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Non-Private Health Insurance Predicts Advanced Stage at Presentation and Amputation in Lower Extremity High Grade Bone Sarcoma: A National Cancer Database Study

Amputation Predicts Survival: An Effect Most Pronounced in Pediatric and AYA Age Group

  • Sarcoma
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A Correction to this article was published on 15 April 2022

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Abstract

Introduction

Advances in diagnostic and treatment modalities for high grade bone sarcomas (HGBS) of lower extremity (LE) have enabled limb salvage resections as a feasible first-line surgical option. However, amputations are still performed. Impact of amputation on survival and predictive factors for amputation and the stage at presentation for HGBS of LE remain unknown.

Methods

National Cancer Database was used to extract 5781 cases of high-grade bone sarcoma of the LE from 2004 to 2017. Kaplan–Meier and Cox regression were used to determine the impact of amputation on survival. Chi square test and logistic regression were used to assess the correlation of predictive factors with amputation and stage at presentation.

Results

Amputation [hazard ratio (HR) 1.516; 95% confidence interval (CI) 1.259–1.826; p < 0.001] and advanced stage (HR 0.248; 95% CI 0.176–0.351; p < 0.001) were independent predictors of poor overall survival. The impact of amputation on survival was most pronounced for pediatric and adolescents and young adults (AYA) age groups (18% decrease in 10-year survival). Amputation was more likely to be performed among those with nonprivate insurance (HR 1.736; 95% CI 1.191–2.531; p = 0.004), a finding that was mirrored for advanced stage at presentation (HR 0.611; 95% CI 0.414–0.902; p = 0.013).

Discussion

Amputation is an independent predictor of poor outcomes among patients with HGBS of LE. The impact of amputation on survival is the highest for the pediatric and AYA age group. Nonprivate insurance is associated with increased likelihood of amputation and an advanced stage at presentation among patients with high-grade bone sarcoma of the LE. This is the largest study highlighting insurance-related disparities in this cohort.

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Acknowledgments

The data used in the study are derived from a de-identified NCDB file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data by the investigator.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of California, Davis, Sacramento, CA, USA

    Muhammad Umar Jawad MD, R. Lor Randall MD, FACS & Steven W. Thorpe MD

  2. Department of Public Health Sciences, University of California, Davis, Davis, CA, USA

    Brad H. Pollock MPH, PhD, FACE

  3. Department of Pediatrics, University of California, Davis, Davis, CA, USA

    Elysia Alvarez MD, MPH

  4. Department of Internal Medicine, University of California, Davis, Davis, CA, USA

    Janai R. Carr-Ascher MD, PhD

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  1. Muhammad Umar Jawad MD
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  2. Brad H. Pollock MPH, PhD, FACE
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  3. Elysia Alvarez MD, MPH
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  6. Steven W. Thorpe MD
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Contributions

Data Curation, Analysis, Statistical analysis, Initial write up: MUJ, BHP, JCA, Manuscript revision: EA, RLR, SWT, Conception and Idea: RLR and SWT

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Correspondence to Steven W. Thorpe MD.

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Jawad, M.U., Pollock, B.H., Alvarez, E. et al. Non-Private Health Insurance Predicts Advanced Stage at Presentation and Amputation in Lower Extremity High Grade Bone Sarcoma: A National Cancer Database Study. Ann Surg Oncol 29, 4363–4372 (2022). https://doi.org/10.1245/s10434-022-11494-4

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