Abstract B138: The association of neighborhood-level socioeconomic status and treatment outcomes in dermatofibrosarcoma protuberans: A United States cohort analysis
Authors: Mirza Fatima N. , Hoang Megan , Goldbach Hayley S , Wisco Oliver J. , Libby Tiffany J. , Weinstock Martin A. , Qureshi Abrar A. , Cho Eunyoung 
Published: September 2024

Abstract
Dermatofibrosarcoma protuberans (DFSP) is a rare, locally aggressive soft tissue sarcoma predominantly affecting the dermis and subcutaneous fat. There has been a lack of research on the intersection of socioeconomic status (SES) and DFSP. Therefore, this study aims to investigate the impact of SES on DFSP outcomes, specifically with differing treatments, an area previously underexplored due to the disease’s rarity. Cases of malignant DFSP from 2006-2018 in the Surveillance, Epidemiology, and End Results Census Tract-level SES and Rurality Database were identified to conduct a retrospective cohort analysis. SES was categorized into 5 groups using the Yost Index, a composite census-tract level measure of SES which incorporates factors like household income, educational level, and home value. Multivariable Cox-proportional hazards regression was conducted to assess relationships of reported characteristics with overall survival. Multivariable logistic regression was used to assess for independent predictors of receipt of Mohs surgery. The associations were also stratified by race/ethnicity. Among the 4995 DFSP cases identified, patients were mostly female (53%), white (52%), and of highest SES (Yost Index Group 5, 29%). Most patients received surgical excision, including Mohs surgery, (93%; Mohs: 9.1%). Higher SES was associated with better overall survival compared to lower SES patients (highest vs lowest SES: hazard ratio [HR], 0.39; 95% confidence interval [CI], 0.26-0.58). Mohs surgery was also the only surgical intervention associated with better survival, compared to no surgery (HR, 0.40; 95% CI, 0.16-0.95). When stratified by race/ethnicity, the association of higher SES with better survival was present in both white (highest vs lowest SES: HR, 0.47; 95% CI, 0.24-0.90) and non-white patients (highest vs lowest SES: HR, 0.34; 95% CI, 0.20-0.58). Higher SES was associated with an increased likelihood of receiving Mohs (highest vs lowest SES: odds ratio [OR], 2.77; 95% CI, 1.80-4.25), and Black patients (23%) were less likely than white patients to receive Mohs (OR, 0.49; 95% CI, 0.33-0.72). When stratified by race/ethnicity, the association of higher SES with receipt of Mohs was present in white patients (highest vs lowest SES: OR, 5.44; 95% CI, 2.88-10.3), though it was not significant in non-white patients. This study demonstrates that higher SES and Mohs were associated with better overall survival for patients with DFSP. Higher SES also increased the likelihood of receiving Mohs, an optimal DFSP treatment. Our study emphasizes that patients with lower SES may have reduced access to more effective treatments like Mohs for DFSP, which may lead to poorer survival. This indicates a need for healthcare policies that address these disparities to improve treatment for patients of all socioeconomic statuses, including racial/ethnic minorities. *Both authors contributed equally
Citation Format: Fatima N. Mirza, Megan Hoang, Hayley S Goldbach, Oliver J. Wisco, Tiffany J. Libby, Martin A. Weinstock, Abrar A. Qureshi, Eunyoung Cho. The association of neighborhood-level socioeconomic status and treatment outcomes in dermatofibrosarcoma protuberans: A United States cohort analysis [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B138.