Survival Benefit of the Surgical Management of Retroperitoneal Sarcoma in a Reference Center: A Nationwide Study of the French Sarcoma Group from the NetSarc Database

Bonvalot, Sylvie; Gaignard, Elodie; Stoeckle, Eberhard; Méeus, Pierre; Decanter, Gauthier; Carrère, Sébastien; Honoré, Charles; Delhorme, Jean-Baptiste; Fau, M.; Tzanis, Dimitri; Causeret, Sylvain; Gimbergues, Pierre; Guillois, J M; Meunier, Brigitte; Cesne, Axel Le; Ducimetière, Françoise; Toulmonde, Maud; Blay, Jean‐Yves

doi:10.1245/s10434-019-07421-9

Cited by 98 publications

(70 citation statements)

References 27 publications

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“…In their study, 36.6% of French patients underwent primary RPS resections at regionalized NetSarc centers of excellence (26 centers with specialized multidisciplinary tumor boards funded by the French NCI), which carried a median annual surgical volume of 23 resections per year. 15 This figure far exceeds the current US estimates of about 10% of patients attending centers performing a mean of 10 procedures per year and highlights the current room for national improvement. Further, the NetSarc patients garnered superior rates of R0 resection (41.9% vs 12.3%) as well as 2-year OS (87% vs 70%) as compared with non-NetSarc centers, justifying a regionalized system such as that in France.…”

Section: Discussionmentioning

confidence: 78%

“…Third, our findings underscore the general lack of regionalization of RPS surgery in the US as compared other health care systems. A study by Bonvalot and colleagues 15 recently demonstrated the benefits of performing RPS surgery in a regionalized system. In their study, 36.6% of French patients underwent primary RPS resections at regionalized NetSarc centers of excellence (26 centers with specialized multidisciplinary tumor boards funded by the French NCI), which carried a median annual surgical volume of 23 resections per year.…”

Section: Discussionmentioning

confidence: 99%

“…[11][12][13][14] Further, 2 recent French analyses assessing quality of sarcoma care delivered in a regionalized system uncovered improved outcomes in patients attending designated "reference" centers for sarcoma, which use at minimum, multidisciplinary tumor boards and 2 pathologist reviews of histologic specimens. 15,16 Despite the call for regionalization of RPS surgery in the United States and its supportive evidence, this trend lags significantly behind other regionalized complex surgical cancers, such as pancreatic. Indeed, we recently found that the rate of regionalization to HVHs for RPS lagged by 30.5% compared with that of pancreatic cancer.…”

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confidence: 99%

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Identifying the Minimum Volume Threshold for Retroperitoneal Soft Tissue Sarcoma Resection: Merging National Data with Consensus Expert Opinion

Villano

Zeymo

Chan

et al. 2020

Journal of the American College of Surgeons

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BACKGROUND: The complexity of retroperitoneal soft tissue sarcoma (RPS) surgery has prompted international recommendations to regionalize it to high-volume hospitals (HVHs). A minimum procedural volume threshold for RPS is not yet defined, hampering effective referral and regionalization in the US. This multihospital study sought to establish an HVH threshold informed by national data and international expert opinion. STUDY DESIGN: The 2004e2015 National Cancer Database identified 8,721 surgically treated RPS patients. Multivariable models, using linear splines, identified annual volume thresholds predictive of overall and 90-day mortality. Transatlantic Australasian Retroperitoneal Soft Tissue Sarcoma Working Group members (n ¼ 48) completed a 15-item survey regarding these data. RESULTS: Overall mortality risk was reduced by 4% per additional case (hazard ratio [HR] 0.96, 95% CI 0.95 to 0.98) up to a threshold of 13 cases/year; no further reduction was observed over 13 (HR 0.99, 95% CI 0.97 to 1.01). After revealing the results from our statistical analysis, 71.4% of respondents who initially chose >30 cases/year as a cutoff shifted their response to a lower value. More than 56% cited 11 to 20 procedures/year as the cutoff for an HVH. Median survival in hospitals with <13 vs >13 cases/year was 94 vs 139 months, respectively (p < 0.001). Forty percent of respondents cited 1% to 2% as an acceptable 90day mortality. This was achieved with a minimum of 13 cases/year based on risk-adjusted survival analysis. CONCLUSIONS: This is the first multicenter analysis to merge data-driven RPS surgery volume thresholds to clinically meaningful sarcoma expert opinions. These findings will help inform national/international consensus recommendations, a practical volume threshold, trial design, and motivate evidence-based hospital referral.

