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Article Dans Une Revue Annals of Oncology Année : 2019

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

1 Department of Medical Oncology [Lyon]
2 Institut de Cancérologie Lucien Neuwirth
3 Département de Chirurgie cancérologique
4 IGR - Institut Gustave Roussy
5 Département d'oncologie médicale
6 UNICANCER/Lille - Centre Régional de Lutte contre le Cancer Oscar Lambret [Lille]
7 UNICANCER/ICO - Institut de Cancérologie de l'Ouest [Angers/Nantes]
8 CHU Trousseau [Tours]
9 IUCT Oncopole - UMR 1037 - Institut Universitaire du Cancer de Toulouse - Oncopole
10 Service d’Oncologie Médicale [Hôpital de la Timone - APHM]
11 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
12 CRLCC - CRLCC Eugène Marquis
13 IRCM - U1194 Inserm - UM - Institut de Recherche en Cancérologie de Montpellier
14 UNICANCER/ICL - Institut de Cancérologie de Lorraine - Alexis Vautrin [Nancy]
15 CRLCC Paul Strauss - Centre Paul Strauss
16 IPC - Institut Paoli-Calmettes
17 UNICANCER/CAL - Centre de Lutte contre le Cancer Antoine Lacassagne [Nice]
18 Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris]
19 Service de chirurgie [Centre Georges-François Leclerc]
20 Department of Surgical Oncology
21 Service d'Oncologie médicale [CHU Limoges]
22 Service d'Oncologie Médicale [CHRU Besançon]
23 Institut Jean Godinot [Reims]
24 UNICANCER/CRLC - Centre Régional de Lutte contre le Cancer François Baclesse [Caen]
25 CLCC Henri Becquerel - Centre de Lutte Contre le Cancer Henri Becquerel Normandie Rouen
26 CHU Pitié-Salpêtrière [AP-HP]
27 Institut Claudius Regaud
28 OSS - Oncogenesis Stress Signaling
29 CRCM - Centre de Recherche en Cancérologie de Marseille
30 Département de radiothérapie [Gustave Roussy]
31 CERMAV - Centre de Recherches sur les Macromolécules Végétales
32 Centre Léon Bérard [Lyon]
33 Laboratoire Interdisciplinaire de Recherche Impliquant la Géologie et la Mécanique
34 Institut Bergonié [Bordeaux]
35 Institut Curie [Paris]
P. Anract
  • Fonction : Auteur
A. Di Marco
  • Fonction : Auteur
Francis Guillemin
J.-P. Spano
J.-C. Ruzic
  • Fonction : Auteur
A. Michot
  • Fonction : Auteur
P. Soibinet
  • Fonction : Auteur
E. Bompas
  • Fonction : Auteur
F. Duffaud
  • Fonction : Auteur
M. Rios
  • Fonction : Auteur
F. Le Loarer
  • Fonction : Auteur
O. Collard
  • Fonction : Auteur
M. Karanian-Philippe
  • Fonction : Auteur
M. Brahmi
  • Fonction : Auteur
A. Dupré
  • Fonction : Auteur
I. Ray-Coquard
  • Fonction : Auteur

Résumé

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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Dates et versions

hal-02509515 , version 1 (03-06-2020)

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Paternité - Pas d'utilisation commerciale

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Citer

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, 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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