Time to Treatment Initiation Analysis in Patients with Localized Extremity Non-Small Round Cell Sarcoma

INTRODUCTION: Time-to-treatment initiation (TTI) is an increasingly recognized factor influencing survival in cancer care. Although prolonged TTI has been associated with worse survival in various malignancies, its impact on patients with localized extremity non-small-round-cell sarcoma (NSRCS) remains unclear. METHODS: Data were extracted from the SEER database, encompassing 11,380 patients diagnosed with localized extremity NSRCS from 2000 to 2019. Patients were categorized into three cohorts based on TTI: less than 1 month, less than 2 months, and less than 4 months. Kaplan-Meier survival analysis and Cox proportional hazards models were used to evaluate the association between TTI and overall survival (OS), adjusting for variables including age, sex, ethnicity, socioeconomic status, tumor location, AJCC stage, and treatment modalities. RESULTS: Multivariate analysis revealed that overall survival (OS) in the TTI delay group was nearly equivalent to that of patients with a TTI of less than 1 month (HR = 1.01; 95% confidence interval CI, 0.97-1.10). In contrast, in cohorts 2 and 3, the TTI delay group demonstrated worse OS (cohort 2: HR = 1.10; 95% CI, 1.02-1.20; cohort 3: HR = 1.30; 95% CI, 1.10-1.70). Subgroup analysis indicated that adjuvant therapy, including chemotherapy and radiation therapy, may potentially mitigate the decreased survival associated with TTI delay. DISCUSSION: This study highlights the detrimental impact of delayed TTI on survival in patients with localized extremity NSRCS. Furthermore, it suggests that adjuvant therapy may help mitigate the adverse effects associated with TTI delay.