PO.PS01.04 · 人群科学
社会经济地位和出行距离对软组织肉瘤治疗结局的影响：一项来自大容量三级诊疗中心的回顾性分析
Impact of socioeconomic status and travel distance on treatment outcomes in soft tissue sarcoma: A retrospective analysis from a high volume tertiary care center
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摘要 Abstract
中文摘要
引言：软组织肉瘤（STS）是罕见的间叶源性肿瘤，临床复杂性很高。尽管肿瘤大小、分级和组织学是公认的预后因素，但社会经济地位（SES）和专科诊疗的地理可及性也可能影响结局。多种癌症的既往研究显示，社会经济弱势和更长的出行距离可延误治疗并恶化预后。大容量肉瘤中心提供可提高生存率的多学科管理，但与SES相关的障碍可能仍会影响可及性。本研究评估了在一个大容量三级中心接受治疗的STS患者中，SES、出行距离、治疗模式及生存结局的影响。
方法：分析了在单一三级中心20年间接受治疗的364例原发性STS患者的回顾性队列。排除诊断时即有转移性疾病、治疗数据不完整或随访不充分的患者，最终纳入357例符合条件的患者。SES采用地区剥夺指数（ADI）测量，并分类为高剥夺（ADI 8-10）或低剥夺（0-7）。出行距离采用Haversine公式计算。Kaplan-Meier分析评估总生存期（OS）、无进展生存期（PFS）及无远处转移生存期（DMFS）。Logistic回归评估与伤口并发症相关的因素。
结果：高ADI组与低ADI组之间在OS（p=0.2）、PFS（p=0.3）、DMFS或伤口并发症（p=0.1）方面未发现显著差异。治疗模式相似，包括辅助化疗（8.9% vs. 8.7%，p=1.000）和放疗（10.7% vs. 11.8%，p=1.000）。高ADI患者出行略远（中位数24.8 vs. 18.5英里），但这一小幅增加与治疗实施或结局的差异无关。多变量分析显示，肿瘤分级、年龄和Karnofsky体能状态可预测OS。
结论：尽管出行距离略长，社会经济弱势患者的治疗模式和生存结局与更有优势的患者相当。微小的出行差异并未妨碍其获得多学科肉瘤诊疗。大容量三级中心通过在多样化人群中提供公平、标准化的治疗，或有助于缓解与SES相关的差异。
查看英文原文 English abstract
Introduction: Soft tissue sarcomas (STS) are rare mesenchymal tumors with substantial clinical complexity. Although tumor size, grade, and histology are established prognostic factors, socioeconomic status (SES) and geographic access to specialized care may also influence outcomes. Prior studies in multiple cancers show that socioeconomic disadvantage and longer travel distances can delay treatment and worsen prognosis. High-volume sarcoma centers offer multidisciplinary management that improves survival, yet SES-related barriers may still affect access. This study evaluates the impact of SES, travel distance, treatment patterns, and survival outcomes among STS patients treated at a high-volume tertiary center.
Methods: A retrospective cohort of 364 patients with primary STS treated over 20 years at a single tertiary center was analyzed. Patients with metastatic disease at diagnosis, incomplete treatment data, or inadequate follow-up were excluded, leaving 357 eligible patients. SES was measured using the Area Deprivation Index (ADI) and classified as high (ADI 8-10) or low (0-7) deprivation. Travel distance was calculated using the Haversine formula. Kaplan-Meier analyses assessed overall survival (OS), progression-free survival (PFS), and distant metastasis-free survival (DMFS). Logistic regression evaluated factors associated with wound complications.
Results: No significant differences were found in OS (p=0.2), PFS (p=0.3), DMFS, or wound complications (p=0.1) between high- and low-ADI groups. Treatment patterns were similar, including adjuvant chemotherapy (8.9% vs. 8.7%, p=1.000) and radiation (10.7% vs. 11.8%, p=1.000). High-ADI patients traveled slightly farther (median 24.8 vs. 18.5 miles), but this modest increase was not associated with differences in treatment delivery or outcomes. On multivariate analysis, tumor grade, age, and Karnofsky Performance Status predicted OS.
Conclusion: Despite marginally longer travel distances, socioeconomically disadvantaged patients had comparable treatment patterns and survival outcomes to more advantaged patients. The small travel difference did not impede access to multidisciplinary sarcoma care. High-volume tertiary centers may help mitigate SES-related disparities by providing equitable, standardized treatment across diverse populations.
利益披露 Disclosure
C. L. McCall, None..
J. Cordero, None..
M. Bedi, None..
D. King, None.