Characteristics of 64 sarcoma patients referred to a sarcoma center after unplanned excision

Dyrop, Heidi Buvarp; Safwat, Akmal; Vedsted, Peter; Maretty-Kongstad, Katja; Hansen, Bjarne Hauge; Jørgensen, Peter; Baad‐Hansen, Thomas; Keller, Johnny

doi:10.1002/jso.24137

Cited by 24 publications

(17 citation statements)

References 38 publications

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“…STS from our cohort undergoing UE had been small and were preferably located clearly visible in the subcutis. Similar observations have been made by other investigators 3,6,12. Interestingly, the quality of symptoms did not significantly alter the rate of inadvertent resections, albeit patients reporting a long history of complaints were more likely to undergo UE.…”

Section: Discussionsupporting

confidence: 88%

The Prognostic Impact of Unplanned Excisions in a Cohort of 728 Soft Tissue Sarcoma Patients: A Multicentre Study

et al. 2017

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BackgroundUnplanned excisions (UE) of soft tissue sarcomas (STS) carry a high risk for local recurrence (LR) due to marginal/intralesional resections. However, there are reports about improved prognosis for UE patients who have re-resection compared with patients who undergo planned surgery. The present multicentre study was designed to define characteristics of UE patients and to investigate the impact of UE on subsequent therapy and patient outcomes.MethodsA total of 728 STS patients (376 males, 352 females; mean age: 58 years) who underwent definite surgery at one of three tumour centres were retrospectively included. Time-to-event analyses were calculated with log-rank and Gray’s tests, excluding patients with primary metastasis (n = 59). A propensity-score (PS) of being in the UE group was estimated, based on differences at baseline between the UE group and non-UE group. An inverse-probability-of-UE weight (IPUEW) was generated and time-to-event analyses calculated after IPUEW weighting.ResultsBefore referral, 38.6% of patients (n = 281) had undergone UE. Unplanned excision patients were younger (p = 0.036), rather male (p = 0.05), and had smaller (p < 0.005), superficially located tumours (p < 0.005). Plastic reconstructions (p < 0.005) and adjuvant radiotherapy (p = 0.041) more often were needed at re-resection. In univariable analysis, re-resected patients had improved overall survival (OS; p = 0.027) and lower risk of distant metastasis (DM; p = 0.002) than primarily resected patients, whereas risk of LR was similar (p = 0.359). After weighting for the IPUEW, however, differences in terms of OS (p = 0.459) and risk of DM (p = 0.405) disappeared.ConclusionsThe present study does not support prior findings of improved outcome for UE patients. Unplanned excisions have a major impact on subsequent therapy, yet they do not seem to affect negatively the long-term oncology outcome.

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Section: Discussionsupporting

confidence: 88%

The Prognostic Impact of Unplanned Excisions in a Cohort of 728 Soft Tissue Sarcoma Patients: A Multicentre Study

et al. 2017

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“…We noticed an improvement in referral to reference centers over time, from 24.2% of patients in 2010 to 55.6% in 2016. Many sarcoma specialists already warned physicians of the pitfalls of delayed referral, assessing the diagnostic pattern of patients regarding their first symptoms [2,8,[19][20][21][22][23][24]. The implementation of an expert network was one of the strategies proposed to improve efficient referral, avoid misdiagnosis, and organize a straightforward sequence of care.…”

Section: Discussionmentioning

confidence: 99%

Conformity to Clinical Practice Guidelines at Initial Management in Adult Soft Tissue and Visceral Tumors since the Implementation of the NetSarc Network in Eastern France

et al. 2019

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Background Soft tissue sarcomas are rare and heterogenous tumors that are hard to diagnose. The aim of this study was to evaluate local practices and conformity to clinical practice guidelines (CPGs) for their initial diagnostic management. Materials and Methods Patients were carriers of a soft tissue or visceral tumor, presented at a sarcoma tumor board (STB) between 2010 and 2016. Conformity to CPGs was evaluated using ten criteria designed for this purpose. Associations between different factors and conformity to composite criteria, reflecting the three main diagnostic steps (imaging, biopsy and histological report) were analyzed. Results A total of 643 patients were included. A preoperative tumor imaging assessment and a biopsy were performed according to CPGs in 80.8% and 36.8% of the cases, respectively. When done, the first surgical resection was R0 in 30.3% of cases, R1 in 28.6%, and R2 in 10.9%. The rest of the operated patients with sarcoma had a second surgical excision (11.4%), an intraoperative fragmentation (4.3%), or margins were unknown (14.4%). Six of the ten quality criteria presented a conformity rate higher than 70%. Two criteria with a conformity rate lower than 20% were the most controversial: presentation at a STB before biopsy and freezing of a tumor fragment. A multivariate analysis revealed that the common predictor of nonconformity to composite criteria was the initial management in a nonexpert center. Conclusion Initial diagnostic management requires improvement, especially outside of specialized centers. Implications for Practice This article supports the essential need to refer patients with soft tissue tumors to specialized centers to improve the management of sarcomas beginning at the diagnostic phase. Indeed, the reported data were very similar to those already described at the national level of the NetSarc network and indicate the necessity to keep raising awareness about this simple issue: early referral to reference centers will save lives.

