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

被引：201

作者：

Blay, J. Y. ^{[1
,2
,3
,4
]}

Honore, C. ^{[5
,6
]}

Stoeckle, E. ^{[7
,8
]}

Meeus, P. ^{[1
,2
,3
,4
]}

Jafari, M. ^{[9
,10
,11
]}

Gouin, F. ^{[1
,2
,3
,4
,12
,13
,14
]}

Anract, P. ^{[15
]}

Ferron, G. ^{[16
,17
]}

Rochwerger, A. ^{[18
,19
]}

Ropars, M. ^{[20
,21
]}

Carrere, S. ^{[22
]}

Marchal, F. ^{[23
,24
]}

Sirveaux, F. ^{[23
,24
]}

Di Marco, A. ^{[25
,26
,27
]}

Le Nail, L. R. ^{[28
]}

Guiramand, J. ^{[29
,30
]}

Vaz, G. ^{[1
,2
,3
,4
]}

Machiavello, J-C ^{[31
,32
]}

Marco, O. ^{[33
]}

Causeret, S. ^{[34
]}

Gimbergues, P. ^{[35
]}

Fiorenza, F. ^{[36
,37
]}

Chaigneau, L. ^{[38
]}

Guillemin, F. ^{[39
,40
]}

Guilloit, J-M ^{[41
]}

Dujardin, F. ^{[42
]}

Spano, J-P ^{[43
]}

Ruzic, J-C ^{[44
]}

Michot, A. ^{[5
,6
]}

Soibinet, P. ^{[39
,40
]}

Bompas, E. ^{[12
,13
,14
]}

Chevreau, C. ^{[16
,17
]}

Duffaud, F. ^{[18
,19
]}

Rios, M. ^{[20
,21
]}

Perrin, C. ^{[20
,21
]}

Firmin, N. ^{[22
]}

Bertucci, F. ^{[29
,30
]}

Le Pechoux, C. ^{[5
,6
]}

Le Loarer, F. ^{[5
,6
]}

Collard, O. ^{[1
,2
,3
,4
]}

Karanian-Philippe, M. ^{[1
,2
,3
,4
]}

Brahmi, M. ^{[1
,2
,3
,4
]}

Dufresne, A. ^{[1
,2
,3
,4
]}

Dupre, A. ^{[1
,2
,3
,4
]}

Ducimetiere, F. ^{[1
,2
,3
,4
]}

Giraud, A. ^{[15
]}

Perol, D. ^{[1
,2
,3
,4
]}

Toulmonde, M. ^{[7
,8
]}

Ray-Coquard, I ^{[1
,2
,3
,4
]}

Italiano, A. ^{[7
,8
]}

机构：

[1] Ctr Leon Berard, Dept Med Oncol, 28 Rue Laennec, F-69373 Lyon 08, France

[2] Ctr Leon Berard, Dept Surg Oncol, Lyon, France

[3] Univ Claude Bernard, Lyon, France

[4] Inst Cancerol L Neuwirth, Villejuif, France

[5] Gustave Roussy, Dept Med Oncol, Canc Campus Surg, Villejuif, France

[6] Gustave Roussy, Dept Surg Oncol, Canc Campus Surg, Villejuif, France

[7] Inst Bergonie, Dept Med Oncol, Bordeaux, France

[8] Inst Bergonie, Dept Surg Oncol, Bordeaux, France

[9] Ctr Oscar Lambret, Dept Med Oncol, Lille, France

[10] Ctr Oscar Lambret, Dept Surg Oncol, Lille, France

[11] CHU, Dept Surg Oncol, Lille, France

[12] Inst Cancerol Nantes, Dept Med Oncol, Nantes, France

[13] Inst Cancerol Nantes, Dept Surg Oncol, Nantes, France

[14] CHU Nantes, Dept Orthoped, Nantes, France

[15] Hop Cochin St Vincent de Paul, Dept Orthoped, Paris, France

[16] Inst Univ Cancerol Toulouse, Dept Med Oncol, Toulouse, France

[17] Inst Univ Cancerol Toulouse, Dept Surg Oncol, Toulouse, France

[18] La Timone Univ Hosp, Dept Med Oncol, Marseille, France

[19] La Timone Univ Hosp, Dept Orthoped, Marseille, France

[20] Eugene Marquis Comprehens Canc Ctr, Med Oncol Dept, Rennes, France

[21] CHU, Dept Orthoped, Rennes, France

[22] Inst Cancerol Montpellier, Med Oncol Dept, Montpellier, France

[23] Ctr Alexis Vautrin, Dept Med Oncol, Vandoeuvre Les Nancy, France

[24] Ctr Alexis Vautrin, Dept Surg Oncol, Vandoeuvre Les Nancy, France

[25] Ctr Paul Strauss, Dept Surg Oncol, Strasbourg, France

[26] Ctr Paul Strauss, Dept Med Oncol, Strasbourg, France

[27] Hop Univ Strasbourg, CHU Strasbourg, Strasbourg, France

[28] CHU Tours, Dept Orthoped, Tours, France

[29] Inst Paoli Calmettes, Dept Med Oncol, Marseille, France

[30] Inst Paoli Calmettes, Dept Surg Oncol, Marseille, France

[31] Ctr Antoine Lacassagne, Dept Med Oncol, Nice, France

[32] Ctr Antoine Lacassagne, Dept Surg Oncol, Nice, France

[33] St Louis Hosp, Oncol Unit, Paris, France

[34] Ctr Georges Francois Leclerc, Dept Surg, Dijon, France

