Improving Long-Term Outcomes for Patients with Extra-Abdominal Soft Tissue Sarcoma Regionalization to High-Volume Centers, Improved Compliance with Guidelines or Both?

Abstract

Introduction Optimization of outcomes of extra-abdominal STS is not clearly understood. We sought to determine whether hospital surgical volume and adherence to NCCN guidelines, or both, are associated with outcomes in the treatment of extra-abdominal soft tissue sarcoma (STS). Methods The National Cancer Database (NCDB) was queried for patients undergoing surgery for extra-abdominal STS diagnosed from 2003 to 2007. Mean annual hospital volume for STS surgery was divided into volume terciles (1T ≤3, 2T 4–10, and 3T ≥11 cases/year). Adherence to NCCN guidelines was determined. Primary outcome was overall survival. Results Our study population consisted of 13,684 patients with a median age of 56 years. 3T hospitals were more likely to adhere to NCCN guidelines for stage III patients (63% versus 47%; p ≤ 0.001) than 1T hospitals. On multivariable analysis, adherence to NCCN guidelines was associated with improved survival (HR = 0.79, CI 0.73–0.87; p < 0.001), but hospital volume was not (3T versus 1T: HR = 0.92, CI 0.82–1.02; p=0.12). Five-year overall survival was comparable for compliant groups at 1T, 2T, and 3T hospitals (72%, 72.4%, and 72.6%, resp.). 3T hospitals were not associated with a lower risk of 30-day mortality (OR 0.70, 95% CI 0.44–1.11) compared to 1T hospitals but did have a higher R0 resection rate (OR 1.43, 95% CI 1.32–1.54). Conclusions Adherence to NCCN guidelines, irrespective of hospital volume, is associated with improved overall survival for patients with extra-abdominal STS. High-volume hospitals more often adhere to guidelines, but low-volume hospitals that follow national guidelines may achieve comparable outcomes.

Surgery in reference centers improves survival of sarcoma patients: a nationwide study

“…We recently reported that presentation to a specialized multidisciplinary tumor board (MDTB) was independently correlated to reduction in the risk of relapse in a nationwide study involving the NETSARC Network [12]. Similar observations were reported by several other national initiatives [13–15].…”

Management of Soft Tissue Sarcomas in Extremities: Variation in Treatment Recommendations and Surveillance According to Specialty and Continent

“…4,5 Although several studies have shown that adherence to guidelines results in better patient outcomes, 32-70% of patients with STS are not consistently treated in accordance with the clinical guidelines. [6][7][8][9][10][11] This study aimed to acquire insight into the variation of eSTS management by assessing the influence of clinical specialty and continent on clinical practice and surveillance. Additionally, this study investigated the extent to which selected patient and disease characteristics are used to distinguish between high-and low-risk patients and the extent to which these factors are used in clinical decision-making for perioperative treatment.…”

Trends in centralization of surgical care and compliance with National Cancer Center Network guidelines for resected cholangiocarcinoma

“…Data from other malignancies such as sarcoma have suggested that adherence to NCCN guidelines, irrespective of hospital volume, was associated with improved overall survival for patients with extra-abdominal soft tissue sarcomas. 30 In fact, while in that study high-volume hospitals were more often adherent to guidelines, low-volume hospitals that followed national guidelines had achieved comparable outcomes. Similarly, we noted that irrespective of high-versus low-volume hospital status, there was an increase in the use of multi-modality therapy for high-risk CCA as recommended by NCCN guidelines, which may have contributed to the "across the board" survival improvements noted over time.…”