The Volume-Outcome Relationship in Retroperitoneal Soft Tissue Sarcoma: Evidence of Improved Short- and Long-Term Outcomes at High-Volume Institutions.

Sanjay P Bagaria,Steven Attia,Emmanuel Gabriel,Nabil Wasif,Richard J Gray,Matthew Neville,Jonathan B Ashman

doi:10.1155/2018/3056562

Sanjay P Bagaria, Steven Attia + Show 5 more

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https://doi.org/10.1155/2018/3056562

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Journal: Sarcoma	Publication Date: Jul 24, 2018
Citations: 36	License type: CC BY 4.0

Affiliation: Mayo Clinic, Winneshiek Medical Center

Abstract

Background We sought to study the association between RPS case volume and outcomes. Although a relationship has been demonstrated between case volume and patient outcomes in some cancers, such a relationship has not been established for retroperitoneal sarcomas (RPSs). Study Design The National Cancer Database (NCDB) was queried for patients undergoing treatment for primary RPS diagnosed between 2004 and 2013. Mean annual patient volume for RPS resection was calculated for all hospitals and divided into low volume (<5 cases/year), medium volume (5–10 cases/year), and high volume (>10 cases/year). Risk-adjusted regression analyses were performed to identify predictors of 30-day surgical mortality, R0 margin status, and overall survival (OS). Results Our study population consisted of 5,407 patients with a median age of 61 years, of whom 47% were male and 3,803 (70%) underwent surgical resection. Absolute 30-day surgical mortality and R0 margin rate following surgery for low-, medium-, and high-volume institutions were 2.4%, 1.3%, and 0.5% (p=0.027) and 68%, 65%, and 82%, (p < 0.001), respectively. Five-year overall survival rates for low, medium, and high-volume institutions were 56%, 57%, and 66%, respectively (p < 0.001). Patients treated at low-volume institutions had a significantly higher risk of 30-day mortality (adjusted OR = 4.66, 95% CI 2.26–9.63) and long-term mortality (adjusted HR = 1.56, 95% CI 1.16–2.11) compared to high-volume institutions. Conclusion We demonstrate the existence of a hospital sarcoma service line volume-oncologic outcome relationship for RPS at the national level and provide benchmark data for cancer care delivery systems and policy makers.

Highlights

Retroperitoneal sarcomas (RPSs) are rare tumors that account for 15–20% of all soft tissue sarcomas. e majority of cases present with localized disease, and surgical resection is the mainstay of treatment
We identified 5,407 patients with primary retroperitoneal sarcomas (RPSs) who comprised our primary study population (Table 1). e median age was 61 years, and 53% were female. e mean tumor size was 18.5 cm, and a plurality of tumors were well differentiated (36%)
0.38 0.21 0.70 0.0019 0.46 0.31 0.70 0.0003 times less likely to die within 30 days of the procedure, 54% more likely to have an R0 margin status, and 52% more likely to be alive by the end of follow-up when compared to patients in low-volume centers. ese results are consistent with a strong volume-outcome association for RPS for both short- and long-term outcomes

Summary

Introduction

Retroperitoneal sarcomas (RPSs) are rare tumors that account for 15–20% of all soft tissue sarcomas. e majority of cases present with localized disease, and surgical resection is the mainstay of treatment. Hospital surgical volume is a well-studied measure associated with improved outcomes in multiple tumor subtypes [1,2,3,4]. Such a relationship has been reported for complex surgical oncologic procedures such as colectomy, nephrectomy, and pancreatectomy, all of which. Absolute 30-day surgical mortality and R0 margin rate following surgery for low-, medium-, and high-volume institutions were 2.4%, 1.3%, and 0.5% (p 0.027) and 68%, 65%, and 82%, (p < 0.001), respectively. We demonstrate the existence of a hospital sarcoma service line volume-oncologic outcome relationship for RPS at the national level and provide benchmark data for cancer care delivery systems and policy makers

Methods

Results

Conclusion