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)
Por:
Martin-Broto, J, Hindi, N, Cruz, J, Martinez-Trufero, J, Valverde, C, De Sande, LM, Sala, A, Bellido, L, De Juan, A, Rubio-Casadevall, J, Diaz-Beveridge, R, Cubedo, R, Tendero, O, Salinas, D, Gracia, I, Ramos, R, Bague, S, Gutierrez, A, Duran-Moreno, J, Lopez-Pousa, A
Publicada:
1 jun 2019
Resumen:
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.
Filiaciones:
Martin-Broto, J:
Univ Seville, Biomed Inst Seville IBIS, Lab 215, CSIC, Seville, Spain
Virgen Rocio Univ Hosp, Dept Med Oncol, Seville, Spain
Hindi, N:
Univ Seville, Biomed Inst Seville IBIS, Lab 215, CSIC, Seville, Spain
Virgen Rocio Univ Hosp, Dept Med Oncol, Seville, Spain
Cruz, J:
Hosp Univ Canarias, Dept Med Oncol, Tenerife, Spain
Martinez-Trufero, J:
Hosp Univ Miguel Servet, Dept Med Oncol, Zaragoza, Spain
Valverde, C:
Vall dHebron Univ Hosp, Dept Med Oncol, Barcelona, Spain
De Sande, LM:
Hosp Leon, Dept Med Oncol, Leon, Spain
Sala, A:
Hosp Basurto, Dept Med Oncol, Bilbao, Spain
Bellido, L:
Hosp Univ Salamanca, Dept Med Oncol, Salamanca, Spain
De Juan, A:
Hosp Univ Marques Valdecilla, Dept Med Oncol, Santander, Spain
Rubio-Casadevall, J:
Hosp Josep Trueta, Inst Catalan Oncol, Dept Med Oncol, Girona, Spain
Diaz-Beveridge, R:
Hosp Univ Fe, Dept Med Oncol, Valencia, Spain
Cubedo, R:
Hosp Univ Puerta Hierro, Dept Med Oncol, Madrid, Spain
Tendero, O:
Hosp Univ Son Espases, Dept Orthoped Surg, Palma De Mallorca, Spain
Salinas, D:
Hosp Univ Son Espases, Dept Orthoped Surg, Palma De Mallorca, Spain
Gracia, I:
Hosp Univ Sant Pau, Dept Orthoped Surg, Barcelona, Spain
Ramos, R:
Hosp Univ Son Espases, Dept Pathol, Palma De Mallorca, Spain
Bague, S:
Hosp Univ Sant Pau, Dept Pathol, Barcelona, Spain
Gutierrez, A:
Hosp Univ Son Espases, Dept Hematol, Palma De Mallorca, Spain
Duran-Moreno, J:
Hosp Univ Son Espases, Dept Med Oncol, Palma De Mallorca, Spain
Lopez-Pousa, A:
Hosp Univ Sant Pau, Dept Med Oncol, Barcelona, Spain
Green Published, Bronze
|