Effect of Timing of First Consultation with a Sarcoma Specialist Following Unplanned Excision: Oncologic Outcomes of Patients with Soft-Tissue Sarcomas.

BACKGROUND: Unplanned excisions (UEs) of soft-tissue sarcoma are resections performed without appropriate preoperative imaging or biopsy confirmation. These procedures represent a large proportion of referrals to sarcoma centers and can negatively influence oncologic outcomes. Limited evidence exists regarding the impact of consultation timing after UE. This study aimed to compare oncologic outcomes of patients evaluated early versus late at a sarcoma center following UE.

METHODS: Of 397 patients treated for soft-tissue sarcoma from 2012 to 2020 at 2 tertiary centers, 117 underwent UE followed by later tumor bed excision and were analyzed. Consultation with a sarcoma specialist was defined as the patient's first visit with a multidisciplinary sarcoma team member, marking entry into the coordinated cancer center. Patients were stratified into early (≤2 months) and late (>2 months) consultation groups. Demographic, clinical, and tumor characteristics were collected. Primary outcomes included local recurrence-free survival (LRFS), metastasis-free survival (MFS), and overall survival (OS). Chi-square and t tests were used for univariate comparisons, and Kaplan-Meier analyses were performed. Multivariable Cox regression and logistic regression analyses were performed, adjusting for patient age, sex, and comorbidities; tumor size, depth, grade, stage, and margin status; and/or follow-up duration.

RESULTS: Among the 117 patients (mean age, 56 years; 55% female; 84% White; 65% non-Hispanic), 26 were seen early and 91 late. The rate of metastasis was significantly higher in the late cohort (48.4% versus 11.5%, p = 0.0016), as was mortality (30.8% versus 3.8%, p = 0.0109). Five-year Kaplan-Meier survival outcomes favored early consultation, including LRFS (84.6% versus 63.7%, p = 0.041), MFS (88.5% versus 50.5%, p = 0.003), and OS (96.2% versus 64.8%, p = 0.005). On multivariable analysis, late consultation was independently associated with inferior LRFS (hazard ratio [HR] = 1.95, p = 0.046), MFS (HR = 2.76, p = 0.004), and OS (HR = 2.53, p = 0.022). Logistic regression showed increased odds of metastasis (odds ratio [OR] = 7.11, p = 0.0027) and mortality (OR = 11.29, p = 0.021) at 5 years in the late group.

CONCLUSIONS: Delayed consultation after UE was associated with significantly worse outcomes, including higher rates of metastasis and mortality and lower LRFS, MFS, and OS. These results emphasize the importance of timely referral to sarcoma centers for early multidisciplinary management.

LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.