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Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Identifying the Minimum Volume Threshold for Retroperitoneal Soft Tissue Sarcoma Resection: Merging National Data with Consensus Expert Opinion

Villano

Zeymo

Chan

et al. 2020

Journal of the American College of Surgeons

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“…However, retroperitoneal sarcomas (RPS) are among the largest tumors in the human body and in addition to their large size, their proximity to critical organs and major vessels makes surgery very challenging. As expected, multiple studies to date have demonstrated that outcomes for RPS patients are clearly better when they are managed by specialists vs nonspecialists 3–5 …”

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confidence: 58%

“…As expected, multiple studies to date have demonstrated that outcomes for RPS patients are clearly better when they are managed by specialists vs nonspecialists. [3][4][5] What is remarkable however is that in the United States, recent data from the National Cancer Database shows that every year since 1998, only approximately 10% of RPS patients undergo surgery at high volume hospitals. 4 The overwhelming majority of patients with this complex, challenging cancer are being treated at hospitals who manage fewer than 10 cases per year or less than one a month.…”

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confidence: 99%

A sommelier to guide wine selection and a specialist to manage the sarcoma patient: Barriers to referral and definition of a sarcoma specialist

Tseng

Gronchi

Bonvalot

et al. 2020

Journal of Surgical Oncology

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Defining the role of neoadjuvant systemic therapy in high‐risk retroperitoneal sarcoma: A multi‐institutional study from the Transatlantic Australasian Retroperitoneal Sarcoma Working Group

Tseng

Barretta

Conti

et al. 2020

Cancer

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Background In patients with retroperitoneal sarcoma (RPS), the incidence of recurrence after surgery remains high. Novel treatment approaches are needed. This retrospective study evaluated patients with primary, high‐risk RPS who received neoadjuvant systemic therapy followed by surgery to 1) determine the frequency and potential predictors of radiologic tumor responses and 2) assess clinical outcomes. Methods Clinicopathologic data were collected for eligible patients treated at 13 sarcoma referral centers from 2008 to 2018. Univariable and multivariable logistic models were performed to assess the association between clinical predictors and response. Overall survival (OS) and crude cumulative incidences of local recurrence and distant metastasis were compared. Results Data on 158 patients were analyzed. A median of 3 cycles of neoadjuvant systemic therapy (interquartile range, 2‐4 cycles) were given. The regimens were mostly anthracycline based; however, there was significant heterogeneity. No patients demonstrated a complete response, 37 (23%) demonstrated a partial response (PR), 88 (56%) demonstrated stable disease, and 33 (21%) demonstrated progressive disease (PD) according to the Response Evaluation Criteria in Solid Tumors, version 1.1. Only a higher number of cycles given was positively associated with PR (P = .005). All patients underwent complete resection, regardless of the tumor response. Overall, patients whose tumors demonstrated PD before surgery showed markedly worse OS (P = .005). An indication of a better clinical outcome was seen in specific regimens given for grade 3 dedifferentiated liposarcoma and leiomyosarcoma. Conclusions In patients with high‐risk RPS, the response to neoadjuvant systemic therapy is fair overall. Disease progression on therapy may be used to predict survival after surgery. Subtype‐specific regimens should be further validated.

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Survival Benefit of the Surgical Management of Retroperitoneal Sarcoma in a Reference Center: A Nationwide Study of the French Sarcoma Group from the NetSarc Database

Cited by 98 publications

References 27 publications

Identifying the Minimum Volume Threshold for Retroperitoneal Soft Tissue Sarcoma Resection: Merging National Data with Consensus Expert Opinion

Identifying the Minimum Volume Threshold for Retroperitoneal Soft Tissue Sarcoma Resection: Merging National Data with Consensus Expert Opinion

A sommelier to guide wine selection and a specialist to manage the sarcoma patient: Barriers to referral and definition of a sarcoma specialist

Defining the role of neoadjuvant systemic therapy in high‐risk retroperitoneal sarcoma: A multi‐institutional study from the Transatlantic Australasian Retroperitoneal Sarcoma Working Group

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