1316O Improved nationwide survival of sarcoma patients 10 years after establishment of the NETSARC+ reference center network

Abstract

Treatment of sarcomas within networks of reference center is associated with improved outcome. We report on the nationwide impact of the NETSARC+ network on sarcoma survival since 2010 in France. NETSARC+ is a national network of 26 reference sarcoma centers with multidisciplinary tumor boards (MDTB) active since 2010, in charge of mandatory pathology review, and collection of patients characteristics in the netsarc.org nationwide database. Exhaustivity of cases collection was reached since 2013. The characteristics of patients with follow-up are presented, as well as the management procedures and overall survival in 3 periods:2010-12 (Period 1, non-exhaustive), 2013-15 (period 2), and 2016-20 (period 3). Patient series is considered exhaustive in periods 2 and 3. 43,975 patients with sarcomas and tumors of intermediate malignancy were included in the NETSARC+ database since 2010 (n=9,266 [2010-12], n=12,247 [2013-15], n=22,435 [2016-20]). Median age is 59 years, 50.5% are women, 13.2% were metastatic at diagnosis. The 3 most frequent histotypes were liposarcomas, leiomyosarcomas, and UPS. Over the 3 periods, the percentage of patients 1) biopsied before surgery increased from 63% to 76%, 2) presented to the MDTB before the 1st treatment increased from 32% to 45%, 3) operated in reference centers increased from 55% to 59%, 4) re-operated after 1st surgery decreased from 13% to 9% (p<0.0001 for all tests across the 3 periods, and for comparisons between the 2 exhaustive periods 2 vs 3). With a median follow-up of 14 months in the whole series, the overall survival was significantly superior in the series of patients operated in the period 2017-20 vs 2013-2016 vs 2010-12 (p<0.0001). Comparison of survival in the two most recent exhaustive periods showed a superior survival for patients in 2016-20 vs 2013-15 periods (HR=0.82) in patients aged >18 (HR=0.81), both metastatic (HR=0.68) and non-metastatic (HR=0.82) (p<0.0001 for all). A 24% reduction of the relative risk of death at 12 months was observed in the 2016-20 period. The implementation of the NETSARC+ national reference network since 2010 in France is associated with an improvement of the overall survival nationwide in sarcoma patients.