Management and Outcomes of Adolescent and Young Adult Sarcoma Patients in the French Multicenter NETSARC Database

Abstract

Introduction: This study evaluates the management of patients aged 0 to 30 years treated for sarcoma with data registered in the NETSARC French national database and compared the survival of adolescents and young adults (AYA) patients managed in reference sarcoma national centers (AYA in NC) and in non-NC (AYA outside NC). Patients and Methods: NETSARC (netsarc.org) is a network of 26 reference sarcoma centers funded by the French National Cancer Institute. Patients’ characteristics and follow-up are prospectively collected in a database regularly monitored and updated. Patients’ survival was compared between groups. The primary endpoint was overall survival (OS). Secondary endpoints were local progression-free survival (LPFS), progression-free survival (PFS), and the quality of initial surgery. Results: Among 3,972 patients aged 0 to 30 years diagnosed between 2010 and 2017, 714 children, 1,290 AYAs in NC and 937 AYAs outside NC were included. Compliance to guidelines between AYAs treated in versus outside reference centers was significantly different (p<0.001), with respectively 85.9% and 48.1% of pre-treatment biopsy, 86.8% and 56.5% of pre-treatment imaging and 62.5% and 22.4% of R0 margins. The 3y-OS rates were 81.1% (95%CI, 78.3%-83.6%) and 82.7% (95%CI, 79.4%-85.5%) respectively. LPFS and PFS were improved in NC compared to non-NC (Hazard Ratios: 0.639 and 0.855 with statistical significance at 1% and 10% levels, respectively). Multivariate regression analysis in AYAs identified no significant difference in OS in and outside NC (p=0.2725). Conclusion: This study confirms the importance of managing AYA patients with sarcoma in reference centers with multidisciplinary medical teams, involving pediatric and adult oncologists. Funding Statement: NetSARC (INCA & DGOS) and RREPS (INCA & DGOS), RESOS (INCA & DGOS), EURACAN (EC 739521), LYRICAN (INCA-DGOS-INSERM 12563), LabEx DEvweCAN (ANR-10-LABX-0061), Institut Convergence PLASCAN (17-CONV-0002), RHU4 DEPGYN (ANR-18-RHUS-0009, Association DAM’s, Ensemble contre Le GIST, Eurosarc (FP7-278742), la Fondation ARC, Infosarcome, InterSARC (INCA), Ligue de L’Ain contre le Cancer, La Ligue contre le Cancer, funded this study. Declaration of Interests:None to declare. Ethics Approval Statement: This study was approved by the I'Institute Bergonie - Centre Regional de Lutte Contre Le Cancer..