How Do Patient Demographics and Socioeconomic Disadvantage Impact Clinical Presentation, Surgical Outcomes, and...

Soft tissue sarcomas (STS) of the upper extremity (UE) are uncommon and may require complex surgical management. Socioeconomic disadvantage, race/ethnicity, sex, and marital status may influence presentation, surgical complexity, local recurrence (LR), and overall survival (OS).

The aim of this work is to examine the influence of socioeconomic and demographic factors on the presentation and outcomes of upper extremity soft tissue sarcomas.

We identified patients treated surgically for primary UE STS (2012-2022). Demographics, tumor characteristics, and outcomes were recorded. Associations between demographics and time to presentation, skin grafting, amputation, and LR were assessed using chi-square and t-tests. Competing risks regression analyzed 3- and 5-year LR, and Kaplan-Meier analysis assessed 5-year OS. Among 181 patients, the mean time to presentation was 17.1 months (SD 34.3), mean tumor size was 7.8 cm (SD 5.7) while 56% required re-excision, 15% underwent amputation, 15% required skin grafting, and 24% experienced LR. Hispanic/Latino patients presented with larger tumor sizes (9.17 ± 5.71 cm vs. 7.43 ± 5.61 cm, p = 0.037). Non-married patients had higher odds of amputation (OR 3.15, p = 0.012), and female sex predicted greater LR risk (OR 2.17, p = 0.037). Twenty-one patients (11.1%) died within five years. In multivariable analysis, increasing tumor size (OR = 1.08; p = 0.010) and high tumor grade (OR = 8.28; p = 0.038) significantly impacted 5-year OS.

While disparities across patient demographics may exist for surgical outcomes for UE STS, racial disparities in overall survival may be mitigated with treatment at an urban, tertiary care sarcoma center.