Abstract 1985P
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
Diagnosis | Treatment |
Subtypes Soft tissue sarcoma (STS) = 295 (54.7%) Bone sarcoma (BS) = 100 (18.5%) Carcinoma = 7 (1.2%) Benign = 7 (1.2%) Others = 10 (2%) Undifferentiated = 1 (0.2%) Discordances a) Major = 61 (16.3%) b) Minor = 99 (26.6%) Major discordance: a) Change of sarcoma subtype = 39 (64%) b) Benign to malignant = 14 (11.7%) c) Carcinoma to sarcoma = 4 (6.5%) d) Low to high grade = 4 (6.5%) e) BS to STS = 3 (5%) | Chemotherapy a) Incorrect regimen (n=28, 16%) b) Inadequate dose/cycles (n=20, 11.3%) c) Not given despite indication (n=17, 9.6%) d) Others (n=4, 2.2%) Surgery a) Inadequate surgery (n=19, 7%) b) Surgery without staging (n=5, 2%) |
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.
Resources from the same session
1981P - Histopathological diagnostic discrepancies in bone and soft tissue tumors referred to a specialist sarcoma center and its clinical impact
Presenter: Akira Kawai
Session: Poster session 15
1982P - Transcriptomic analysis and tumor microenvironment (TME) classification reveals unique immune biology in HIV patients with Kaposi sarcoma (KS)
Presenter: Jihua Yang
Session: Poster session 15
1983P - Palliative spatially fractionated stereotactic radiation therapy (Lattice) for large sarcoma
Presenter: Gabriela Studer
Session: Poster session 15
1984P - Sex differences in anticancer treatment delivery and toxicity in patients with sarcoma in a reference center
Presenter: Ilaria Tortorelli
Session: Poster session 15
1986P - Impact of SARS-CoV-2 vaccines and recent chemotherapy on COVID-19 morbidity and mortality in patients with soft tissue sarcoma: An analysis from the OnCovid registry
Presenter: Alessandro Mazzocca
Session: Poster session 15
1987TiP - Pembrolizumab in combination with eftilagimod alpha and radiotherapy in neoadjuvant treatment of patients with soft tissue sarcomas: EFTISARC-NEO trial
Presenter: Katarzyna Kozak
Session: Poster session 15
2213P - Impact of the diagnosis-to-treatment interval on the survival of patients with papillary thyroid cancer
Presenter: Tingting Wei
Session: Poster session 15
2214P - Identification of prognosis-associated genes in locally advanced well-differentiated thyroid cancer using TCGA cohort analysis
Presenter: Ah Ra Jung
Session: Poster session 15
2216P - Clinicopathologic and genetic characteristics of patients of different ages with diffuse sclerosing variant papillary thyroid carcinoma
Presenter: Soo Young Kim
Session: Poster session 15
2220P - MOLTHY project (TTCC-2020-02): A Spanish observational study for MOLecular characterization of THYroid carcinoma
Presenter: Neus Baste Rotllan
Session: Poster session 15