Regional disparities in osteosarcoma and soft tissue sarcoma treatment across Northwest China: a cross-sectional multicenter survey

Vollständiger Abstract

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Abstract Osteosarcoma and soft tissue sarcoma are rare but aggressive malignancies requiring multidisciplinary care. Despite consensus guidelines, real-world treatment patterns across Northwest China remain poorly characterized. We conducted a cross-sectional, questionnaire-based multicenter survey of 67 hospitals treating osteosarcoma and 60 treating soft tissue sarcoma across three regional clusters in Northwest China (Xinjiang-Qinghai, Gansu-Ningxia, Shaanxi-Shanxi). The survey instrument, developed through literature review and expert panel review with pilot testing, covered seven domains: hospital demographics, multidisciplinary team implementation, chemotherapy protocols, tumor necrosis rate assessment and surgical management. Regional comparisons were performed using Fisher’s exact test and Chi-square tests. Patient volume distribution differed significantly between disease types, with osteosarcoma centers concentrated in lower-volume strata compared with soft tissue sarcoma centers (Chi-square = 15.92, p = 0.003). Tumor necrosis rate detection showed a decreasing trend from 80.0% in Xinjiang-Qinghai to 50.0% in Shaanxi-Shanxi; however, this difference did not reach statistical significance ( p = 0.057). Neoadjuvant methotrexate dosing exhibited significant regional variation (Chi-square = 13.28, p = 0.039), and anti-angiogenic TKI utilization demonstrated highly significant regional disparity (Chi-square = 22.52, p < 0.001). Amputation rates declined west-to-east from 27.5% to 10.6%, while limb-salvage rates were comparable. Substantial regional disparities exist in sarcoma treatment across Northwest China, highlighting the need for standardized treatment protocols, regional resource equalization, and policy interventions to ensure equitable access to guideline-concordant sarcoma care.