One-year mortality in patients with bone and soft tissue sarcomas as an indicator of delay in presentation.
BACKGROUND
For many cancers, one-year mortality following diagnosis is a reflection of either advanced stage at diagnosis, multiple co-morbidities and/or complications of treatment. One-year mortality has not been reported for soft tissue or bone sarcomas. This study reports 1-year sarcoma mortality data over a 25-year period, investigates prognostic factors and considers whether a delay in presentation affects 1-year mortality.


METHODS
A total of 4,945 newly diagnosed bone sarcoma and soft tissue sarcoma patients were identified from a prospectively maintained, single institution oncology database. Of these, 595 (12%) died within 1 year of diagnosis. Both patient factors and tumour characteristics available at diagnosis were analysed for effect.


RESULTS
There was significant variation in one-year mortality between different histological subtypes. There has been no significant change in mortality rate during the last 25 years (mean: 11.7%, standard deviation: 2.8 percentage points). Soft tissue sarcoma patients who survived over one year reported a longer duration of symptoms preceding diagnosis than those who died (median: 26 vs 20 weeks, p<0.001). Prognostic factors identified in both bone and soft tissue sarcomas mirrored those for mid to long-term survival, with high tumour stage, large tumour size, metastases at diagnosis and increasing age having the greatest predictive effect.


CONCLUSIONS
One-year mortality in bone and soft tissue sarcoma patients is easy to measure, and could be a proxy for late presentation and therefore a potential performance indicator, similar to other cancers. It is possible to predict the risk of one-year mortality using factors available at diagnosis. Death within one year does not correlate with a long history but is associated with advanced disease at diagnosis.
Royal Orthopaedic Hospital NHS Foundation Trust, UK.
R
R
Nandra
Royal Orthopaedic Hospital NHS Foundation Trust, UK.
N
N
Hwang
Royal Orthopaedic Hospital NHS Foundation Trust, UK.
G S
GS
Matharu
Royal Orthopaedic Hospital NHS Foundation Trust, UK.
K
K
Reddy
Royal Orthopaedic Hospital NHS Foundation Trust, UK.
R
R
Grimer
D001859:Bone Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000473:pathology; D057210:Delayed Diagnosis; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D012509:Sarcoma / Q000175:diagnosis / Q000401:mortality* / Q000473:pathology / Q000556:secondary; D012983:Soft Tissue Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000473:pathology; D013997:Time Factors; D055815:Young Adult
Diagnosis; Mortality; One-year; Prognostic factors; Sarcoma; Symptoms