title: Racial Disparities in Extremity Soft-Tissue Sarcoma Outcomes: A Nationwide Analysis.
abstract: BACKGROUND
  Racial disparities in access and survival have been reported in a variety of cancers. These issues, however, have yet to be explored in detail in patients with soft-tissue sarcomas (STS). The purpose of this paper was to investigate the independent role of race with respect to survival outcomes in STS.
  
  
  METHODS
  A total of 7601 patients were evaluated in this study. A SEER registry query for patients over 20 years old with extremity STS diagnosed between 2004 and 2009 (n=7225) was performed. Survival outcomes were analyzed after patients were stratified by race. Multivariable survival models were used to identify independent predictors of sarcoma-specific death. The Wilcoxon rank-sum test was used to compare continuous variables. Statistical significance was maintained at P<0.05.
  
  
  RESULTS
  This study showed that African American patients were more likely to die of their STS. They were younger at presentation (P=0.001), had larger tumors (P<0.001), had less surgery (P=0.002), received radiotherapy less frequently (P=0.024), had higher family income (P<0.001), and were less likely to be married (P<0.001). African American race by itself was not an independent predictor of death.
  
  
  CONCLUSIONS
  African Americans encounter death due to STS at a much larger proportion and faster rate than their respective white counterparts. African Americans frequently present with a larger size tumor, do not undergo surgical resection, or receive radiation therapy as frequently as compared with their white peers. Barriers to timely and appropriate care should be further investigated in this group of at-risk patients.
authors.affiliation: Departments of *Orthopaedics and Rehabilitation †Biostatistics, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Vignesh K
authors.initials: VK
authors.lastname: Alamanda
authors.forename: Yanna
authors.initials: Y
authors.lastname: Song
authors.forename: Herbert S
authors.initials: HS
authors.lastname: Schwartz
authors.forename: Ginger E
authors.initials: GE
authors.lastname: Holt
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D017668:Age of Onset; D000368:Aged; D001213:Asian / Q000706:statistics & numerical data; D005121:Extremities / Q000473:pathology*; D005260:Female; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000208:ethnology*; D051677:Histiocytoma, Malignant Fibrous / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data; D004930:Inuit / Q000706:statistics & numerical data; D007890:Leiomyosarcoma / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D008080:Liposarcoma / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D044468:Native Hawaiian or Pacific Islander / Q000706:statistics & numerical data; D011878:Radiotherapy / Q000706:statistics & numerical data; D018426:SEER Program; D012509:Sarcoma / Q000401:mortality / Q000473:pathology / Q000628:therapy; D016019:Survival Analysis; D047368:Tumor Burden; D014481:United States; D044465:White People / Q000706:statistics & numerical data*