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Surgery in reference centers improves survival of sarcoma patients: a nationwide study

J.-Y. Blay 1, 2, 3, * C. Honore 4 E. Stoeckle 5 P. Méeus 1, 3, 2 M. Jafari 6 F. Gouin 1, 3, 2, 7 P. Anract 8 G. Ferron 9 A. Rochwerger 10 M. Ropars 11, 12 S. Carrere 13 F. Marchal 14 F. Sirveaux 14 A. Di Marco 15 L.R. Le Nail 8 J. Guiramand 16 G. Vaz 1, 3, 2 J.-C. Machiavello 17 O. Marco 18 S. Causeret 19 P. Gimbergues 20 F. Fiorenza 21 L. Chaigneau 22 F. Guillemin 23 J.-M. Guilloit 24 F. Dujardin 25 J.-P. Spano 26 J.-C. Ruzic A. Michot P. Soibinet E. Bompas C. Chevreau 27 F. Duffaud M. Rios C. Perrin 28 N. Firmin 13 F. Bertucci 29 C. Le Péchoux 30 F. Le Loarer O. Collard M. Karanian-Philippe M. Brahmi A. Dufresne 31 A. Dupré F. Ducimetière 32 A. Giraud 33 D. Pérol 32 M. Toulmonde 34 I. Ray-Coquard A. Italiano 34 A. Le Cesne 4 N. Penel 6 S. Bonvalot 35
* Corresponding author
Abstract : BackgroundNETSARC (netsarc.org) is a network of 26 sarcoma reference centers with specialized multidisciplinary tumor boards (MDTB) aiming to improve the outcome of sarcoma patients. Since 2010, presentation to an MDTB and expert pathological review are mandatory for sarcoma patients nationwide. In the present work, the impact of surgery in a reference center on the survival of sarcoma patients investigated using this national NETSARC registry.Patients and methodsPatients’ characteristics and follow-up are prospectively collected and data monitored. Descriptive, uni- and multivariate analysis of prognostic factors were conducted in the entire series (N = 35 784) and in the subgroup of incident patient population (N = 29 497).ResultsAmong the 35 784 patients, 155 different histological subtypes were reported. 4310 (11.6%) patients were metastatic at diagnosis. Previous cancer, previous radiotherapy, neurofibromatosis type 1 (NF1), and Li–Fraumeni syndrome were reported in 12.5%, 3.6%, 0.7%, and 0.1% of patients respectively. Among the 29 497 incident patients, 25 851 (87.6%) patients had surgical removal of the sarcoma, including 9949 (33.7%) operated in a NETSARC center. Location, grade, age, size, depth, histotypes, gender, NF1, and surgery outside a NETSARC center all correlated to overall survival (OS), local relapse free survival (LRFS), and event-free survival (EFS) in the incident patient population. NF1 history was one of the strongest adverse prognostic factors for LRFS, EFS, and OS. Presentation to an MDTB was associated with an improved LRFS and EFS, but was an adverse prognostic factor for OS if surgery was not carried out in a reference center. In multivariate analysis, surgery in a NETSARC center was positively correlated with LRFS, EFS, and OS [P < 0.001 for all, with a hazard ratio of 0.681 (95% CI 0.618–0.749) for OS].ConclusionThis nationwide registry of sarcoma patients shows that surgical treatment in a reference center reduces the risk of relapse and death.
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J.-Y. Blay, C. Honore, E. Stoeckle, P. Méeus, M. Jafari, et al.. Surgery in reference centers improves survival of sarcoma patients: a nationwide study. Annals of Oncology, Elsevier, 2019, Annals of oncology official journal of the European Society for Medical Oncology, 30 (7), pp.1143-1153. ⟨10.1093/annonc/mdz124⟩. ⟨hal-02509515⟩

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