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Race is an independent predictor of survival in patients with soft tissue sarcoma of the extremities
BACKGROUND: In the United States, race and socioeconomic status are well known predictors of adverse outcomes in several different cancers. Existing evidence suggests that race and socioeconomic status may impact survival in soft tissue sarcoma (STS). We investigated the National Cancer Database (NC...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5923002/ https://www.ncbi.nlm.nih.gov/pubmed/29703171 http://dx.doi.org/10.1186/s12885-018-4397-3 |
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author | Lazarides, Alexander L. Visgauss, Julia D. Nussbaum, Daniel P. Green, Cindy L. Blazer, Dan G. Brigman, Brian E. Eward, William C. |
author_facet | Lazarides, Alexander L. Visgauss, Julia D. Nussbaum, Daniel P. Green, Cindy L. Blazer, Dan G. Brigman, Brian E. Eward, William C. |
author_sort | Lazarides, Alexander L. |
collection | PubMed |
description | BACKGROUND: In the United States, race and socioeconomic status are well known predictors of adverse outcomes in several different cancers. Existing evidence suggests that race and socioeconomic status may impact survival in soft tissue sarcoma (STS). We investigated the National Cancer Database (NCDB), which contains several socioeconomic and medical variables and contains the largest sarcoma patient registry to date. Our goal was to determine the impact of race, ethnicity and socioeconomic status on patient survival in patients with soft tissue sarcoma of the extremities (STS-E). METHODS: We retrospectively analyzed 14,067 STS-E patients in the NCDB from 1998 through 2012. Patients were stratified based on race, ethnicity and socioeconomic status. Univariate and multivariate analyses were used to correlate specific outcomes and survival measures with these factors. Then, long-term survival between groups was evaluated using the Kaplan-Meier (KM) method with comparisons based on the log-rank test. Multiple variables were analyzed between two groups. RESULTS: Of the 14,067 patients analyzed, 84.9% were white, 11% were black and 4.1% were Asian. Black patients were significantly more likely (7.18% vs 5.65% vs 4.47%) than white or Asian patients to receive amputation (p = 0.027). Black patients were also less likely to have either an above-median education level or an above-median income level (p < 0.001). In addition, black patients were more likely to be uninsured (p < 0.001) and more likely to have a higher Charleson Comorbidity Score than white or Asian patients. Tumors were larger in size upon presentation in black patients than in white or Asian patients (p < 0.001). Black patients had significantly poorer overall survival than did white or Asian patients (p < 0.001) with a KM 5-year survival of 61.4% vs 66.9% and 69.9% respectively, and a 24% higher independent likelihood of dying in a multivariate analysis. CONCLUSION: This large database review reveals concerning trends in black patients with STS-E. These include larger tumors, poorer resources, a greater likelihood of amputation, and poorer survival than white and Asian patients. Future studies are warranted to help ensure adequate access to effective treatment for all patients. |
format | Online Article Text |
id | pubmed-5923002 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-59230022018-05-07 Race is an independent predictor of survival in patients with soft tissue sarcoma of the extremities Lazarides, Alexander L. Visgauss, Julia D. Nussbaum, Daniel P. Green, Cindy L. Blazer, Dan G. Brigman, Brian E. Eward, William C. BMC Cancer Research Article BACKGROUND: In the United States, race and socioeconomic status are well known predictors of adverse outcomes in several different cancers. Existing evidence suggests that race and socioeconomic status may impact survival in soft tissue sarcoma (STS). We investigated the National Cancer Database (NCDB), which contains several socioeconomic and medical variables and contains the largest sarcoma patient registry to date. Our goal was to determine the impact of race, ethnicity and socioeconomic status on patient survival in patients with soft tissue sarcoma of the extremities (STS-E). METHODS: We retrospectively analyzed 14,067 STS-E patients in the NCDB from 1998 through 2012. Patients were stratified based on race, ethnicity and socioeconomic status. Univariate and multivariate analyses were used to correlate specific outcomes and survival measures with these factors. Then, long-term survival between groups was evaluated using the Kaplan-Meier (KM) method with comparisons based on the log-rank test. Multiple variables were analyzed between two groups. RESULTS: Of the 14,067 patients analyzed, 84.9% were white, 11% were black and 4.1% were Asian. Black patients were significantly more likely (7.18% vs 5.65% vs 4.47%) than white or Asian patients to receive amputation (p = 0.027). Black patients were also less likely to have either an above-median education level or an above-median income level (p < 0.001). In addition, black patients were more likely to be uninsured (p < 0.001) and more likely to have a higher Charleson Comorbidity Score than white or Asian patients. Tumors were larger in size upon presentation in black patients than in white or Asian patients (p < 0.001). Black patients had significantly poorer overall survival than did white or Asian patients (p < 0.001) with a KM 5-year survival of 61.4% vs 66.9% and 69.9% respectively, and a 24% higher independent likelihood of dying in a multivariate analysis. CONCLUSION: This large database review reveals concerning trends in black patients with STS-E. These include larger tumors, poorer resources, a greater likelihood of amputation, and poorer survival than white and Asian patients. Future studies are warranted to help ensure adequate access to effective treatment for all patients. BioMed Central 2018-04-27 /pmc/articles/PMC5923002/ /pubmed/29703171 http://dx.doi.org/10.1186/s12885-018-4397-3 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Lazarides, Alexander L. Visgauss, Julia D. Nussbaum, Daniel P. Green, Cindy L. Blazer, Dan G. Brigman, Brian E. Eward, William C. Race is an independent predictor of survival in patients with soft tissue sarcoma of the extremities |
title | Race is an independent predictor of survival in patients with soft tissue sarcoma of the extremities |
title_full | Race is an independent predictor of survival in patients with soft tissue sarcoma of the extremities |
title_fullStr | Race is an independent predictor of survival in patients with soft tissue sarcoma of the extremities |
title_full_unstemmed | Race is an independent predictor of survival in patients with soft tissue sarcoma of the extremities |
title_short | Race is an independent predictor of survival in patients with soft tissue sarcoma of the extremities |
title_sort | race is an independent predictor of survival in patients with soft tissue sarcoma of the extremities |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5923002/ https://www.ncbi.nlm.nih.gov/pubmed/29703171 http://dx.doi.org/10.1186/s12885-018-4397-3 |
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