Abstract
BackgroundTreatments for soft tissue sarcoma (STS) include extensive surgical resection, radiation and chemotherapy, and can necessitate specialized care and excellent social support. Studies have demonstrated that socioeconomic factors, such as income, marital status, urban/rural residence, and educational attainment as well as treatment at high-volume institution may be associated with overall survival (OS) in STS.MethodsIn order to explore the effect of socio-economic factors on OS in patients treated at a high-volume center, we performed a retrospective analysis of STS patients treated at a single institution.ResultsOverall, 435 patients were included. Thirty-seven percent had grade 3 tumors and 44% had disease larger than 5 cm. Patients were most commonly privately insured (38%), married (67%) and retired or unemployed (43%). Median distance from the treatment center was 42 miles and median area deprivation index (ADI) was 5 (10 representing most deprived communities). The majority of patients (52%) were treated with neoadjuvant therapy followed by resection. As expected, higher tumor grade (HR 3.1), tumor size > 5 cm (HR 1.3), and involved lymph nodes (HR 3.2) were significantly associated with OS on multivariate analysis. Demographic and socioeconomic factors, including sex, age at diagnosis, marital status, employment status, urban vs. rural location, income, education, distance to the treatment center, and ADI were not associated with OS.ConclusionsIn contrast to prior studies, we did not identify a significant association between socioeconomic factors and OS of patients with STS when patients were treated at a single high-volume center. Treatment at a high volume institution may mitigate the importance of socio-economic factors in the OS of STS.
Highlights
Treatments for soft tissue sarcoma (STS) include extensive surgical resection, radiation and chemotherapy, and can necessitate specialized care and excellent social support
This may be due to the fact that many sarcomas require complex multimodality therapy including surgical resection, chemotherapy, and advanced radiation therapy, which may require experience and special expertise [6,7,8,9]
In the group of patients treated with neoadjuvant therapy followed by resection, increasing distance was associated with better overall survival (OS) (HR: 0.91 per 50% increase in distance, p = 0.039)
Summary
Treatments for soft tissue sarcoma (STS) include extensive surgical resection, radiation and chemotherapy, and can necessitate specialized care and excellent social support. Studies have demonstrated that socioeconomic factors, such as income, marital status, urban/rural residence, and educational attainment as well as treatment at high-volume institution may be associated with overall survival (OS) in STS. Patients with STS who were treated at high volume centers had improved overall survival compared to patients treated at centers with lower volumes [4, 5]. This may be due to the fact that many sarcomas require complex multimodality therapy including surgical resection, chemotherapy, and advanced radiation therapy, which may require experience and special expertise [6,7,8,9]. Prior authors have discussed that such retrospective studies must be interpreted with caution [10]
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