Abstract
Early diagnosis is assumed to improve patient survival, but whether symptom interval (SI i.e. the period between the onset of the first symptoms signs of the disease and its definitive diagnosis) has significant impact on outcome or not remain unclear.
Methods
In a series of 575 patients < 21 years of age with soft tissue sarcomas (STS) we investigated the association patterns between SI patient/tumour characteristics or disease outcome. The analysis was based on multivariate models (linear for association's patient/tumour characteristics and Cox's for survival).
Results
The SI ranged between one week and 60 months (median 2 months) and tended to be longer the older the patient (i.e. the interval was longer in adolescents than in children) and the larger tumour's size and for tumours located at the extremities and for “non rhabmomio sarcoma” STS (as opposed to rhabmomio sarcomas). A longer SI unfavourably influenced survival (p=0.002): for SI of 1, 12 and 24 months, the 5-year survival for rhabmomio sarcoma was 65%, 46% and 19% respectively. A different pattern of association between SI and survival emerged for different types of STS histology.
Conclusion
Our study shows that sarcoma-specific mortality increased with longer SI. This was far from obvious or expected. The independent prognostic effect of SI cannot be explained by its associations with other factors, such as patient's age (Adolescents having the longest diagnostic delays) or site, size (large tumour may be indicative, to some degree at least, of a late diagnosis) stage and histology of the tumour. Future studies should focus more on the possible cause of SI in pediatric STS populations to enable corrective measures to be implemented to reduce the diagnostic delay.
