Abstract
e23551 Background: Non-rhabdomyosarcoma soft tissue sarcomas (NRSTS) are a heterogeneous group of soft tissue tumors whose management benefits from a multidisciplinary therapeutic approach, especially for patients with metastatic or unresectable disease. Published data suggest that cancer treatment at a specialized cancer center (SCC) can mitigate poor outcomes for other cancers. Therefore, we examined the impact of location of treatment, sociodemographic and clinical factors on survival in adolescents and young adults (AYAs) with NRSTS. Methods: We performed a retrospective, population-based analysis of patients (ages 15-39) hospitalized within one year of diagnosis with first primary NRSTS between 2000–2014 using the California Cancer Registry linked with state hospitalization data. Patients were divided into two groups based on receiving all inpatient treatment at a SCC (Children’s Oncology Group and/or National Cancer Institute-designated center) versus part/none. Multivariable Cox proportional hazards regression identified factors associated with overall and sarcoma-specific survival. Kaplan Meier survival analysis was stratified by location of treatment. Results are presented as adjusted hazard ratios (HR) and 95% confidence intervals (CI). Results: Of the 1532 AYA patients with NRSTS, 40.4% percent received all their inpatient care at a SCC. Kaplan Meier analysis demonstrated a higher 5-year survival in patients who received all (vs part/none) care at a SCC (60.0% vs 51.8%; p = 0.0002). Multivariable analysis found that having all treatment at a SCC was associated with significantly better overall (HR 0.81, CI 0.68-0.96) and sarcoma-specific (HR 0.73, CI 0.58-0.92) survival. In addition, inferior survival was associated with African American race/ethnicity, nerve sheath tumor, tumor size > 5 cm, non-localized disease, comorbidities and body wall/visceral tumor location (vs extremity). Conclusions: Our findings demonstrate that treatment for NRSTS at a SCC independently predicts better survival in AYAs and confirms other known predictors of outcomes in this patient population. Eliminating barriers to treatment of AYAs with NRSTS at SCCs could improve survival.
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