Adherence to treatment guidelines for primary sarcomas affects patient survival: a side study of the European CONnective TIssue CAncer NETwork (CONTICANET).

BACKGROUND The impact of adherence to clinical practice guidelines (CPGs) for loco-regional treatment (i.e. surgery and radiotherapy) and chemotherapy on local disease control and survival in sarcoma patients was investigated in a European study conducted in an Italian region (Veneto). PATIENTS AND METHODS The completeness of the adherence to the Italian CPGs for sarcomas treatment was assessed by comparing the patient's charts and the CPGs. Propensity score-adjusted multivariate survival analysis was used to assess the impact of CPGs adherence on patient clinical outcomes. RESULTS A total of 151 patients were included. Adherence to CPGs for loco-regional therapy and chemotherapy was observed in 106 out of 147 (70.2%) and 129 out of 139 (85.4%) patients, respectively. Non-adherence to CPGs for loco-regional treatment was independently associated with AJCC stage III disease [odds ratio (OR) 1.77, P = 0.011] and tumor-positive excision margin (OR 3.55, P = 0.003). Patients not treated according to the CPGs were at a higher risk of local recurrence [hazard ratio (HR) 5.4, P < 0.001] and had a shorter sarcoma-specific survival (HR 4.05, P < 0.001), independently of tumor stage. CONCLUSIONS Incomplete adherence to CPGs for loco-regional treatment of sarcomas was associated with worse prognosis in patients with non-metastatic tumors.

[1]  C. Fletcher.  The evolving classification of soft tissue tumours – an update based on the new 2013 WHO classification , 2014, Histopathology.

[2]  J. Blay,et al.  Incidence of soft tissue sarcoma and beyond , 2012, Cancer.

[3]  B. O'Sullivan,et al.  Radiotherapy for management of extremity soft tissue sarcomas: why, when, and where? , 2012, International journal of radiation oncology, biology, physics.

[4]  R. Cervera,et al.  SEOM clinical guidelines for the management of adult soft tissue sarcomas. , 2012 .

[5]  C. Blomqvist,et al.  Soft tissue sarcoma – a population-based, nationwide study with special emphasis on local control , 2012, Acta oncologica.

[6]  N Sevdalis,et al.  Multidisciplinary team working across different tumour types: analysis of a national survey. , 2012, Annals of oncology : official journal of the European Society for Medical Oncology.

[7]  T. Delaney.  Radiation therapy: neoadjuvant, adjuvant, or not at all. , 2012, Surgical oncology clinics of North America.

[8]  J. Kane,et al.  Margin Status , Local Recurrence , and Survival : Correlation or Causation ? , 2022 .

[9]  J. Blay,et al.  Clinicians' adherence versus non adherence to practice guidelines in the management of patients with sarcoma: a cost-effectiveness assessment in two European regions , 2012, BMC Health Services Research.

[10]  L. Delrue,et al.  Radiotherapy and surgery—An indispensable duo in the treatment of retroperitoneal sarcoma , 2011, Cancer.

[11]  J. Blay,et al.  Incidence of Sarcoma Histotypes and Molecular Subtypes in a Prospective Epidemiological Study with Central Pathology Review and Molecular Testing , 2011, PloS one.

[12]  Nick Sevdalis,et al.  Quality of Care Management Decisions by Multidisciplinary Cancer Teams: A Systematic Review , 2011, Annals of Surgical Oncology.

[13]  J. Wunder,et al.  Soft tissue sarcoma presenting with metastatic disease , 2011, Cancer.

[14]  I. Judson,et al.  Guidelines for the management of soft tissue sarcomas . The British Sarcoma Group , 2010 .

[15]  E. Álava,et al.  Bone sarcomas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. , 2014, Annals of oncology : official journal of the European Society for Medical Oncology.

[16]  P. Casali,et al.  Gastrointestinal stromal tumours: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. , 2010, Annals of oncology : official journal of the European Society for Medical Oncology.

[17]  M. Nooij,et al.  Improved diagnosis and treatment of soft tissue sarcoma patients after implementation of national guidelines: a population-based study. , 2009, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[18]  Peter C Austin,et al.  A comparison of the ability of different propensity score models to balance measured variables between treated and untreated subjects: a Monte Carlo study , 2007, Statistics in medicine.

[19]  A. Brandes,et al.  Adult soft tissue sarcomas: conventional therapies and molecularly targeted approaches. , 2006, Cancer treatment reviews.

[20]  C. Fletcher.  The evolving classification of soft tissue tumours: an update based on the new WHO classification , 2006, Histopathology.

[21]  C. Mussi,et al.  Dermatofibrosarcoma protuberans treated at a single institution: a surgical disease with a high cure rate. , 2005, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[22]  Cyril Fisher,et al.  Soft-tissue sarcomas in adults. , 2005, The New England journal of medicine.

[23]  M. A. Smith,et al.  Soft tissue sarcomas: are current referral guidelines sufficient? , 2005, Annals of the Royal College of Surgeons of England.

[24]  J. Thomas,et al.  Delay in referral to a specialist soft-tissue sarcoma unit. , 2005, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[25]  I. Ray-Coquard,et al.  Conformity to clinical practice guidelines, multidisciplinary management and outcome of treatment for soft tissue sarcomas. , 2004, Annals of oncology : official journal of the European Society for Medical Oncology.

[26]  S. Love,et al.  Survival Analysis Part III: Multivariate data analysis – choosing a model and assessing its adequacy and fit , 2003, British Journal of Cancer.

[27]  J. Kane,et al.  The Treatment and Outcome of Patients With Soft Tissue Sarcomas and Synchronous Metastases , 2002, Sarcoma.

[28]  A. Davis,et al.  Adjuvant Chemotherapy Following Complete Resection of Soft Tissue Sarcoma in Adults: A Clinical Practice Guideline , 2002, Sarcoma.

[29]  H. Hoekstra,et al.  Soft tissue sarcoma—Compliance with guidelines , 2001, Cancer.

[30]  R. D'Agostino.  Adjustment Methods: Propensity Score Methods for Bias Reduction in the Comparison of a Treatment to a Non‐Randomized Control Group , 2005 .

[31]  K. Tilling,et al.  Variable management of soft tissue sarcoma: Regional audit with implications for specialist care , 1997, The British journal of surgery.

[32]  F. Harrell,et al.  Prognostic/Clinical Prediction Models: Multivariable Prognostic Models: Issues in Developing Models, Evaluating Assumptions and Adequacy, and Measuring and Reducing Errors , 2005 .

[33]  P. G. Casali,et al.  Gastrointestinal stromal tumours: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. , 2014, Annals of oncology : official journal of the European Society for Medical Oncology.

[34]  P. Casali,et al.  Soft tissue sarcomas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. , 2010, Annals of oncology : official journal of the European Society for Medical Oncology.

[35]  A. Gerbaulet,et al.  Soft tissue sarcomas of the extremities in adults , 2003 .

[36]  M. Montesco,et al.  STUDY PROTOCOL Open Access Study protocol A European project on incidence, treatment, and , 2022 .