[35] Ctr Jean Perrin ERTICa EA 4677, Dept Surg, Clermont Ferrand, France

[36] CHU Limoges, Dept Med Oncol, Limoges, France

[37] CHU Limoges, Dept Surg Oncol, Limoges, France

[38] CHU Besancon, Med Oncol Dept, Besancon, France

[39] Inst J Godinot Reims, Dept Med Oncol, Caen, France

[40] Inst J Godinot Reims, Dept Surg Oncol, Caen, France

[41] Ctr Francois Baclesse, Dept Surg Oncol, Caen, France

[42] Ctr Henri Becquerel, Dept Surg, Rouen, France

[43] La Pitie Salpetriere Tenon Bicetre, AP HP, Med Oncol Dept, Paris, France

[44] CHU La Reunion, Med Oncol Dept, St Pierre, La Reunion, France

[45] Inst Curie, Surg Dept, Paris, France

来源：

ANNALS OF ONCOLOGY | 2019年 / 30卷 / 07期

关键词：

sarcoma; resection; surgery; relapse; survival; reference center; SOFT-TISSUE SARCOMA; CLINICAL-PRACTICE GUIDELINES; POPULATION-BASED COHORT; UNPLANNED EXCISION; MANAGEMENT; DIAGNOSIS; PROGNOSIS; RESECTION; MARGINS; IMPACT;

D O I：

10.1093/annonc/mdz124

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Background NETSARC (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 methods Patients' 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=35784) and in the subgroup of incident patient population (N=29497). Results Among the 35784 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 29497 incident patients, 25851 (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]. Conclusion This nationwide registry of sarcoma patients shows that surgical treatment in a reference center reduces the risk of relapse and death.

引用

页码：1143 / 1153

页数：11

共 31 条

[1]

[Anonymous], VALUE HEALTH

[2]

Bagaria Sanjay P., 2018, Sarcoma, V2018, P8141056, DOI 10.1155/2018/8141056

[3] Improved survival using specialized multidisciplinary board in sarcoma patients [J].

Blay, J-Y ;

Soibinet, P. ;

Penel, N. ;

Bompas, E. ;

Duffaud, F. ;

Stoeckle, E. ;

Mir, O. ;

Adam, J. ;

Chevreau, C. ;

Bonvalot, S. ;

Rios, M. ;

Kerbrat, P. ;

Cupissol, D. ;

Anract, P. ;

Gouin, F. ;

Kurtz, J-E ;

Lebbe, C. ;

Isambert, N. ;

Bertucci, F. ;

Toumonde, M. ;

Thyss, A. ;

Piperno-Neumann, S. ;

Dubray-Longeras, P. ;

Meeus, P. ;

Ducimetiere, F. ;

Giraud, A. ;

Coindre, J-M ;

Ray-Coquard, I. ;

Italiano, A. ;

Le Cesne, A. .

ANNALS OF ONCOLOGY, 2017, 28 (11) :2852-2859

[4] The value of research collaborations and consortia in rare cancers [J].

Blay, Jean-Yves ;

Coindre, Jean-Michel ;

Ducimetiere, Francoise ;

Ray-Coquard, Isabelle .

LANCET ONCOLOGY, 2016, 17 (02) :E62-E69

[5] Soft tissue and visceral sarcomas: ESMO-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up (vol 29, pg 51, 2018) [J].

Casali, P. G. ;

Abecassis, N. ;

Aro, H. T. ;

Bauer, S. ;

Biagini, R. ;

Bielack, S. ;

Bonvalot, S. ;

Boukovinas, I. ;

Bovee, J. V. M. G. ;

Brodovvicz, T. ;

Broto, J. M. ;

Buonadonna, A. ;

De Alava, E. ;

Tos, A. P. Dei ;

Del Muro, X. G. ;

Dileo, P. ;

Eriksson, M. ;

Fedenko, A. ;

Ferraresi, V. ;

Ferrari, A. ;

Ferrari, S. ;

Frezza, A. M. ;

Gasperoni, S. ;

Gelderblom, H. ;

Gil, T. ;

Grignani, G. ;

Gronchi, A. ;

Haas, R. L. ;

Hassan, B. ;

Hohenberger, P. ;

Lssels, R. ;

Joensuu, H. ;

Jones, R. L. ;

Judson, I. ;

Jutte, P. ;

Kaal, S. ;

Kasper, B. ;

Kopeckova, K. ;

Krakorova, D. A. ;

Le Cesne, A. ;

Lugowska, I. ;

Merimsky, O. ;

Montemurro, M. ;

Pantaleo, M. A. ;

Piana, R. ;

Picci, P. ;

Piperno-Neumann, S. ;

Pousa, A. L. ;

Reichardt, P. ;

Robinson, M. H. .

