title: Length of symptoms before referral: prognostic variable for high-grade soft tissue sarcoma?
abstract: BACKGROUND
  It is commonly assumed patients with high-grade soft tissue sarcomas who are diagnosed and treated quickly after the first onset of symptoms fare better than those with longer symptoms before treatment. The literature contains no substantive data to support this assumption for soft tissue sarcomas, particularly for high-grade lesions.
  
  
  OBJECTIVE
  We examined selected potential prognostic factors for high-grade soft tissue sarcoma and determined whether the time from first symptom to diagnosis has an impact on survival or disease-free survival and whether subcutaneous sarcomas are diagnosed more quickly than deep sarcomas.
  
  
  METHODS
  We retrospectively reviewed 381 consecutive patients treated for high-grade soft tissue sarcoma between 1992 and 2007. Each patient's time from first symptom (pain and/or palpable mass) was prospectively entered into a surgical oncology database. The patients were followed for disease recurrence and survival. We compared length of symptoms with disease-free survival, overall survival, metastases at diagnosis, tumor size, and patient age. Minimum followup was 1 month (mean, 57 months; range, 1-201 months).
  
  
  RESULTS
  The overall 5-year survival was 64.7% and disease-free survival was 54.5%. Tumor size and metastatic disease correlated with overall survival and disease-free survival but not length of symptoms. Length of symptoms did not correlate with overall survival or disease-free survival.
  
  
  CONCLUSIONS
  Our data do not support the assumption that longer length of symptoms before diagnosis predicts worse overall survival, disease-free survival, or metastatic disease at diagnosis.
  
  
  METHODS
  Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: OrthoIndy, 8450 Northwest Blvd, Indianapolis, IN 46278, USA. brougraff@aol.com
authors.forename: Bruce T
authors.initials: BT
authors.lastname: Rougraff
authors.forename: Jackie
authors.initials: J
authors.lastname: Lawrence
authors.forename: Kenneth
authors.initials: K
authors.lastname: Davis
mesh_terms: D018572:Disease-Free Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D009362:Neoplasm Metastasis; D011379:Prognosis; D012017:Referral and Consultation; D012189:Retrospective Studies; D012509:Sarcoma / Q000401:mortality* / Q000473:pathology; D040521:Subcutaneous Tissue / Q000473:pathology; D013997:Time Factors