) figures and compared using the log-rank test. Variables with p-value less than 0.2 were subsequently selected as candidates for a multivariate stepwise Cox proportional hazard model, which yielded no variables at the end for either OS or EFS significant at α = 0.05 with risk group already in the model. Considering EFS events, the 5-year survival for intermediate-risk infants and intermediate-risk non-infants were 0.76 (95% CI: 0.33, 0.92) and 0.68 (95% CI: 0.60, 0.74) respectively. Considering OS events, the 5-year survival for intermediate-risk infants and intermediate-risk non-infants were 0.87 (95% CI: 0.42, 0.97) and 0.78 (95% CI: 0.71, 0.83) respectively. It was found that infant patients had a higher FNCLCC grade than that of non-infant patients (p = 0.044). FNCLCC grade was also found to be correlated with invasiveness among infant patients (p = 0.0294). No significant risk factors for either EFS or OS were found, presumably due to a small sample size (N=17) with only 6 events.

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Creator Lam, Sze Chit Nelson (author)

Core Title Infants in non-rhabdomyosarcoma soft tissue sarcoma

School Keck School of Medicine

Degree Master of Science

Degree Program Biostatistics

Publication Date 04/24/2019

Defense Date 03/20/2019

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag Children's Oncology Group (COG),Cox proportional hazard regression,event-free survival (EFS),Infants,non-rhabdomyosarcoma,NRSTS,OAI-PMH Harvest,SAS,soft tissue sarcoma,survival analysis

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Advisor Barkauskas, Donald (committee chair), Dang, Ha (committee member), Franklin, Meredith (committee member)

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Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the a...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus MC 2810, 3434 South Grand Avenue, 2nd Floor, Los Angeles, California 90089-2810, USA