Income and Insurance-Based Disparities in Primary Soft Tissue Sarcoma of the Extremities

Background and Objectives: Soft tissue sarcomas (STSs) are rare but can be devastating. Paradigm shifts in adjuvant treatment have expanded the availability of limb salvage; however, a subset of patients still require amputation. The aim of this study was to examine the impact of patient, disease, and practice-related factors on rates of amputation in STS. Methods: All adults undergoing resection for STS of the extremities were tabulated from the 2004-2021 National Cancer Database (NCDB). Multivariable models were utilized to evaluate risk factors for undergoing amputation. Results: Of 31 805 patients, 1880 (6%) underwent amputation. Those who underwent amputation were younger (57 vs. 60, p < 0.001), more commonly Black (12% vs. 9%, p < 0.00), and more frequently Medicaid insured (11% vs. 6%, p < 0.001). Amputation patients experienced a longer time from diagnosis to surgery, compared to limb salvage patients (46 [23-91] vs. 37 days [9-93], p < 0.001). Amputation was associated with a significantly greater hazard of overall mortality over 10 years following resection (HR 1.66, p < 0.001). Conclusion: We report significant race-, income-, and insurance-based disparities in amputation risk and overall survival for patients with STS of the extremities. We also report a significantly increased risk of amputation for patients with delayed clinical presentation. Multidisciplinary sarcoma care teams should be aware of these disparities.