Background: Although shorter delays in soft tissue sarcoma (STS) diagnosis may improve overall survival (OS), the influence of time to treatment initiation (TTI) on OS in STS has not been determined.Objective: To determine if TTI influences OS in localized, high-grade STS.Methods: An analysis of the National Cancer Database identified 8648 patients meeting criteria with localized, high-grade STS diagnosed between 2004 and 2012.TTI and secondary variable associations with OS were determined using Kruskal-Wallis tests in univariate analyses, and a Cox regression multivariable model.
Results:In a multivariable Cox regression, TTI was associated with OS in a nonlinear fashion with a minimum hazard ratio (HR) demonstrated at 42 days. Secondary variables significantly associated (P < .05) with decreased OS included, advanced age, increased Charlson/Deyo score, nonprivate insurance, axial tumor location, tumor size more than 5 cm, stage III disease, and a nonsurgical treatment modality.
Conclusions:Minimum HR was observed at a TTI of 42 days, with HR = 0.64, when compared with TTI = 1 day. Appropriate referrals to a higher volume sarcoma centers may account for these delays and explain a potential OS advantage. This is important in counseling patients, who may seek referral to a higher volume treatment center. K E Y W O R D S overall survival, soft tissue sarcoma, time to treatment initiation, treatment delay | 1249 https://www.facs.org/quality-programs/cancer/ncdb/puf with the permission of the ACS NCDB. ORCID Gannon L. Curtis