Time to treatment initiation and survival in adult localized, high-grade soft tissue sarcoma

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.