title: Adherence to treatment guidelines for primary sarcomas affects patient survival: a side study of the European CONnective TIssue CAncer NETwork (CONTICANET).
abstract: BACKGROUND
  The impact of adherence to clinical practice guidelines (CPGs) for loco-regional treatment (i.e. surgery and radiotherapy) and chemotherapy on local disease control and survival in sarcoma patients was investigated in a European study conducted in an Italian region (Veneto).
  
  
  METHODS
  The completeness of the adherence to the Italian CPGs for sarcomas treatment was assessed by comparing the patient's charts and the CPGs. Propensity score-adjusted multivariate survival analysis was used to assess the impact of CPGs adherence on patient clinical outcomes.
  
  
  RESULTS
  A total of 151 patients were included. Adherence to CPGs for loco-regional therapy and chemotherapy was observed in 106 out of 147 (70.2%) and 129 out of 139 (85.4%) patients, respectively. Non-adherence to CPGs for loco-regional treatment was independently associated with AJCC stage III disease [odds ratio (OR) 1.77, P = 0.011] and tumor-positive excision margin (OR 3.55, P = 0.003). Patients not treated according to the CPGs were at a higher risk of local recurrence [hazard ratio (HR) 5.4, P < 0.001] and had a shorter sarcoma-specific survival (HR 4.05, P < 0.001), independently of tumor stage.
  
  
  CONCLUSIONS
  Incomplete adherence to CPGs for loco-regional treatment of sarcomas was associated with worse prognosis in patients with non-metastatic tumors.
authors: Melanoma and Sarcomas Unit, Veneto Institute of Oncology-IRCCS, Padova, Italy. carlor.rossi@unipd.it
authors: C R
authors: CR
authors: Rossi
authors: A
authors: A
authors: Vecchiato
authors: G
authors: G
authors: Mastrangelo
authors: M C
authors: MC
authors: Montesco
authors: F
authors: F
authors: Russano
authors: S
authors: S
authors: Mocellin
authors: S
authors: S
authors: Pasquali
authors: G
authors: G
authors: Scarzello
authors: U
authors: U
authors: Basso
authors: A
authors: A
authors: Frasson
authors: P
authors: P
authors: Pilati
authors: D
authors: D
authors: Nitti
authors: A
authors: A
authors: Lurkin
authors: I
authors: I
authors: Ray-Coquard
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009372:Neoplasms, Connective Tissue / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy*; D017410:Practice Guidelines as Topic / Q000592:standards*; D012509:Sarcoma / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
keywords: clinical practice guidelines; prognosis; sarcomas