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“…Although avoiding unplanned excisions from occurring altogether is not feasible, we propose a twofold approach to prevent the increased morbidity in high‐grade tumors: (a) preoperative identification of tumors based on the clinical history and radiographic appearance and (b) multimodality therapy in the neoadjuvant and adjuvant setting after UE has occurred. Previous groups have reported that more than one‐third of patients with sarcomas who have undergone UE had the presence of “alarm” symptoms before the surgery which may have warranted referral or further diagnostic imaging before surgery . Further, radiographic appearance on ultrasound may demonstrate suspicious features even in small lesions, and core‐needle biopsy has been demonstrated to identify the grade and histological subtype of STS .…”

Section: Discussionmentioning

confidence: 99%

“…In this study, a large multi-institutional cohort of patients was utilized to create a propensity score weighted cohort of patients to circumvent these strongly prognostic tumor characteristics, to assess the reported that more than one-third of patients with sarcomas who have undergone UE had the presence of "alarm" symptoms before the surgery which may have warranted referral or further diagnostic imaging before surgery. 25 Further, radiographic appearance on ultrasound may demonstrate suspicious features even in small lesions, and core-needle biopsy has been demonstrated to identify the grade and histological subtype of STS. [26][27][28][29] In the present study, all patients were treated at tertiary or quaternary referral centers after UE with multidisciplinary specialists in the treatment of STS.…”

Section: Discussionmentioning

confidence: 99%

The impact of unplanned excisions of truncal/extremity soft tissue sarcomas: A multi‐institutional propensity score analysis from the US Sarcoma Collaborative

Zaidi

Ethun

Liu

et al. 2019

Journal of Surgical Oncology

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Objective Our aim was to compare outcomes in patients who underwent unplanned excisions (UE) of soft‐tissue sarcomas (STS) against patients with planned excisions (PE). Methods The retrospective 7‐institution US Sarcoma Collaborative database was used. Patients with curative‐intent resection of truncal/extremity STS between 2000 and 2016 were included. Propensity score weighting analysis (PSWA) was performed. Endpoints were locoregional recurrence‐free survival (LRFS), distant metastasis‐free survival (DMFS), and disease‐specific survival (DSS). Results One thousand five hundred and ninety‐six patients were included. Eighty‐two percent (n = 1315) underwent PE and 18% (n = 281) underwent UE. Compared with PE, patients with UE were younger with smaller tumors with similar tumor grade. Unmatched analysis revealed PE was associated with worse DMFS (hazard ratio [HR] 1.95, P = .009) and DSS (HR 1.78, P = .039), but not LRFS compared with UE. On PSWA, UE had earlier LRFS (3‐year LRFS: 80.5% vs 89.8%, P = .039), but not DMFS or DSS. By grade, patients with high‐grade tumors and UE had worse LRFS (1‐year LRFS: 90% vs 94%, P = .015), but similar DMFS and DSS compared with PE. In low‐grade patients, UE and PE had similar LRFS, DMFS, or DSS. Conclusions UE of STS is not associated with worse prognosis compared to PE, though UE is associated with earlier locoregional recurrence in patients with high‐grade tumors. Multimodality therapy is needed to achieve improved outcomes in these patients.

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Characteristics of 64 sarcoma patients referred to a sarcoma center after unplanned excision

Cited by 24 publications

References 38 publications

The Prognostic Impact of Unplanned Excisions in a Cohort of 728 Soft Tissue Sarcoma Patients: A Multicentre Study

The Prognostic Impact of Unplanned Excisions in a Cohort of 728 Soft Tissue Sarcoma Patients: A Multicentre Study

Conformity to Clinical Practice Guidelines at Initial Management in Adult Soft Tissue and Visceral Tumors since the Implementation of the NetSarc Network in Eastern France

The impact of unplanned excisions of truncal/extremity soft tissue sarcomas: A multi‐institutional propensity score analysis from the US Sarcoma Collaborative

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