Racial and ethnic differences in treatment and survival among adults with primary extremity soft‐tissue sarcoma

Abstract

BACKGROUND.Limb preservation is preferred to amputation for patients with extremity soft tissue sarcoma (ESTS). Disparities in the treatment and outcomes of several malignancies have been reported, but not for ESTS. The authors assessed racial/ethnic differences in patient‐ and tumor‐specific characteristics, treatment, and disease‐specific survival in a population of adults with ESTS.METHODS.The Surveillance, Epidemiology, and End Results (SEER) database was used to identify 6406 adult patients with ESTS who were diagnosed and treated between 1988 and 2003. Patients were categorized into 1 of 4 racial/ethnic groups: whites, blacks, Hispanics, and Asians. Comparisons of treatment and disease‐specific survival were conducted with regression models that adjusted for patient age, sex, SEER geographic region, extent of disease, tumor grade, tumor size, and histology.RESULTS.Relative to whites, blacks received lower rates of adjuvant radiation with surgery (odds ratio [OR], 0.77; 95% confidence interval [95% CI], 0.66–0.90). Hispanics received significantly lower rates of limb‐sparing surgery (OR, 0.76; 95% CI, 0.59–0.97). In a multivariate analysis controlling for patient age, sex, SEER geographic region, extent of disease, tumor grade, tumor size, and histology, blacks displayed a worse disease‐specific survival (hazard ratio [HR] 1.39; 95% CI, 1.13–1.70), whereas Asians demonstrated superior disease‐specific survival (HR, 0.67; 95% CI, 0.46–0.97).CONCLUSIONS.There were significant racial/ethnic differences in treatment and survival among adults with ESTS. Compared with whites, survival was poorer for blacks but better for Asians. These disparities were not explained by differences in patient or tumor characteristics. Cancer 2008. © 2008 American Cancer Society.

Limb‐sparing surgery plus radiotherapy results in superior survival: an analysis of patients with high‐grade, extremity soft‐tissue sarcoma from the NCDB and SEER

“…Others have also found that postoperative RT, malignant fibrous histiocytoma, and liposarcoma histologies were predictors of improved OS . While at least one SEER study found that black patients had worse SM and OS compared to white patients, our study did not find a similar difference based on race although this was not the primary variable evaluated in the current study. Our study identified additional variables associated with reduced OS including not having private insurance, living in communities with less high school graduates, and having more pre‐existing comorbidities.…”

Evaluation of the use of prophylactic cranial irradiation in small cell lung cancer

“…However, this finding is not unique insofar as other reports have observed similarly poorer outcomes affecting African Americans with breast cancer, soft tissue sarcoma, and gynecologic malignancies. [18][19][20][21] Further investigations are necessary to determine whether these differences are a result of tumor biology, differences in screening and access to care, the type of care received, or other factors or combinations of factors. One of the limitations of the current study is that only those patients with primary, nonmetastatic small cell carcinoma of the lung for the years 1988 through 1997 were included as the analyzable population, because for the periods before and after, the use of whole-brain radiotherapy was not recorded in the SEER database.…”

“…However, this finding is not unique insofar as other reports have observed similarly poorer outcomes affecting African Americans with breast cancer, soft tissue sarcoma, and gynecologic malignancies. [18][19][20][21] Further investigations are necessary to determine whether these differences are a result of tumor biology, differences in screening and access to care, the type of care received, or other factors or combinations of factors.…”

Comparative analysis of clinicopathologic features, treatment, and survival of Asian women with a breast cancer diagnosis residing in the United States

“…The geographic scope of the current SEER database has been reported previously. [13][14][15] The stage recorded in the SEER database is derived from a combination of clinical and pathologic information. For patients who were diagnosed before 2004, the derived stage reflects the third edition of the American Joint Committee on Cancer (AJCC) staging system; and, for patients who were diagnosed in 2004 or later, the derived stage reflects the sixth edition of the AJCC staging system.…”