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Background <p>The Area Deprivation Index (ADI) is a validated measure of neighborhood-level socioeconomic disadvantage. This study aimed to assess the association between ADI and long-term (1) disease-specific survival (DSS), (2) metastasis-free survival (MFS), and (3) local recurrence-free survival (RFS) in patients with localized extremity soft tissue sarcoma (STS).</p> Methods <p>This was a retrospective study of 238 patients who underwent resection of a localized extremity or pelvis STS from January 2010 to December 2021. Patients with American Joint Committee on Cancer (AJCC) stage 4 were excluded. The ADI is a range with higher values indicating greater deprivation. We categorized ADI into three groups (ADI 1 = 0 to 33, ADI 2 = 34 to 66, ADI 3 = 67 to 100). A Kaplan-Meier analysis was used to estimate the five- and ten-year DSS, MFS, and RFS, with log-rank test and Cox proportional hazards models used to assess significance.</p> Results <p>Five-year DSS was worse for patients in ADI 3 and ADI 2 compared to ADI 1 (68.4% vs. 74.2% vs. 91.4%, <i>p</i> = 0.04), with similar patterns at ten-years (42.0% vs. 52.1% vs. 91.4%, <i>p</i> = 0.04). When controlling for age, race, histologic grade, and AJCC stage, ADI 3 was associated with increased five-year risk of disease-specific death compared to ADI 1 [HR 3.47 (1.03–11.66), <i>p</i> = 0.04], while at ten years both ADI group 2 [HR 3.8 (1.13–12.81), <i>p</i> = 0.03] and ADI group 3 [HR 4.88 (1.47–16.18), <i>p</i> = 0.01] demonstrated significantly increased risk of disease-specific death. Five and ten-year risk of metastasis showed similar, but insignificant, trends in unadjusted models but significant differences in adjusted models. Signficant differences in risk of local recurrence for ADI Group 2 and 3 were observed at ten-years in adjusted models.</p> Conclusion <p>Patients with soft-tissue sarcoma are significalty impacted by social determinants of health. Efforts to identify the causes of these differences are needed to ensure equity in sarcoma care. Possible explanations include delayed diagnosis, infrequent visits, and physician bias.</p> <p>Level of Evidence: III</p>

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Neighborhood socioeconomic disadvantage is associated with worse survival in localized extremity soft tissue sarcoma

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月9日

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  • Brian Benyamini,
  • Riley O’Toole,
  • Mareike Haaren,
  • Joseph Wooley,
  • Dale Shepard,
  • Shauna R. Campbell,
  • Jacob G. Scott,
  • Nathan W. Mesko,
  • Lukas M. Nystrom,
  • Zachary D.C. Burke

摘要

Background

The Area Deprivation Index (ADI) is a validated measure of neighborhood-level socioeconomic disadvantage. This study aimed to assess the association between ADI and long-term (1) disease-specific survival (DSS), (2) metastasis-free survival (MFS), and (3) local recurrence-free survival (RFS) in patients with localized extremity soft tissue sarcoma (STS).

Methods

This was a retrospective study of 238 patients who underwent resection of a localized extremity or pelvis STS from January 2010 to December 2021. Patients with American Joint Committee on Cancer (AJCC) stage 4 were excluded. The ADI is a range with higher values indicating greater deprivation. We categorized ADI into three groups (ADI 1 = 0 to 33, ADI 2 = 34 to 66, ADI 3 = 67 to 100). A Kaplan-Meier analysis was used to estimate the five- and ten-year DSS, MFS, and RFS, with log-rank test and Cox proportional hazards models used to assess significance.

Results

Five-year DSS was worse for patients in ADI 3 and ADI 2 compared to ADI 1 (68.4% vs. 74.2% vs. 91.4%, p = 0.04), with similar patterns at ten-years (42.0% vs. 52.1% vs. 91.4%, p = 0.04). When controlling for age, race, histologic grade, and AJCC stage, ADI 3 was associated with increased five-year risk of disease-specific death compared to ADI 1 [HR 3.47 (1.03–11.66), p = 0.04], while at ten years both ADI group 2 [HR 3.8 (1.13–12.81), p = 0.03] and ADI group 3 [HR 4.88 (1.47–16.18), p = 0.01] demonstrated significantly increased risk of disease-specific death. Five and ten-year risk of metastasis showed similar, but insignificant, trends in unadjusted models but significant differences in adjusted models. Signficant differences in risk of local recurrence for ADI Group 2 and 3 were observed at ten-years in adjusted models.

Conclusion

Patients with soft-tissue sarcoma are significalty impacted by social determinants of health. Efforts to identify the causes of these differences are needed to ensure equity in sarcoma care. Possible explanations include delayed diagnosis, infrequent visits, and physician bias.

Level of Evidence: III