A. J. Jacobs1, E. Lindholm2, C. Fein Levy3, J. D. Fish3, R. D. Glick2 1Hofstra Northwell School Of Medicine,Hempstead, NY, USA 2Cohen Children’s Medical Center,Pediatric Surgery,New Hyde Park, NY, USA 3Cohen Children’s Medical Center,Pediatric Hematology/Oncology,New Hyde Park, NY, USA
Introduction:
Childhood sarcomas are rare diseases, and the interdisciplinary care these patients require is specialized and expensive. Vast improvements have been made in the diagnosis and treatment of these malignancies over the last decades. The goal of this study was to determine treatment trends over time and to determine if racial or ethnic disparities exist for pediatric sarcoma patients in the United States.
Methods:
The United States’ National Cancer Institute’s Surveillance, Epidemiology, and End Results database (SEER) was used to identify patients aged 0-21 diagnosed with primary sarcomas from 1973-2012. Patients were considered by race and ethnicity. Survival curves were computed using the Kaplan-Meier method and the log-rank test. Cox proportional hazard regression was used for multivariate analysis.
Results:
A total of 11,502 patients with histologically confirmed sarcoma were included in this study. A greater proportion of patients were male (57%), and the majority of patients were between ages of 11 and 17 at time of diagnosis. Of the total population, 6877 (60%) patients had soft tissue tumors, and 4625 (40%) patients had bony tumors. The most common soft tissue tumors were non-rhabdomyosarcoma (66%), and the most common bony tumor was osteosarcoma (58%). The majority of patients presented with localized disease (36.9%), followed closely by regional disease 30.8%, and lastly distant disease (18.9%). When stratified by race, there were significant differences between stage and tumor size at the time of diagnosis between white and non-white patients (Table 1). Among those patients with soft tissue sarcomas, 46% of non-Hispanic White patients received radiation therapy, compared to 40% of non-Hispanic Black patients (p=0.01). There was, however, no significant difference between the proportion of white and non-white patients who underwent surgery (p=0.21). Overall 10–year survival improved during the study period from 52.5% in 1973-1979 to 65.3% in 2000-2012. The 10-year OS was 64.5% for non-Hispanic White patients, 62.3% for Hispanic patients, and 61.8% for non-Hispanic Black patients (p=0.01).
Conclusion:
While an improvement in pediatric sarcoma survival was seen over the past 4 decades, this survival improvement still lags far behind that of hematologic malignancies. Racial and ethnic disparities are seen in the treatment patterns and survival of these rare tumors in the United States. Non-white patients are presenting at a later stage and have overall worse survival than white counterparts.
