DIFFERENCES IN THE INITIAL PRESENTATION OF ADULT PATIENTS WITH SOFT TISSUE SARCOMAS OF THE EXTREMITIES BETWEEN THE PRIVATE AND PUBLIC HEALTH SYSTEMS IN BRAZIL – A SINGLE-CENTER ANALYSIS

Background: In Brazil, there are scarce data regarding first presentation of patients (pts) with sarcoma. Early diagnosis can reduce radical surgeries, improve quality of life, and prolong survival. We aimed to characterize the clinical staging of pts with soft tissue sarcoma (STS) of the extremities, and evaluate the symptom-to-diagnosis (SD) and symptom-to-treatment (ST) intervals, comparing findings between pts in private health insurance (PrivHIn) and public health insurance (PubHIn) systems treated in a Brazilian cancer center. Methods: Retrospective chart review was performed for pts >18y with STS of the extremities referred for initial treatment at our center from 2011 to 2019. Histologies included were leiomyosarcoma (LMS), liposarcoma (LPS), undifferentiated pleomorphic sarcoma, synovial sarcoma (SS), malignant peripheral nerve sheath tumor, and myxofibrosarcoma. Pts who initiated treatment at another hospital were excluded, as those diagnosed during follow up of another cancer. Kaplan-Meier method and the log-rank test were used for survival analyses. Univariate analyses used chi-squared or Fisher exact tests. Results: 237 pts were included: 175 (73.8%) from PrivHIn and 62 (26.2%) from PubHIn. Median age at dx was 51y (18–85y). Most of the pts were ≤60y (70.5%). Most frequent STS were LMS (21.9%), UPS (19.4%), and SS (18.1%). Primary site was the lower extremity in 53.6%; 81% of the tumors were grade 2/3 . Median size of tumors in PrivHIn was 7 cm (0.9-45 cm) vs 10.3 cm (0.830.5 cm) in pts from PubHIn (p=0.0001). Metastasis were present in 15 pts (8.6%) of PrivHIn and in 15 pts (24.2%) of PubHIn (p=0.003). Median SD interval was 6.6 months in PubHIn and 5.4 months in PrivHIn (p=0.942), and median ST interval was 7.8 months in the PubHIn and 6.6 months in PrivHIn (p=0.997). Median follow up time was 57 months. There was significant difference in the OS according to the histologic subtype (p=0.04), and pts with LMS presented the worse prognosis. There was no OS difference between pts from PrivHIn and PubHIn. Conclusion: Pts from PubHIn presented significantly larger lesions and more metastatic disease at dx than those from PrivHIn. SD and ST intervals were high in both groups. These findings suggest low expertise in sarcoma management among community health services in Brazil. Further studies are needed to understand if discrepancy in tumor size at dx results in more mutilating surgeries, worst quality of life, and higher treatment costs.