(P 316) AREA DEPRIVATION INDEX (ADI) AND OUTCOMES IN LOCALIZED SOFT TISSUE SARCOMA: DO SOCIAL DETERMINANTS INFLUENCE SURVIVAL?

Objective: The Area Deprivation Index (ADI) is a validated measure of neighborhood-level socioeconomic disadvantage. This study aimed to assess the association between ADI and five-year 1) disease-specific survival (DSS), 2) metastasis-free survival (MFS), and 3) recurrence-free survival (RFS) in patients with localized soft tissue sarcoma (STS).

Methods: This was a retrospective study of 286 patients who underwent resection of a localized STS from January 2010 to December 2021. Patients with American Joint Committee on Cancer (AJCC) stage 4 were excluded. The ADI is a range with higher values indicating greater deprivation. We categorized ADI into three groups (ADI1 = 0 to 33, ADI2 = 34 to 66, ADI3 = 67 to 100). A Kaplan-Meier analysis was used to estimate the five-year DSS, MFS, and RFS, with log-rank test and Cox proportional hazards models used to assess significance.

Results: Five-year DSS was worse for patients in ADI3 and ADI2 compared to ADI1 (66% vs. 77% vs. 93%, p = 0.01). When controlling for age and AJCC stage, ADI3 was associated with worse DSS compared to ADI1 [HR 4.98 (1.03-8.34), p = 0.03]. Although five-year MFS and RFS trends were similar to DSS, the findings were not statistically significant for ADI3 vs. ADI2 vs. AD1, respectively [MFS: 53% vs. 64% vs. 76%, p = 0.11; RFS: 77% vs. 83% vs. 90%, p = 0.30). However, when controlling for age and AJCC stage, ADI3 was associated with worse MFS compared to ADI1 [HR 2.26 (1.0-5.13), p = 0.05].

Conclusion: ADI was associated with significantly worse DSS in patients with localized STS, even after adjusting for clinical factors. These findings suggest that a patient’s neighborhood location, which serves as a proxy for socioeconomic status, can directly impact cancer outcomes. Possible drivers include delayed diagnosis, reduced access to specialized care, and barriers to timely adjuvant therapy. Further efforts to improve sarcoma outcomes must address social determinants of health to ensure equity in cancer care.

Patient Demographics and Survival Outcomes