Racial and ethnic differences in treatment and survival among adults with primary extremity soft-tissue sarcoma.
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.
Martinez
Steve R
SR
Division of Surgical Oncology, University of California at Davis Cancer Center, Sacramento, CA 95817, USA. steve.martinez@ucdmc.ucdavis.edu
Robbins
Anthony S
AS
Meyers
Frederick J
FJ
Bold
Richard J
RJ
Khatri
Vijay P
VP
Goodnight
James E
JE
D000671:Amputation, Surgical; D044466:Asian People; D044383:Black People; D005006:Ethnicity; D005121:Extremities; D054625:Healthcare Disparities; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D008875:Middle Aged; D018714:Radiotherapy, Adjuvant; D012509:Sarcoma / Q000208:ethnology* / Q000401:mortality / Q000628:therapy*; D012959:Socioeconomic Factors; D015996:Survival Rate; D044465:White People