Disparity in limb-salvage surgery among sarcoma patients.

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DOI: 10.1016/j.amjsurg.2009.12.003


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.

Journal Title

American journal of surgery





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MeSH Keywords

Adult; African Americans; Aged; Aged, 80 and over; Amputation; Asian Americans; European Continental Ancestry Group; Female; Health Services Accessibility; Healthcare Disparities; Hispanic Americans; Humans; Limb Salvage; Logistic Models; Male; Middle Aged; Multivariate Analysis; Neoadjuvant Therapy; Odds Ratio; Proportional Hazards Models; Radiotherapy, Adjuvant; SEER Program; Sarcoma; United States


Amputees; Sarcoma; Limb Saving Surgery; Disparities; Inequalities; SEER database