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A new study reveals that socioeconomic factors and marital status can influence surgical outcomes and tumor size in patients with soft tissue sarcomas of the upper extremity.
Patients facing a diagnosis of soft tissue sarcoma (STS) in the upper extremity (UE) may experience significant variations in their surgical journey and overall prognosis, depending on their socioeconomic background and demographic characteristics. A recent study, published in Cancer Reports in 2026, sheds light on these disparities, highlighting the critical need to address social determinants of health in STS care. UE STS, while rare, represent 15% of all STS cases and can have devastating consequences for patients, requiring careful consideration during surgical planning due to limited resection margins.
Understanding the Challenges in STS Care
Standard treatment for STS typically involves surgical resection and radiotherapy. However, rates of local recurrence (LR) remain relatively high, ranging from 13% to 39% across cases. Despite advancements in multidisciplinary care, disparities in outcomes persist, with socioeconomic and insurance-related factors linked to variations in amputation rates and overall survival. This underscores the importance of understanding how broader social factors impact access to, and the quality of, STS care.
Study Details and Patient Demographics
The research, conducted between January 1, 2021, and December 31, 2022, utilized data from the University of California, Los Angeles, encompassing the demographics of 190 patients diagnosed with UE STS. The patient cohort was comprised of 59% male patients. Regarding race and ethnicity, the breakdown was as follows: 62% White, 17% self-identified as “other,” 12% Asian/Pacific Islander, and 6% Black. More than half of the patients (56%) were married at the time of diagnosis.
Researchers collected data on basic demographics – including sex, race, age, and ethnicity – alongside indicators of socioeconomic status, such as zip code, insurance status, and employment status. Socioeconomic deprivation was quantified using the area deprivation index (ADI), derived from the University of Wisconsin’s Validated Neighborhood Atlas, which incorporates 17 metrics related to housing, education, income, and employment. Patients were assigned an ADI score ranging from 1 to 100, with 100 representing the highest level of deprivation; the overall mean ADI score for the study population was 17.1.
Key Findings: Demographic Impacts on Tumor Size and Surgical Outcomes
The average time to presentation for UE STS was 17.1 months and remained consistent across all demographic groups examined. However, a notable difference emerged in presenting tumor size. While the overall mean tumor size was 7.8 cm, patients identifying as Hispanic/Latino presented with significantly larger tumors (9.17 ± 5.71 cm vs. 7.43 ± 5.61 cm, P = 0.037).
Surgical outcomes also revealed disparities. Fifteen percent (28 patients) of the cohort underwent amputations, and these patients were significantly more likely to be unmarried compared to their married counterparts. There were no significant demographic differences observed among the 15% (29 patients) who received skin grafting.
Regarding local recurrence, 25% (45 patients) experienced LR. Female patients demonstrated a higher rate of LR compared to male patients. However, the ADI score did not correlate with LR rates. Several factors were significantly associated with LR, including undergoing initial excision at a non-sarcoma center (OR 4.69, P < 0.001), undergoing an R1 or R2 resection (OR 3.53, P = 0.005), and being an older patient (OR 1.02, P = 0.03).
The overall 5-year survival rate was encouraging at 88.9%, with 21 patients succumbing to the disease within five years of their initial surgery. Importantly, no differences in 5-year overall survival were observed when stratified by sex, race, marital status, primary language, insurance status, employment status, or ADI quartile.
Limitations and the Path Forward
The authors acknowledge that this single-center study may have limited generalizability, as disparities observed in larger, national registry studies might be less pronounced in an urban tertiary care setting with standardized access to specialized care. Furthermore, the study could not fully account for “upstream barriers” such as health literacy, language proficiency, mistrust of the medical system, or lack of social support. Unmeasured psychosocial factors may also have contributed to the findings, such as the larger tumor size observed in Hispanic/Latino patients and the increased amputation risk among unmarried individuals.
“Timely referral to specialized multidisciplinary programs may mitigate underlying disparities,” the study authors concluded. “The higher amputation risk in non-married patients and elevated local recurrence risk in women highlight the importance of proactive engagement in these patient populations.” Addressing these social determinants of health is crucial to ensuring equitable access to high-quality STS care and improving outcomes for all patients.
