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. 2024 Jun;31(6):4138-4147.
doi: 10.1245/s10434-024-15074-6. Epub 2024 Feb 23.

High Community-Level Social Vulnerability is Associated with Worse Recurrence-Free Survival (RFS) After Resection of Extremity and Truncal Soft Tissue Sarcoma

Raymond S Traweek  1 , Heather G Lyu  1 , Russell G Witt  1   2 , Rebecca A Snyder  1   3 , Elise F Nassif  4 , David D Krijgh  5 , Jeffrey M Smith  6 , Gordon S Tilney  6 , Chun Feng  7 , Yi-Ju Chiang  1 , Keila E Torres  1 , Margaret J Roubaud  6 , Christopher P Scally  1 , Kelly K Hunt  1 , Emily Z Keung  1 , Alexander F Mericli  6 , Christina L Roland  8
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High Community-Level Social Vulnerability is Associated with Worse Recurrence-Free Survival (RFS) After Resection of Extremity and Truncal Soft Tissue Sarcoma

Raymond S Traweek et al. Ann Surg Oncol. 2024 Jun.

Abstract

Background: Although social vulnerability has been associated with worse postoperative and oncologic outcomes in other cancer types, these effects have not been characterized in patients with soft tissue sarcoma. This study evaluated the association of social vulnerability and oncologic outcomes.

Methods: The authors conducted a single-institution cohort study of adult patients with primary and locally recurrent extremity or truncal soft tissue sarcoma undergoing resection between January 2016 and December 2021. The social vulnerability index (SVI) was measured on a low (SVI 1-39%, least vulnerable) to high (60-100%, most vulnerable) SVI scale. The association of SVI with overall survival (OS) and recurrence-free survival (RFS) was evaluated by Kaplan-Meier analysis and Cox proportional hazard regression.

Results: The study identified 577 patients. The median SVI was 44 (interquartile range [IQR], 19-67), with 195 patients categorized as high SVI and 265 patients as low SVI. The median age, tumor size, histologic subtype, grade, comorbidities, stage, follow-up time, and perioperative chemotherapy and radiation utilization were similar between the high and low SVI cohorts. The patients with high SVI had worse OS (p = 0.07) and RFS (p = 0.016) than the patients with low SVI. High SVI was independently associated with shorter RFS in the multivariate analysis (hazard ratio, 1.64; 95% confidence interval, 1.06-2.54) but not with OS (HR, 1.47; 95% CI 0.84-2.56).

Conclusion: High community-level social vulnerability appears to be independently associated with worse RFS for patients undergoing resection of extremity and truncal soft tissue sarcoma. The effect of patient and community-level social risk factors should be considered in the treatment of patients with extremity sarcoma.

Keywords: Social determinants of health; Social vulnerability; Soft-tissue sarcoma.

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Conflict of interest statement

Conflicts of interest:

The authors have no relevant conflicts of interest to disclose

Figures

Figure 1
Figure 1
Geographic mapping of individual social vulnerability. Each point represents an individual patient that underwent surgery at MD Anderson Cancer Center. Social vulnerability index (SVI) shaded by color: red indicates a higher SVI; blue indicates a lower SVI
Figure 2
Figure 2
Impact of social vulnerability index (SVI) on survival. Kaplan-Meier curve of (A) overall survival (OS) and (B) recurrence-free survival (RFS) in patients with high vs low SVI from date of presentation to censoring or death.
Figure 3
Figure 3
Multivariable analysis as predictors of survival. Forest plot of multivariable Cox proportional-hazards regression examining the independent association of high social vulnerability index (SVI) as an independent predictor of overall survival and recurrence-free survival. Variables included were determined a priori based on known prognostic factors affecting survival outcomes in soft-tissue sarcoma. Intermediate vulnerability patients were excluded to facilitate more direct comparison of high and low vulnerability.
Figure 4
Figure 4
Calibration plots by social vulnerability. Predicted 5-year overall survival as determined by the Sarculator nomogram compared to actual median 5-year overall survival for (A) total study cohort, (B) low vulnerability patients.
See this image and copyright information in PMC

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