Disparity in limb-salvage surgery among sarcoma patients.
BACKGROUND
Recent studies have shown that aggressive preoperative radiation increases the likelihood of limb salvage in sarcoma patients.


METHODS
The Surveillance, Epidemiology and End Results database was used to run an adjusted logistic regression for the receipt of cancer-directed treatment modalities.


RESULTS
Of patients with specific surgical procedures recorded (n = 2,104), 86.0% had undergone a limb-sparing procedure. On bivariate analysis, African American patients were less likely to receive a limb-sparing procedure than white patients (80.4% vs 86.9%; P = .02). On multivariate analysis, African Americans were significantly more likely to receive preoperative radiation (odds ratio [OR], 2.31; 95% confidence interval [CI], 1.22-4.40; P = .011), yet this did not translate into an increase in limb salvage (OR, .67; 95% CI, .42-1.08; P = .10). Limb salvage significantly increased for all groups in 2001 and after (OR, 2.75; 95% CI, 1.55-4.88; P = .001) without a decrease in survival. For those with tumors greater than 4 cm, there was a trend away from limb salvage for African Americans (OR, .59; 95% CI, .32-1.07; P = .08).


CONCLUSIONS
Our results of an increase in limb-salvage surgeries after 2001 without a decrease in survival support previous studies. The trend away from limb salvage for African Americans cannot be answered by this study.
Downing
Stephanie
S
Department of Surgery, Howard University College of Medicine, 2041 Georgia Ave. NW, Suite 4000, Washington, DC 20060, USA.
Ahuja
Nita
N
Oyetunji
Tolulope A
TA
Chang
David
D
Frederick
Wayne A I
WA
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D001213:Asian / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D023821:Limb Salvage / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy / Q000379:methods; D016017:Odds Ratio; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D018426:SEER Program; D012509:Sarcoma / Q000208:ethnology* / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data