NEW ORLEANS — A study that compared survival rates of patients with high-grade soft-tissue sarcomas with their length of symptoms found the two factors did not correlate with one another, according to a presentation of the results made here at the Annual Meeting of the American Academy of Orthopaedic Surgeons.
“Size and pain were strong prognostic variables for outcome of a high-grade soft-tissue sarcoma. The length of symptoms and time of diagnosis, though, did not predict size” or other key factors, Bruce Rougraff, MD, of Indianapolis, said.
He was assisted by colleague Jackie Lawrence in what he described as a thorough gathering of the length of symptoms of the study’s 381 patients, who were treated between 1992 and 2007 for a high-grade soft-tissue sarcoma (average follow-up 4.9 years).
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Bruce Rougraff
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According to Rougraff, it is frequently assumed patients with sarcomas who are diagnosed and treated soon after the onset of symptoms fare better than those who had symptoms with a longer duration. However, there is little or no data to substantiate that belief, which has medicolegal implications, as well.
Rougraff prospectively entered patient information in a surgical oncology database, including time of first symptom, such as pain or palpable mass, and then followed patients to track disease recurrence, disease-free survival and metastatic disease.
“As you’d expect 5-year survival is 65% and disease-free survival is 55%. We did find size was a strong factor,” he said.
Stage was also an important prognostic factor, Rougraff said, but noted length of symptoms in weeks did not correlate with metastases at diagnosis or disease-free survival.
Rougraff B, Length of symptoms prior to treatment for high grade soft tissue sarcomas: Prognostic variable? Paper #414. Presented at the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons. March 9-13, 2010. New Orleans.
Rougraff has no conflicts of interests related to products or companies mentioned in this article.
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I think that there are some medical issues and some legal issues that this study addresses. One of the big issues on the legal side is delay in diagnosis. Early diagnosis is supposedly good and earlier is even better, but there is actually no data on that. In medicolegal circles, delayed diagnosis is always assumed to be a bad thing, but in Rougraff’s study it actually was not. In fact, the people with the longest duration of symptoms seemed to do better.
So the important point here is not that we don’t want to treat someone, but that a delay in diagnosis does not have the implications that society thinks they do.
– Richard D. Lackman, MD, FACS
Paul B. Magnuson Professor of Bone and Joint Surgery
University of Pennsylvania, Philadelphia