Sarcomas in the United States: Recent trends and a call for improved staging

// Michele M. Gage 1 , Neeraja Nagarajan 1 , Jessica M. Ruck 1 , Joseph K. Canner 1 , Salma Khan 2 , Katherine Giuliano 1 , Faiz Gani 1 , Christopher Wolfgang 1 , Fabian M. Johnston 1 , and Nita Ahuja 1, 3 1 Department of Surgery, Johns Hopkins University, Baltimore, Maryland, USA 2 Rehman Medical Institute, Hayatabad, Pakistan 3 Department of Surgery, Yale University, New Haven, Connecticut, USA Correspondence to: Nita Ahuja, email: nita.ahuja@yale.edu Keywords: sarcoma; mesenchymal tumors; connective tissue tumors; SEER; trends of sarcoma Received: November 06, 2018      Accepted: February 19, 2019      Published: March 29, 2019 ABSTRACT Background and objectives: Sarcomas represent a heterogeneous group of tumors, and there is lack of data describing contemporary changes in patterns of care. We evaluated the epidemiology of sarcomas over 12 recent years Methods: The Surveillance, Epidemiology and End Results (SEER) database was queried for sarcoma cases from 2002-2014. Patient, tumor and treatment factors, and trends over time were studied overall and by subtype. Univariable and multivariable logistic regression models and 5-year survival and cause-specific mortality (CSM) were summarized. Results: There were 78,527 cases of sarcomas with an overall incidence of 7.1 cases per 100,000 people, increasing from 6.8 in 2002 to 7.7 in 2014. Sarcoma NOS(14.8%) and soft tissue(43.4%) were the most common histology and primary site, respectively. A majority of tumors were high-grade(33.6%) and >5 cm(51.3%). CSM was 28.6% and 5-year survival was 71.4%. Many patients had unknown-grade(42.2%), which associated with 2.6 times increased odds of no surgical intervention. Conclusions: This comprehensive national study highlights important trends including increasing incidence, changing histologic types, and underestimation of true incidence. A large proportion of sarcomas are inadequately staged (unknown-grade 42.2%) with lack of appropriate surgical treatment. Our study highlights need for standardization of care for sarcomas.