Neighborhood-level disadvantage and disparities in treatment and recurrence in tenosynovial giant cell tumor.

Abstract

e23528 Background: Tenosynovial giant cell tumor (TGCT) is a rare, locally aggressive neoplasm arising from the synovial lining of the joint, bursa, and tendon sheath. Although socioeconomic conditions negatively affect many rare cancers, its impact on TGCT is unknown. Real-world data are needed to define how neighborhood-level disadvantage, a composite measure of socioeconomic conditions derived from United States (US) census block data, affects TGCT treatments and outcomes. Methods: A total of 574 US adults enrolled in the TGCT Support Patient Registry (Oct 2022-Dec 2024). Residential addresses were geocoded to Area Deprivation Index deciles and grouped as more (ADI ≥ 8) or less disadvantaged (ADI < 8). 1:2 Propensity score matching (PSM; caliper 0.02) was performed based on sex, TGCT subtype, and tumor location. Conditional logistic regression models were adjusted for surgeries, recurrences, and surgical technique. Models were further adjusted for access to academic multidisciplinary teams (MDTs). Results: Among 574 eligible patients included, PSM resulted in 334 matched patients: 117 more disadvantaged and 217 less disadvantaged patients. Baseline demographic and clinical variables were similar except for education and employment. More disadvantaged patients were significantly less likely to receive systemic therapy (OR: 0.5; 95% CI 0.3-0.9; p = 0.04), more likely to undergo arthroplasty (OR: 3.6; 95% CI 1.5-8.5; p = 0.03), and numerically more likely to receive radiotherapy (OR: 1.8; 95% CI 0.6-5.1; p = 0.26) compared to less disadvantaged patients. After additional adjustment for MDT access, disparities in systemic therapy (OR: 0.9; 95% CI 0.4-2.0; p = 0.76), arthroplasty (OR: 1.7; 95% CI 0.9-3.7; p = 0.14), and radiotherapy (OR: 1.3; 95% CI 0.5-3.6; p = 0.58) attenuated. In contrast, more disadvantaged patients had significantly higher odds of local recurrence than less disadvantaged patients after full adjustment (OR 1.9; 95% CI 1.1-3.2; p = 0.02). Conclusions: This real-world analysis suggests that inequitable access to MDTs and neighborhood-level deprivation contribute to disparities in treatments and local recurrence rates among US TGCT patients. Treatments by disadvantage status using matched, adjusted conditional logistic regression. Less Disadvantaged (ref; n=217) (n, %) More Disadvantaged (n=117) (n, %) Adjusted OR (95% CI) p value Adjusted OR for Access to MDTs (95% CI) p value Systemic Therapy 52 (24.0) 18 (15.4) 0.5 (0.3, 0.9) 0.04 0.9 (0.4, 2.0) 0.76 Pexidartinib 41 (18.9) 13 (16.2) 0.5 (0.3, 1.0) 0.05 0.9 (0.4, 2.0) 0.72 Imatinib 17 (7.8) 8 (6.8) 0.7 (0.2, 1.8) 0.36 0.9 (0.3, 3.2) 0.91 Arthroplasty 11 (5.1) 18 (15.4) 3.6 (1.5, 8.5) 0.03 1.7 (0.9, 3.7) 0.14 Radiotherapy 11 (5.1) 8 (6.8) 1.8 (0.6, 5.1) 0.26 1.3 (0.5, 3.6) 0.58 Prior Surgery n=204 n=102 Recurrence(s) 103 (50.5) 66 (64.7) 1.6 (2.7, 1.0) 0.045 1.9 (1.1, 3.2) 0.02 No Recurrence 101 (49.5) 36 (35.3)