Association between area deprivation index (ADI) and initial treatment among patients with desmoid tumors^☆

Desmoid fibromatosis is a locally aggressive, non-metastasizing soft tissue tumor associated with substantial morbidity. Management has shifted away from routine surgical resection toward surveillance and systemic therapies. Socioeconomic disadvantage may influence treatment selection even among patients evaluated at tertiary referral centers. This study evaluated the association between neighborhood-level socioeconomic disadvantage, measured by the area deprivation index (ADI), and initial treatment strategy among patients with desmoid tumors.

Adults evaluated for desmoid fibromatosis at The Ohio State University between January 1, 2010, and January 1, 2021, were included in this retrospective cohort. Residential addresses were mapped to national ADI scores using the Neighborhood Atlas, and initial management was categorized as surgery, systemic therapy, or radiation. Associations between ADI and treatment selection were examined using prespecified univariate regression analyses.

Among 151 patients, initial treatment included surgery (72 %), systemic therapy (24 %), or radiation (4 %). Patients residing in higher-ADI neighborhoods had significantly higher ADI scores when treated with systemic therapy compared with surgery (mean ADI 65 vs 50, P = 0.013), and higher ADI was associated with selection of systemic therapy rather than upfront surgery.

In this single-institution cohort, higher neighborhood socioeconomic disadvantage was associated with selection of non-surgical initial management for desmoid fibromatosis. These findings reflect treatment patterns during a transitional era in desmoid care and suggest that socioeconomic factors may influence management decisions even among patients accessing specialized care. Further multi-institutional studies in contemporary cohorts are needed to clarify how socioeconomic disadvantage affects treatment selection and outcomes.