Abstract
PurposeThe 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.Experimental designBetween 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.ResultsThe 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.ConclusionsThis study demonstrates impact of CPGs and treatment within an expert center on survival for STS patients in a whole population-based cohort.
Highlights
Clinical practice guidelines (CPGs) provide a set of recommendations for diagnostic and therapeutic procedures, with the aim of improving patient care and disease outcomes [1]
This study demonstrates impact of CPGs and treatment within an expert center on survival for Soft-tissue sarcoma (STS) patients in a whole population-based cohort
CPGs during diagnosis were conformed for only 277 patients of 469, resulting in an adherence rate of 59Á1%
Summary
Clinical practice guidelines (CPGs) provide a set of recommendations for diagnostic and therapeutic procedures, with the aim of improving patient care and disease outcomes [1]. In the field of rare cancer management, development of CPGs is challenging because of the variability of disease presentation and the complexity of therapeutic decisions to interpret scientific data [1]. Several scientific societies and national groups have developed CPGs dedicated to sarcoma [9,10,11]. Only a minority of patients is treated according to CPGs in most studies reported so far, during initial management which may impact the most on long-term outcome [12,13,14,15]
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