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Delayed Treatment Associated With Worse Survival in High-grade Undifferentiated Pleomorphic Sarcoma.

Aidan C O'Brien1, Sawyer H Farmer1, Prajeeth K Koyada2

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Delayed treatment initiation significantly reduces survival for patients with high-grade undifferentiated pleomorphic sarcoma of the extremity and trunk. Prompt treatment is crucial for better outcomes in these soft tissue sarcoma patients.

Keywords:
National Cancer DatabaseSoft tissue sarcomaSurvivalTime-to-treatment initiationUndifferentiated pleomorphic sarcoma

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Area of Science:

  • Oncology
  • Surgical Pathology
  • Clinical Research

Background:

  • Time to treatment initiation impacts survival in various cancers.
  • The role of treatment delay in soft tissue sarcomas, especially high-grade undifferentiated pleomorphic sarcoma (UPS), is not well understood.
  • Individualized evaluation of histologic subtypes is key for patient-centered care.

Purpose of the Study:

  • To investigate the association between the time to treatment initiation and survival rates.
  • To specifically analyze this association in patients diagnosed with localized, high-grade UPS.

Main Methods:

  • Retrospective analysis of 6220 patients with localized, high-grade UPS from the National Cancer Database (2004-2021).
  • Exclusion of non-eligible cases to ensure study cohort integrity.
  • Application of Kaplan-Meier and multivariable Cox proportional hazards models to assess survival outcomes relative to treatment delay.

Main Results:

  • Initiating treatment more than 4 weeks after diagnosis was linked to a significant decrease in 5-year survival (P < 0.001).
  • For extremity and trunk tumors, longer delays in treatment initiation were independently associated with poorer survival (HR = 1.01 per week; P = 0.013).
  • No significant association between treatment delay and survival was found for head and neck or abdominal/pelvic tumors.

Conclusions:

  • Prolonged time to treatment initiation is an independent predictor of reduced survival for localized, high-grade UPS in the extremity and trunk.
  • Observed increases in treatment initiation time may stem from evolving diagnostic procedures and insurance-related delays.
  • Findings underscore the importance of timely treatment for specific soft tissue sarcoma subtypes.