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. 2018 Apr 3:2018:8141056.
doi: 10.1155/2018/8141056. eCollection 2018.

Improving Long-Term Outcomes for Patients with Extra-Abdominal Soft Tissue Sarcoma Regionalization to High-Volume Centers, Improved Compliance with Guidelines or Both?

Sanjay P Bagaria  1 , Yu-Hui Chang  2   3 , Richard J Gray  4 , Jonathan B Ashman  5 , Steven Attia  6 , Nabil Wasif  3   4
Affiliations

Improving Long-Term Outcomes for Patients with Extra-Abdominal Soft Tissue Sarcoma Regionalization to High-Volume Centers, Improved Compliance with Guidelines or Both?

Sanjay P Bagaria et al. Sarcoma. .

Abstract

Introduction: Optimization of outcomes of extra-abdominal STS is not clearly understood. We sought to determine whether hospital surgical volume and adherence to NCCN guidelines, or both, are associated with outcomes in the treatment of extra-abdominal soft tissue sarcoma (STS).

Methods: The National Cancer Database (NCDB) was queried for patients undergoing surgery for extra-abdominal STS diagnosed from 2003 to 2007. Mean annual hospital volume for STS surgery was divided into volume terciles (1T ≤3, 2T 4-10, and 3T ≥11 cases/year). Adherence to NCCN guidelines was determined. Primary outcome was overall survival.

Results: Our study population consisted of 13,684 patients with a median age of 56 years. 3T hospitals were more likely to adhere to NCCN guidelines for stage III patients (63% versus 47%; p ≤ 0.001) than 1T hospitals. On multivariable analysis, adherence to NCCN guidelines was associated with improved survival (HR = 0.79, CI 0.73-0.87; p < 0.001), but hospital volume was not (3T versus 1T: HR = 0.92, CI 0.82-1.02; p=0.12). Five-year overall survival was comparable for compliant groups at 1T, 2T, and 3T hospitals (72%, 72.4%, and 72.6%, resp.). 3T hospitals were not associated with a lower risk of 30-day mortality (OR 0.70, 95% CI 0.44-1.11) compared to 1T hospitals but did have a higher R0 resection rate (OR 1.43, 95% CI 1.32-1.54).

Conclusions: Adherence to NCCN guidelines, irrespective of hospital volume, is associated with improved overall survival for patients with extra-abdominal STS. High-volume hospitals more often adhere to guidelines, but low-volume hospitals that follow national guidelines may achieve comparable outcomes.

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Figures

Figure 1
Figure 1
Kaplan–Meier plots of overall survival stratified by (a) hospital surgical volume and (b) adherence to NCCN guidelines.
Figure 2
Figure 2
Kaplan–Meier plots displaying the impact of adherence to NCCN guidelines on overall survival stratified by hospital volume: (a) 1T hospitals, (b) 2T hospitals, and (c) 3T hospitals.
See this image and copyright information in PMC

References

    1. Ihse I. The volume-outcome relationship in cancer surgery: a hard sell. Annals of Surgery. 2003;238(6):777–781. doi: 10.1097/01.sla.0000098616.19622.af. - DOI - PMC - PubMed
    1. Fong Y., Gonen M., Rubin D., Radzyner M., Brennan M. F. Long-term survival is superior after resection for cancer in high-volume centers. Annals of surgery. 2005;242(4):540–544. - PMC - PubMed
    1. Begg C. B., Cramer L. D., Hoskins W. J., Brennan M. F. Impact of hospital volume on operative mortality for major cancer surgery. JAMA. 1998;280(20):1747–1751. doi: 10.1001/jama.280.20.1747. - DOI - PubMed
    1. Bach P. B., Cramer L. D., Schrag D., Downey R. J., Gelfand S. E., Begg C. B. The influence of hospital volume on survival after resection for lung cancer. New England Journal of Medicine. 2001;345(3):181–188. doi: 10.1056/nejm200107193450306. - DOI - PubMed
    1. Hillner B. E., Smith T. J., Desch C. E. Hospital and physician volume or specialization and outcomes in cancer treatment: importance in quality of cancer care. Journal of Clinical Oncology. 2000;18(11):2327–2340. doi: 10.1200/jco.2000.18.11.2327. - DOI - PubMed

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