Improved nationwide survival of sarcoma patients with a network of reference centers
Jean‐Yves Blay, Nicolas Penel, Thibaud Valentin, P. Anract, Florence Duffaud, Armelle Dufresne, Benjamin Verret, A. Córdoba, Antoîne Italiano, Mehdi Brahmi, Clémence Henon, Thomas Amouyel, Isabelle Ray‐Coquard, Gwénaël Ferron, Pascaline Boudou‐Rouquette, Camille Tlemsani, Sébastien Salas, Richard Alexandre Rochwerger, Matthieu Faron, Emmanuelle Bompas, Anne Ducassou, D. Gangloff, F. Gouin, Nelly Firmin, Sophie Piperno‐Neumann, María Rios, M. Ropars, Jean‐Emmanuel Kurtz, Louis‐Romée Le Nail, François Bertucci, Sébastien Carrère, C. Llacer, Sarah Watson, S. Bonvalot, Agnès Leroux, Christophe Perrin, Justine Gantzer, Marc Pracht, B. Narciso, Audrey Monneur, Célèste Lebbé, Alice Hervieu, Esma Saâda-Bouzid, Pascale Dubray‐Longeras, F. Fiorenza, L. Chaigneau, Z.-M. Nevieres, Pauline Soibinet, Olivier Bouché, Cécile Guillemet, J.-P. Spano, J Ruźić, Nicolás Isambert, Gualter Vaz, Pierre Méeus, Marie Karanian, Carine Ngo, Jean‐Michel Coindre, Gonzague de Pinieux, François Le Loarer, Françoise Ducimetière, Claire Chemin, M. Morelle, Maud Toulmonde, Axel Le Cesne
Abstract
•The creation of nationwide network of reference centers in France was associated with improved survival of sarcoma patients•The compliance to clinical practice guidelines over 10 years and the quality of surgery nationwide increased significantly•Improvement in compliance to CPG was seen both in and outside reference centers but the compliance was lower outside•These observations support the systematic referral of sarcoma patients to a network of sarcoma reference centers•Further work on improvement and monitoring of compliance to clinical practice guidelines must be implemented We investigated the impact of the implementation of a network of reference centers for sarcomas (NETSARC) on the care and survival of sarcoma patients in France since 2010.Patients and methodsNETSARC (netsarc.org) is a network of 26 reference sarcoma centers with specialized multidisciplinary tumor boards (MDTB), funded by the French INCA since 2010. Its aims are to improve the quality of diagnosis and care of sarcoma patients. Patients’ characteristics, treatments and outcomes are collected in a nationwide database. The objective of this analysis was to compare the survival of patients in three periods: 2010-12 (non-exhaustive), 2013-15, and 2016-20.Results43,975 patients with sarcomas, GIST or connective tissue tumors of intermediate malignancy were included in the NETSARC+ database since 2010 (n=9,266 before 2013, n=12,274 between 2013-15, n=22,435 in 2016-2020). Median age was 56 years, 50.5% were women, 13.2% had metastasis at diagnosis. Overall survival was significantly superior in the period 2016-20 vs 2013-2015 vs 2010-12 for the entire population, for patients>18, and for both metastatic and non-metastatic patients in univariate and multivariate analyses (p<0.0001).Over the three periods, we observed a significantly improved compliance to clinical practice guidelines nationwide: the proportion of patients biopsied before surgery increased from 62.9% to 72.6%; the percentage of patients presented to NETSARC MDTB before first surgery increased from 31.7% to 44.4% (p<0.0001). The proportion of patients with R0 resection on first surgery increased (from 36.1% to 46.6%), while R2 resection rate decreased (from 10.9% to 7.9%), with a better compliance and improvement in NETSARC centers.ConclusionsThe implementation of the national reference network for sarcoma was associated with an improvement of overall survival and compliance to guidelines nationwide in sarcoma patients. Referral to expert networks for sarcoma patients should be encouraged, though a better compliance to Clinical Practice Guidelines can still be achieved. We investigated the impact of the implementation of a network of reference centers for sarcomas (NETSARC) on the care and survival of sarcoma patients in France since 2010. NETSARC (netsarc.org) is a network of 26 reference sarcoma centers with specialized multidisciplinary tumor boards (MDTB), funded by the French INCA since 2010. Its aims are to improve the quality of diagnosis and care of sarcoma patients. Patients’ characteristics, treatments and outcomes are collected in a nationwide database. The objective of this analysis was to compare the survival of patients in three periods: 2010-12 (non-exhaustive), 2013-15, and 2016-20. 43,975 patients with sarcomas, GIST or connective tissue tumors of intermediate malignancy were included in the NETSARC+ database since 2010 (n=9,266 before 2013, n=12,274 between 2013-15, n=22,435 in 2016-2020). Median age was 56 years, 50.5% were women, 13.2% had metastasis at diagnosis. Overall survival was significantly superior in the period 2016-20 vs 2013-2015 vs 2010-12 for the entire population, for patients>18, and for both metastatic and non-metastatic patients in univariate and multivariate analyses (p<0.0001). Over the three periods, we observed a significantly improved compliance to clinical practice guidelines nationwide: the proportion of patients biopsied before surgery increased from 62.9% to 72.6%; the percentage of patients presented to NETSARC MDTB before first surgery increased from 31.7% to 44.4% (p<0.0001). The proportion of patients with R0 resection on first surgery increased (from 36.1% to 46.6%), while R2 resection rate decreased (from 10.9% to 7.9%), with a better compliance and improvement in NETSARC centers. The implementation of the national reference network for sarcoma was associated with an improvement of overall survival and compliance to guidelines nationwide in sarcoma patients. Referral to expert networks for sarcoma patients should be encouraged, though a better compliance to Clinical Practice Guidelines can still be achieved.