ANNALS OF ONCOLOGY, 2018, 29 :268-269

[6] Bone sarcomas: ESMO-PaedCan-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up [J].

Casali, P. G. ;

Bielack, S. ;

Abecassis, N. ;

Aro, H. T. ;

Bauer, S. ;

Biagini, R. ;

Bonvalot, S. ;

Boukovinas, I. ;

Bovee, J. V. M. G. ;

Brennan, B. ;

Brodowicz, T. ;

Martin-Broto, J. ;

Brugieres, L. ;

Buonadonna, A. ;

De Alava, E. ;

Dei Tos, A. P. ;

Del Muro, X. G. ;

Dileo, P. ;

Dhooge, C. ;

Eriksson, M. ;

Fagioli, F. ;

Fedenko, A. ;

Ferraresi, V. ;

Ferrari, A. ;

Ferrari, S. ;

Frezza, A. M. ;

Gaspar, N. ;

Gasperoni, S. ;

Gelderblom, H. ;

Gil, T. ;

Grignani, G. ;

Gronchi, A. ;

Haas, R. L. ;

Hassan, B. ;

Hecker-Nolting, S. ;

Hohenberger, P. ;

Issels, R. ;

Joensuu, H. ;

Jones, R. L. ;

Judson, I. ;

Jutte, P. ;

Kaal, S. ;

Kager, L. ;

Kasper, B. ;

Kopeckova, K. ;

Krakorova, D. A. ;

Ladenstein, R. ;

Le Cesne, A. ;

Lugowska, I. ;

Merimsky, O. .

ANNALS OF ONCOLOGY, 2018, 29 :79-95

[7] Gastrointestinal stromal tumours: ESMO-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up (vol 29, pg 68, 2018) [J].

Casali, P. G. ;

Abecassis, N. ;

Aro, H. T. ;

Bauer, S. ;

Biagini, R. ;

Bielack, S. ;

Bonvalot, S. ;

Boukovinas, I. ;

Bovee, J. V. M. G. ;

Brodowicz, T. ;

Broto, J. M. ;

Buonadonna, A. ;

De Alava, E. ;

Tos, A. P. Dei ;

Del Muro, X. G. ;

Dileo, P. ;

Eriksson, M. ;

Fedenko, A. ;

Ferraresi, V. ;

Ferrari, A. ;

Ferrari, S. ;

Frezza, A. M. ;

Gasperoni, S. ;

Gelderblom, H. ;

Gil, T. ;

Grignani, G. ;

Gronchi, A. ;

Haas, R. L. ;

Hassan, B. ;

Hohenberger, P. ;

Issels, R. ;

Joensuu, H. ;

Jones, R. L. ;

Judson, I. ;

Jutte, P. ;

Kaal, S. ;

Kasper, B. ;

Kopeckova, K. ;

Krakorova, D. A. ;

Le Cesne, A. ;

Lugowska, I. ;

Merimsky, O. ;

Montemurro, M. ;

Pantaleo, M. A. ;

Piana, R. ;

Picci, P. ;

Piperno-Neumann, S. ;

Pousa, A. L. ;

Reichardt, P. ;

Robinson, M. H. .

ANNALS OF ONCOLOGY, 2018, 29 :267-267

[8] The effect of an unplanned excision of a soft-tissue sarcoma on prognosis [J].

Chandrasekar, C. R. ;

Wafa, H. ;

Grimer, R. J. ;

Carter, S. R. ;

Tillman, R. M. ;

Abudu, A. .

JOURNAL OF BONE AND JOINT SURGERY-BRITISH VOLUME, 2008, 90B (02) :203-208

[9] Outcomes of unplanned sarcoma excision: impact of residual disease [J].

Charoenlap, Chris ;

Imanishi, Jungo ;

Tanaka, Takaaki ;

Slavin, John ;

Ngan, Samuel Y. ;

Chander, Sarat ;

Dowsey, Michelle Maree ;

Goyal, Chatar ;

Choong, Peter F. M. .

CANCER MEDICINE, 2016, 5 (06) :980-988

[10] UK guidelines for the management of soft tissue sarcomas [J].

Dangoor, Adam ;

Seddon, Beatrice ;

Gerrand, Craig ;

Grimer, Robert ;

Whelan, Jeremy ;

Judson, Ian .

CLINICAL SARCOMA RESEARCH, 2016, 6

← 1 2 3 4 →