Abstract
Objective Few studies have evaluated the prognostic implication of the length of time from diagnosis to treatment initiation in bone sarcoma. The purpose of this study is to determine if time to treatment initiation (TTI) influences overall survival in adults diagnosed with primary bone sarcoma. Methods A retrospective analysis of the National Cancer Database identified 2,122 patients who met inclusion criteria with localized, high-grade bone sarcoma diagnosed between 2004 and 2012. TTI was defined as length of time in days from diagnosis to initiation of treatment. Patient, disease-specific, and healthcare-related factors were also assessed for their association with overall survival. Kruskal-Wallis analysis was utilized for univariate analysis, and Cox regression modeling identified covariates associated with overall survival. Results Any 10-day increase in TTI was not associated with decreased overall survival (hazard ratio (HR) = 1.00; P=0.72). No differences in survival were detected at 1 year, 5 years, and 10 years, when comparing patients with TTI = 14, 30, 60, 90, and 150 days. Decreased survival was significantly associated (P < 0.05) with patient ages of 51–70 years (HR = 1.66; P=0.004) and > 71 years (HR = 2.89; P < 0.001), Charlson/Deyo score ≥2 (HR = 2.02; P < 0.001), pelvic tumor site (HR = 1.58; P < 0.001), tumor size >8 cm (HR = 1.52; P < 0.001), radiation (HR = 1.81; P < 0.001) as index treatment, and residing a distance of 51–100 miles from the treatment center (HR = 1.30; P=0.012). Increased survival was significantly associated (P < 0.05) with chordoma (HR = 0.27; P=0.010), chondrosarcoma (HR = 0.75; P=0.002), treatment at an academic center (HR = 0.64; P=0.039), and a private (HR = 0.67; P=0.006) or Medicare (HR = 0.71; P=0.043) insurer. A transition in care was not associated with a survival disadvantage (HR = 0.90; P=0.14). Conclusions Longer TTI was not associated with decreased overall survival in localized, high-grade primary bone sarcoma in adults. This is important in counseling patients, who may delay treatment to receive a second opinion or seek referral to a higher volume sarcoma center.
Highlights
Primary bone sarcomas are rare malignancies with a national incidence in the United States of around 3,200 cases annually and a five-year relative survival between 60 and 70% in localized disease [1]
Prognosis in bone sarcoma is closely correlated with tumor grade and disease stage, which argues for earlier diagnosis and treatment [2, 3]
Despite the obvious benefits of expedited treatment, other factors such as treatment at an established multidisciplinary sarcoma program are believed to positively affect prognosis but may result in a treatment delay due to coordination and transfer of care [6,7,8]. us, the inquiry as to if treatment initiation (TTI) affects prognosis in bone sarcoma is nuanced, and the rarity of the disease has led to limited data addressing this issue [9]
Summary
Primary bone sarcomas are rare malignancies with a national incidence in the United States of around 3,200 cases annually and a five-year relative survival between 60 and 70% in localized disease [1]. Prognosis in bone sarcoma is closely correlated with tumor grade and disease stage, which argues for earlier diagnosis and treatment [2, 3]. E primary aim of this study was to determine if TTI influences OS in patients diagnosed with localized, highgrade bone sarcoma.
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