Abstract
Objective: Diagnostic delay is well recognised in soft tissue sarcoma (STS). The aim of this paper is to assess whether symptom duration/time to diagnosis, has any impact on patient survival and also if patient and tumour-related factors are related to the duration of symptoms prior to presentation.
Method: We performed a retrospective analysis of prospectively collected data for all patients diagnosed or treated with STS at our centre over a 20-year period. Information regard¬ing when the patients first experienced symptoms was entered into a local oncology database at their first consultant-outpatient appointment. Symptom duration was defined as time in weeks from first symptoms experienced by the patient to the time of diagnosis. Data analysis was performed using StatView and R. Risk factors were assessed by Kaplan-Meier analysis and the Cox proportional hazards model. Stat¬istical significance was determined using 95% confidence intervals where appropriate. Students t-test was used to compare categorical data.
Results: The study population comprised 1508 patients. 159 had metastatic disease at diagnosis and overall 5-year survival in this group was 14%. In view of this poor prognosis these patients were excluded from further analyses. In the remaining 1349 patients overall 5-year survival was 60%. Mean symptom duration within our study was 70.2 weeks. A Cox Proportional hazards model showed that duration of symptoms had a significant impact on survival (p=0.0037) with each additional week of symptoms reducing the monthly hazard rate by 0.2%. Patient and tumour-related factors that were significantly associated with longer symptom durations were low grade, subcutaneous tumours, and those patients with either epitheliod or synovial sarcomas. Symptom duration was not associated with tumour size or patient age/gender.
Conclusion: Patients presenting with long symptom durations/diagnostic delay, tend to have low grade disease and a more favourable outcome than patients who experience short symp¬tom durations.
The abstracts were prepared by Mrs Leslie O’Leary. Correspondence should be addressed to her at British Orthopaedic Association, 35–43 Lincoln’s Inn Fields, London WC2A 3PE or at l.oleary@boa.ac.uk
