Clinical characteristics and neighborhood factors associated with patient survival among adolescents and young adults with bone sarcoma.

Abstract

e23500 Background: Compared to pediatric patients, adolescents and young adults (AYA) with bone sarcomas experience clinical and socioeconomic challenges that leads to poorer survival outcomes. Socioeconomic challenges can be measured by Area Deprivation Index (ADI) which is a validated census block- group tool that ranks neighborhoods. We sought to evaluate the association between ADI and clinical outcomes for AYA patients with bone sarcomas treated at a tertiary cancer center. Methods: A retrospective cohort was curated of 292 AYA patients (15 to 39 years old) with bone sarcoma treated between 1997 to 2023. To identify factors associated with patient outcomes, survival analyses were conducted by demographic characteristics, histology, treatment, and neighborhood ADI. ADI was derived from patients’ residential addresses at diagnosis and linked to neighborhood-level deprivation scores. ADI was analyzed as a categorical variable grouped into quartiles, with higher quartiles representing greater neighborhood disadvantage. Results: Among this cohort of AYA patients, the most common diagnosis being osteosarcoma (62.0%). Survival rates for all patients at 12, 36, and 60 months were 90.0%, 70.1%, and 60.3%, respectively. Local recurrence (LR) occurred among 24.3% of the patients, and the median time to recurrence was 19.4 months (IQR 11.9 - 48.3). Overall survival and LR did not significantly differ by age, sex assigned at birth, race, ethnicity, marital status, insurance status, tumor site, alcohol use, education level, or employment status. ADI at the federal level was associated with 60-month survival, with patients residing in higher deprivation areas demonstrating worse survival compared with those in lower deprivation areas (53.7% vs. 66.3%, p =0.04). Conclusions: Among AYA osteosarcoma patients, long-term survival is driven primarily by tumor biology and initial stage, rather than age, sex, race, lifestyle factors. Patients living in more socioeconomically deprived neighborhoods (higher federal ADI) experienced significantly worse overall survival. Advanced stages and the need for complex, multimodal therapy mark the steepest survival declines. These findings underscore the need for strategies focused on access to multidisciplinary care and targeted support for patients residing in socioeconomically disadvantaged communities.