Facility type as a prognostic factor? The role of academic centers in outcomes and treatment for patients with leiomyosarcoma.

Abstract

185 Background: Leiomyosarcoma is a highly aggressive form of cancer that comprises roughly 10-20% of soft tissue sarcomas. It originates in smooth muscle tissue and its prognosis largely depends on how quickly it is detected – with surgical resection being potentially curative if the cancer is caught before it metastasizes. Previous studies have shown that patients from lower socioeconomic statuses with soft tissue sarcomas have worse survival rates; however, it appears that the relationship between leiomyosarcoma, specifically, and socioeconomic status has yet to be determined. Using the National Cancer Database, we aim to uncover this relationship and define the role of academic centers on the treatment and outcomes of these patients. Methods: The National Cancer Database (NCDB) was used to identify patients diagnosed with leiomyosarcoma from 2004 to 2019 using the histology codes 8890 and 8891. Socioeconomic and treatment variables were identified as assigned by the Commission on Cancer Accreditation program. Survival data was computed using logrank testing and a Cox proportional hazards model. Data was analyzed using IBM SPSS Statistics for Windows, Version 27.0 software (IBM Corp., Armonk, NY) and statistical significance was set at α = 0.05. Results: Initial search revealed 16,573 patients to be included for analysis. 7,003 patients (42.4%) were treated at an academic facility. Patients treated at academic/research facilities experienced improved overall survival (76.78 months vs. 60.52 months; p<0.001), greater utilization of adjuvant chemotherapy (88.5 vs. 82.2%; p<0.001), and higher rates of complete resection (87 vs. 83.4%; p<0.001) compared with those treated at non-academic facilities. Furthermore, people traveled further for care at academic facilities (62.4 vs. 25.5 miles; p<0.001), and were more likely to be younger, in higher income groups (36.9 vs. 33.2%; p<0.001), Black, carry private insurance (44.9 vs 41.3%; p<0.001), and less likely to have Medicare (42.7 vs. 49.4%; p<0.001) compared with those at non-academic facilities. Extent of disease varied between facility type with patients at academic facilities presenting with higher rates of stages II and III disease, whereas those who presented to non-academic facilities had higher rates of stages I and IV disease. There were no differences observed between rates of palliative treatment, phase I radiation primary treatment volume, or tumor size between the two facility types. Conclusions: This analysis identifies various patient characteristics (e.g., income, race, insurance type) associated with seeking treatment at academic facilities for leiomyosarcoma, as well as the influence of facility type on patient outcomes with this cancer.