Disparity in limb-salvage surgery among sarcoma patients

Downing, Stephanie; Ahuja, Nita; Oyetunji, Tolulope A.; Chang, David; Frederick, Wayne A.I.

doi:10.1016/j.amjsurg.2009.12.003

« Previous Next »The American Journal of Surgery
Volume 199, Issue 4 , Pages 549-553, April 2010

Disparity in limb-salvage surgery among sarcoma patients

Stephanie Downing, M.D.
- Department of Surgery, Howard University College of Medicine, 2041 Georgia Ave. NW, Suite 4000, Washington, DC 20060, USA
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Nita Ahuja, M.D.
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Tolulope A. Oyetunji, M.D., M.P.H.
- Department of Surgery, Howard University College of Medicine, 2041 Georgia Ave. NW, Suite 4000, Washington, DC 20060, USA
David Chang, Ph.D., M.P.H., M.B.A.
- Department of Surgery, Howard University College of Medicine, 2041 Georgia Ave. NW, Suite 4000, Washington, DC 20060, USA
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Wayne A.I. Frederick, M.D.
- Department of Surgery, Howard University College of Medicine, 2041 Georgia Ave. NW, Suite 4000, Washington, DC 20060, USA
- Corresponding author. Tel.: +1-202-865-6409; fax: +1-202-865-6433

Received 19 August 2009; received in revised form 8 December 2009

Abstract

Background

Recent studies have shown that aggressive preoperative radiation increases the likelihood of limb salvage in sarcoma patients.

Method

The Surveillance, Epidemiology and End Results database was used to run an adjusted logistic regression for the receipt of cancer-directed treatment modalities.

Results

Of patients with specific surgical procedures recorded (n = 2,104), 86.0% had undergone a limb-sparing procedure. On bivariate analysis, African American patients were less likely to receive a limb-sparing procedure than white patients (80.4% vs 86.9%; P = .02). On multivariate analysis, African Americans were significantly more likely to receive preoperative radiation (odds ratio [OR], 2.31; 95% confidence interval [CI], 1.22–4.40; P = .011), yet this did not translate into an increase in limb salvage (OR, .67; 95% CI, .42–1.08; P = .10). Limb salvage significantly increased for all groups in 2001 and after (OR, 2.75; 95% CI, 1.55–4.88; P = .001) without a decrease in survival. For those with tumors greater than 4 cm, there was a trend away from limb salvage for African Americans (OR, .59; 95% CI, .32–1.07; P = .08).

Conclusions

Our results of an increase in limb-salvage surgeries after 2001 without a decrease in survival support previous studies. The trend away from limb salvage for African Americans cannot be answered by this study.

Keywords: SEER, Sarcoma, Limb-salvage surgery, Disparities in medicine