Survival impact of centralization and clinical guidelines for soft tissue sarcoma (A prospective and exhaustive population-based cohort).
OBJECTIVE
The outcome of sarcoma has been suggested in retrospective and non-exhaustive studies to be better through management by a multidisciplinary team of experts and adherence to clinical practice guidelines (CPGs). The aim of this prospective and exhaustive population based study was to confirm the impact of adherence to CPGs on survival in patients with localized sarcoma.


METHODS
Between 2005 and 2007, all evaluable adult patients with a newly diagnosis of localized sarcoma located in Rhone Alpes region (n = 634), including 472 cases of soft-tissue sarcoma (STS), were enrolled. The prognostic impact of adherence to CPGs on progression-free survival (PFS) and overall survival (OS) was assessed by multivariate Cox model in this cohort.


RESULTS
The median age was 61 years (range 16-92). The most common subtypes were liposarcoma (n = 133, 28%), unclassified sarcoma (n = 98, 20.7%) and leiomyosarcoma (n = 69, 14.6%). In the initial management phase, from diagnosis to adjuvant treatment, the adherence to CPGs for patients with localized STS was 36% overall, corresponding to 56%, 85%, 96% and 84% for initial surgery, radiation therapy, chemotherapy and follow-up, respectively. Adherence to CPGs for surgery was the strongest independent prognostic factor of PFS, along with age, gender, grade, and tumor size. For OS, multivariate analysis adherence to CPGs for surgery was a strong independent prognostic factor, with an important interaction with a management in the regional expert centers.


CONCLUSIONS
This study demonstrates impact of CPGs and treatment within an expert center on survival for STS patients in a whole population-based cohort.
Department of Medical Oncology, Centre Léon Bérard, Lyon, France.
Olfa
O
Derbel
Department of Medical Oncology, Centre Léon Bérard, Lyon, France.
Pierre Etienne
PE
Heudel
Department of Biostatistics, Centre Léon Bérard, Lyon, France.
Claire
C
Cropet
Department of Surgery, Centre Léon Bérard, Lyon, France.|Groupe Sarcome Français, Groupe d'Etude des Tumeurs Osseuses (GSF-GETO), Lyon France.
Pierre
P
Meeus
Department of Surgery, Centre Léon Bérard, Lyon, France.|Groupe Sarcome Français, Groupe d'Etude des Tumeurs Osseuses (GSF-GETO), Lyon France.|Department of Orthopedic Surgery, Clinique des IRIS, Lyon, France.
Gualter
G
Vaz
Department of Medical Oncology, Centre Léon Bérard, Lyon, France.
Pierre
P
Biron
Department of Medical Oncology, Centre Léon Bérard, Lyon, France.
Philippe
P
Cassier
Department of Pathology, Centre Léon Bérard, Lyon, France.
Anne-Valérie
AV
Decouvelaere
Groupe Sarcome Français, Groupe d'Etude des Tumeurs Osseuses (GSF-GETO), Lyon France.|Department of Pathology, Centre Léon Bérard, Lyon, France.
Dominique
D
Ranchere-Vince
Groupe Sarcome Français, Groupe d'Etude des Tumeurs Osseuses (GSF-GETO), Lyon France.|Institut de Cancérologie Lucien Neuwirth, Saint-Priest en Jarez, France.
Olivier
O
Collard
Institut de Cancérologie Lucien Neuwirth, Saint-Priest en Jarez, France.
Eric
E
De Laroche
Department of Radiology, Centre Léon Bérard, Lyon, France.
Philippe
P
Thiesse
Réseau Espace Santé Cancer, Rhône-Alpes, France.
Fadila
F
Farsi
Department of Medical Oncology, Centre Léon Bérard, Lyon, France.
Dominic
D
Cellier
Claude Bernard University, Lyon, France.
François-Noel
FN
Gilly
Department of Medical Oncology, Centre Léon Bérard, Lyon, France.|Groupe Sarcome Français, Groupe d'Etude des Tumeurs Osseuses (GSF-GETO), Lyon France.|Réseau Espace Santé Cancer, Rhône-Alpes, France.|Claude Bernard University, Lyon, France.|Laboratoire HESPER EA 7425, Lyon 1 University, Lyon, France.
Jean-Yves
JY
Blay
Department of Medical Oncology, Centre Léon Bérard, Lyon, France.|Groupe Sarcome Français, Groupe d'Etude des Tumeurs Osseuses (GSF-GETO), Lyon France.|Réseau Espace Santé Cancer, Rhône-Alpes, France.|Claude Bernard University, Lyon, France.|Laboratoire HESPER EA 7425, Lyon 1 University, Lyon, France.
Isabelle
I
Ray-Coquard
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007890:Leiomyosarcoma / Q000401:mortality / Q000473:pathology; D008080:Liposarcoma / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D011446:Prospective Studies; D012509:Sarcoma / Q000401:mortality / Q000473:pathology*; D055815:Young Adult