Original Research—Head and Neck Surgery Analysis of Clinical Prognostic Factors for Adult Patients with Head and Neck Sarcomas Otolaryngology– Head and Neck Surgery 2014, Vol. 151(6) 976–983 Ó American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/0194599814551539 http://otojournal.org Amy E. Chang 1 , Xiaoyu Chai, MS 2 , Seth M. Pollack, MD 2,3,4 , Elizabeth Loggers, MD 3,4 , Eve Rodler, MD 3,4 , Jasjit Dillon, MD 1 , Upendra Parvathaneni, MD 5 , Kris S. Moe, MD 6 , Neal Futran, MD 6 , and Robin L. Jones, MD 2,3,4 Sponsorships or competing interests that may be relevant to content are dis- closed at the end of this article. Abstract Objective. To evaluate the treatment, outcome, and prognos- tic factors in patients with head and neck sarcomas treated in an academic medical center. Study Design. Case series. Setting. Academic medical center. Subjects and Methods. We performed a retrospective analysis of adult patients (n = 97) with primary head and neck sarco- mas treated between 2000 and 2012. We analyzed the treatment, outcome, and potential factors predictive of disease-free survival and disease-specific survival. We also evaluated the outcome and prognostic factors in patients with bone and soft tissue sarcomas. Results. The median overall survival was 6.8 years, with 2- year and 5-year overall survival rates of 78% (95% confidence interval [CI], 66%-86%) and 59% (95% CI, 44%-72%), respec- tively. Univariable analysis revealed that age at diagnosis (.60 years: hazard ratio [HR], 2.7; 95% CI, 1.2-6.2; P = .01), surgi- cal intervention (HR, 8.3; 95% CI, 3.5-19.5; P \ .001), and metastatic disease (HR, 4.3; 95% CI, 1.3-13.6; P = .01) were significantly associated with disease-specific survival. Conclusion. In this study, patients over the age of 60 years at diagnosis and those with inoperable disease at initial presen- tation had significantly worse disease-specific survival. Surgical intervention remains the optimal treatment modal- ity for those with resectable disease and was associated with significantly better survival in this heterogeneous series. Further multi-institutional studies are required to better define prognostic factors in individual histological subtypes. Keywords head and neck, sarcoma, soft tissue sarcoma, bone, out- come, prognostic factors Received November 27, 2013; revised June 12, 2014; accepted August 26, 2014. S arcomas are rare heterogeneous mesenchymal tumors that constitute about 1% of adult and 12% of pedia- tric malignancies. 1,2 Head and neck sarcomas com- prise about 5% to 15% of all sarcomas 3-8 and are traditionally thought to have a worse prognosis compared to sarcomas arising from other anatomic sites. There have been few studies evaluating the treatment, outcome, and potential prognostic factors in these tumors. 3-5,7 Such stud- ies have been hampered by the rarity and heterogeneity of head and neck sarcomas. Consequently, these are challen- ging tumors to manage. In addition, it is often difficult to obtain negative surgical margins in tumors located adjacent to vital structures. The optimal management of localized disease consists of complete surgical resection with or with- out radiation. Chemotherapy plays a role in certain histolo- gical subtypes and also potentially in high-grade tumors and is the mainstay of management in metastatic disease. Ideally, these tumors should be managed in specialized cen- ters with experienced multidisciplinary teams. The aim of our study was to evaluate the treatment, out- come, and prognostic factors in a consecutive series of patients with head and neck sarcomas treated at the University of Washington Medical Center (UWMC)/Seattle 1 University of Washington School of Medicine, Seattle, Washington, USA 2 Fred Hutchinson Cancer Research Center, Seattle, Washington, USA 3 Department of Medicine, University of Washington Medical Center, Seattle, Washington, USA 4 Seattle Cancer Care Alliance, Seattle, Washington, USA 5 Department of Radiation Oncology, University of Washington Medical Center, Seattle, Washington, USA 6 Department of Otolaryngology, University of Washington Medical Center, Seattle, Washington, USA Corresponding Author: Robin L. Jones, MD, University of Washington/Fred Hutchinson Cancer Research Center, 825 Eastlake Avenue East, Seattle, WA 98109-1023, USA. Email: rjones@seattlecca.org