Relevance of Reference Centers in Sarcoma Care and Quality Item Evaluation: Results from the Prospective Registry of the Spanish Group for Research in Sarcoma (GEIS)

The oncologist

article

Javier Martin-Broto¹  Jordi Rubió-Casadevall³  Roberto Diaz-Beveridge⁴  Ricardo Cubedo⁵  Oscar Tendero⁶  Diego Salinas⁶  Isidro Gracia⁷  Rafael Ramos⁸  Silvia Baguè⁹  Antonio Gutierrez^1,10  José Duran-Moreno^1,11  Nadia Hindi¹  Antonio Lopez-Pousa^1,12  Josefina Cruz^1,13  Javier Martinez-Trufero^1,14  Claudia Valverde^1,15  Luis M. De Sande^1,16  Angeles Sala^1,17  Lorena Bellido^1,18  Ana De Juan^1,19 

[1] Biomedicine Institute of Seville (IBIS), Lab 215, University of Seville;Medical Oncology Department, Virgen del Rocio University Hospital;Medical Oncology Department, Hospital Josep Trueta, Instituto Catalán de Oncología;Medical Oncology Department, Hospital Universitario La Fe;Medical Oncology Department, Hospital Universitario Puerta de Hierro;Department of Orthopedic Surgery, Hospital Universitario Son Espases;Department of Orthopedic Surgery, Hospital Universitari Sant Pau;Department of Pathology, Hospital Universitario Son Espases;Department of Pathology, Hospital Universitari Sant Pau;Department of Hematology, Hospital Universitario Son Espases;Department of Medical Oncology, Hospital Universitario Son Espases;Department of Medical Oncology, Hospital Universitari Sant Pau;Medical Oncology Department, Hospital Universitario de Canarias;Medical Oncology Department, Hospital Universitario Miguel Servet;Medical Oncology Department, Vall d'Hebron University Hospital;Medical Oncology Department, Hospital de León;Medical Oncology Department, Hospital de Basurto;Medical Oncology Department, Hospital Universitario de Salamanca;Medical Oncology Department, Hospitalario Universitario Marqués de Valdecilla

关键词: Sarcoma;    Reference centers;    Multidisciplinary management;    Outcome;    Diagnostic process;   

DOI  :  10.1634/theoncologist.2018-0121

学科分类：地质学

来源: AlphaMed Press Incorporated

【 摘 要 】

Background Reference centers (RCs) are a key point for improving the survival of patients with soft-tissue sarcomas (STS). The aim of this study was to evaluate selected items in the management of patients with STS, comparing results between RC and local hospitals (LHs). Materials and Methods Diagnostic and therapeutic data from patients diagnosed between January 2004 and December 2011 were collected. Correlation with outcome was performed. Results A total of 622 sarcomas were analyzed, with a median follow-up of 40 months. Imaging of primary tumor preoperatively (yes vs. no) correlated with a higher probability of free surgical margins (77.4% versus 53.7%; p = .006). The provenance of the biopsy (RC vs. LH) significantly affected relapse-free survival (RFS; 3-year RFS 66% vs. 46%, respectively; p = .019). Likewise, 3-year RFS was significantly worse in cases with infiltrated (55.6%) or unknown (43.4%) microscopic surgical margins compared with free margins (63.6%; p < .001). Patients managed by RCs had a better 3-year overall survival compared with those managed by LHs (82% vs. 70.4%, respectively; p = .003). Perioperative chemotherapy in high-risk STS, more frequently administered in RCs than in LHs, resulted in significantly better 3-year RFS (66% vs. 44%; p = .011). In addition, patients with stage IV disease treated in RCs survived significantly longer compared with those in LHs (30.4 months vs. 18.5 months; p = .036). Conclusion Our series indicate that selected quality-of-care items were accomplished better by RCs over LHs, all with significant prognostic value in patients with STS. Early referral to an RC should be mandatory if the aim is to improve the survival of patients with STS. Implications for Practice This prospective study in patients diagnosed with soft-tissue sarcoma shows the prognostic impact of reference centers in the management of these patients. The magnitude of this impact encompasses all steps of the process, from the initial management (performing diagnostic biopsy) to the advanced disease setting. This is the first prospective evidence showing improvement in outcomes of patients with metastatic disease when they are managed in centers with expertise. This study provides extra data supporting referral of patients with sarcoma to reference centers.

【 授权许可】

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