1985P - Expert sarcoma care is the need of the hour: Diagnostic and management challenges at a tertiary-care centre in India

Background

Sarcomas are rare mesenchymal tumors that require multidisciplinary care. Referral centres receiving patients (pts) from peripheral set-ups face challenges which highlight the need for expert sarcoma pathology and specialised treatment.

Methods

This is a retrospective study in pts referred with pathological and/or clinico-radiological diagnosis of sarcoma (January 2021 to December 2022). Clinical, diagnostic, prior treatment details were reviewed from records. Pathologic discordances (PD) were classified as major (sarcoma to carcinoma or benign, soft tissue sarcoma to bone sarcoma or vice versa, any change influencing treatment) or minor.

Results

539 pts included (incl) 58% males (n=312) with median age of 35 (1-89 years), residing at median distance of 160 kilometres (km) (3-2600) from our centre. Median presenting time was 11 months (15 days-20 years) from symptom onset; recurrent/metastatic (n=255, 47%) and locally advanced (n=134, 25%) stages predominated. Common primary sites were extremity (45.5%), abdomen (27%) with symptoms of pain (67%) and swelling (64%). 499 (92.5%) pts had pathology reports from outside and available comparison (n=372) showed 42.9% discordance (16.3% major, 26.6% minor) (Table). Sarcoma diagnosis changed to benign (1.3%), carcinoma (1.3%), fibromatosis (0.2%), germ cell tumor (0.2%) after review. Ultra-rare sarcomas (URS) (n=33, 6%) showed higher PD (73%). Molecular testing was done in 4.6% (n=11) of pts with testing indications. Most had received treatment outside (surgery in 50.6%, chemotherapy in 32.6%); deviation from standard guidelines was noted in 39.7% chemotherapy and 8.7% surgeries (Table). Univariate analysis did not yield significant factors associated with diagnostic or treatment discordance. Table: 1985P

Details of subjects and discordances in diagnosis and treatment

Conclusions

The significant discrepancies noted in diagnosis and management of pts in this study highlight the importance of expert pathologists and early referral for better treatment outcomes in sarcomas.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.