Socioeconomic Factors Linked to Surgical Outcomes in Upper Extremity Soft Tissue Sarcoma

Patients with soft tissue sarcomas (STS) of the upper extremity (UE) may experience variations in surgical outcomes based on socioeconomic and demographic factors, according to a recent study published in Wiley.1

STS of the UE are quite rare but have the potential for devastating effects on patients. UE STS are defined by tumors arising from the shoulder girdle proximally to the fingertip distally. They represent 15% of all STS cases and present with distinct surgical considerations given the narrow margins for resection.

Examining Social Determinants of Health in STS Care

Standard care for STS, which includes surgical resection and radiotherapy, has rates of local recurrence (LR) across cases that remain relatively high and range from 13% to 39%. Despite advances in multidisciplinary care, disparities in outcomes persist, with socioeconomic and insurance-related factors linked to variations in amputation rates and overall survival, underscoring the need to better understand how social determinants of health impact access to and quality of STS care.2

Socioeconomic and demographic factors were associated with variations in surgical outcomes among patients with upper extremity soft tissue sarcoma. | Image credit: @syahrir-adobestock.jpeg

The study was conducted from January 1, 2021, to December 31, 2022, using the University of California, Los Angeles’ database for patient demographics of those with UE STS. A total of 190 patients were included in the trial; 59% of them were male. In regard to race, 118 (62%) of patients were White, 33 (17%) self-identified as other, 22 (12%) were Asian/Pacific Islander, and 12 (6%) were Black. Out of all the patients, 56% were married.1

Patient data pulled from the university UE STS data included basic patient demographics (sex, race/ethnicity, age, etc.) in addition to markers of socioeconomic status and health (zip code, insurance status, employment status, etc.). Socioeconomic deprivation was quantified as the area deprivation index (ADI) with a mean of 17.1 overall. The ADI was derived from the University of Wisconsin’s Validated Neighborhood Atlas and 17 metrics that reflected housing, education, income, and employment. Patients were assigned an ADI score on a scale from 1 to 100, with 100 indicating the highest level of deprivation. Patients were then categorized into 4 quartiles, with the lowest representing the least deprived.

Key Findings: Demographic Impacts on Tumor Size and Amputation Risk

The mean time to presentation of UE STS was 17.1 months and did not vary across sex, race, marital status, cohorts, and ADI quartiles. The overall mean presenting tumor size was 7.8 cm, but patients who identified as Hispanic/Latino were associated with a larger tumor size upon presentation (9.17 ± 5.71 cm vs 7.43 ± 5.61 cm, P = 0.037).

In terms of surgical outcomes, 28 (15%) patients out of 190 underwent amputations and were more likely to be non-married when compared to married patients. There was no difference in demographics for the 29 (15%) patients who received skin grafting.

Of the 45 (25%) who experienced LR, females were associated with a higher rate of LR when compared to males. There was no difference in the demographics of ADI in LR rates. However, patients who underwent an initial excision at a non-sarcoma center (OR 4.69, P < 0.001), underwent an R1 or R2 resection (OR 3.53, P = 0.005), and older patients (OR 1.02, P = 0.03) were significantly associated with LR.

The overall 5-year survival rate was 88.9%, as 21 patients died within 5 years of their index surgery. There was no difference in 5-year OS when stratified for sex, race, marital status, primary language, insurance status, employment status, or ADI quartile.

Study Limitations and the Role of Specialized Care

This single-center study may have limited generalizability, as disparities seen in national registry studies may be attenuated in an urban tertiary care setting with standardized access to specialty care. Although no differences were found in time to presentation, local recurrence, or overall survival by race, insurance, or socioeconomic status, the study could not fully account for upstream barriers such as health literacy, language, mistrust, or social support. Additionally, unmeasured psychosocial factors may have influenced findings such as larger tumor size at presentation among Hispanic/Latino patients and higher amputation risk among non-married patients.

“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.”

References

1. Newman‑Hung NJ, Khabaz K, Juels M, et al. How do patient demographics and socioeconomic disadvantage impact clinical presentation, surgical outcomes, and survival for upper extremity soft tissue sarcoma? Cancer Reports (Hoboken). 2026;9(1):e70445. doi:10.1002/cnr2.70445

2. Wahle CF, Sakowitz S, Newman-Hung NJ, Bernthal NM, Benharash P, Wessel LE. Income and insurance-based disparities in primary soft tissue sarcoma of the extremities. J Surg Oncol. 2025 Jun;131(7):1431-1438. doi: 10.1002/jso.28077