Joseph Featherall1, Gannon L Curtis2, Joshua M Lawrenz2, Yuxuan Jin3, Jaiben George2, Jacob Scott4, Chirag Shah4, Dale Shepard5, Brian P Rubin6, Lukas M Nystrom2, Nathan W Mesko2. 1. Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio. 2. Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland, Ohio. 3. Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland, Ohio. 4. Department of Radiation Oncology, Taussig Cancer Institute, Cleveland, Ohio. 5. Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland, Ohio. 6. Department of Pathology, Pathology and Laboratory Medicine Institute, Cleveland, Ohio.
Abstract
BACKGROUND: Although shorter delays in soft tissue sarcoma (STS) diagnosis may improve overall survival (OS), the influence of time to treatment initiation (TTI) on OS in STS has not been determined. OBJECTIVE: To determine if TTI influences OS in localized, high-grade STS. METHODS: An analysis of the National Cancer Database identified 8648 patients meeting criteria with localized, high-grade STS diagnosed between 2004 and 2012. TTI and secondary variable associations with OS were determined using Kruskal-Wallis tests in univariate analyses, and a Cox regression multivariable model. RESULTS: In a multivariable Cox regression, TTI was associated with OS in a nonlinear fashion with a minimum hazard ratio (HR) demonstrated at 42 days. Secondary variables significantly associated (P < .05) with decreased OS included, advanced age, increased Charlson/Deyo score, nonprivate insurance, axial tumor location, tumor size more than 5 cm, stage III disease, and a nonsurgical treatment modality. CONCLUSIONS: Minimum HR was observed at a TTI of 42 days, with HR = 0.64, when compared with TTI = 1 day. Appropriate referrals to a higher volume sarcoma centers may account for these delays and explain a potential OS advantage. This is important in counseling patients, who may seek referral to a higher volume treatment center.
BACKGROUND: Although shorter delays in soft tissue sarcoma (STS) diagnosis may improve overall survival (OS), the influence of time to treatment initiation (TTI) on OS in STS has not been determined. OBJECTIVE: To determine if TTI influences OS in localized, high-grade STS. METHODS: An analysis of the National Cancer Database identified 8648 patients meeting criteria with localized, high-grade STS diagnosed between 2004 and 2012. TTI and secondary variable associations with OS were determined using Kruskal-Wallis tests in univariate analyses, and a Cox regression multivariable model. RESULTS: In a multivariable Cox regression, TTI was associated with OS in a nonlinear fashion with a minimum hazard ratio (HR) demonstrated at 42 days. Secondary variables significantly associated (P < .05) with decreased OS included, advanced age, increased Charlson/Deyo score, nonprivate insurance, axial tumor location, tumor size more than 5 cm, stage III disease, and a nonsurgical treatment modality. CONCLUSIONS: Minimum HR was observed at a TTI of 42 days, with HR = 0.64, when compared with TTI = 1 day. Appropriate referrals to a higher volume sarcoma centers may account for these delays and explain a potential OS advantage. This is important in counseling patients, who may seek referral to a higher volume treatment center.
Authors: Michael Roth; Amy Berkman; Clark R Andersen; Branko Cuglievan; J Andrew Livingston; Michelle Hildebrandt; Archie Bleyer Journal: Oncologist Date: 2022-03-04 Impact factor: 5.837
Authors: Joshua M Lawrenz; Joseph Featherall; Gannon L Curtis; Jaiben George; Yuxuan Jin; Peter M Anderson; Dale R Shepard; John D Reith; Brian P Rubin; Lukas M Nystrom; Nathan W Mesko Journal: Sarcoma Date: 2020-05-04
Authors: Denise Garcia; Julie B Siegel; David A Mahvi; Biqi Zhang; David M Mahvi; E Ramsay Camp; Whitney Graybill; Stephen J Savage; Antonio Giordano; Sara Giordano; Denise Carneiro-Pla; Mahsa Javid; Aaron P Lesher; Andrea Abbott; Nancy Klauber DeMore Journal: Clin Oncol Res Date: 2020-06-26