RELEVANCE OF REFERENCE CENTERS

Sarcoma is a heterogenous group of tumors accounting for 1-2% of adult malignancies. Multidisciplinary management is mandatory in order to obtain the best outcome results.

There is not a unique definition for Reference Center in sarcoma, but there are some general characteristics that have to be fulfilled:

  • Multidisciplinary team (oncologist, surgeons, pathologist, radiologist), with weekly meetings.
  • Expertise in sarcoma derived from high volume of patients.
  • Facilities to apply clinical practice guidelines.
  • Involvement in clinical and traslational research.

There are several studies showing the prognostic impact of patient’s management within reference or expert centers.

STUDY YEAR OBJECTIVES N RESULTS CONCLUSIONS
Martin- Broto et al (Spain) 1 2018 Reference Center  (RC) vs Local Hospital (LH) 622

Biopsy (RC vs. LH) on 3-y RFS (66% vs. 46%,  p = .019)

3y- OS (RC vs LH) (82% vs. 70.4%, p = .003).

Perioperative chemo in high-risk STS, and impact on 3y-RFS (66% vs. 44%; p = .011).

Median OS for patients with Stage IV disease (RC vs LH): (30.4 months vs. 18.5 months; p = .036).

 Improved results are seen in Reference Centers with Multidisciplinar teams
Blay JY et al (France) 2 2017 Patients outcome regarding presentation in multidisciplinary boards (MTDB) before of after treatment 12 528

Presentation to a MDTB before treatment was associated with a better compliance to clinical practice guidelines, for example, biopsy before surgery, imaging, quality of initial surgery, and less reoperations (all P<0.001).

Local RFS:  better 2-year for MTDB before (65.4% vs  76.9% , p <0.001)

RFS:  better 2-year for MTDB before (46.6%  vs 51.7% , p<0.001)

 Compliance to clinical practice guidelines and relapse-free survival of sarcoma patientsare better if MTBD discussion is before treatment
Bhanghu et al. (UK) 3 2004 Specialist Center vs General Hospital 263

5-year RFS: 39% vs 19%

OS: HR 0,59 in High Risk

 Centralization improves LC and OS in some.
Ray-Coquard et al. (France) 4 2004 To assess the conformity of medical practice to Clinical Guidelines 100 Presurgery MDT and management in SC: predicted conformity and better LC Treatment strategy within MDT: improves clinical out
Paszat et al. (Canada) 5 2002 Search a surrogate for expertise centers after a population based case series 1467 Risk for die: x1.4 and  for amputation x3 if no treated in SC in the first 3 m Advisable to refer patients with STS within first 3 m
Bauer et al. (Sweden) 6 2001 Report from Scandinavian Registry 1851

CT/MRI preS: 35 vs 80%

Wide margin: 11 vs 66%

LR: 0.7 vs 0.2

 Improving outcome with referring policies
Wiklund et al. (Finland) 7 1996 Compare results after an MDT of STS 134

LR: 48 vs 13%

DFS: 36 vs 69%

 Improved results are seen in that institution with that MDT

RFS: Relapse-free survival; LC: local control; OS: overall Survival; SC: sarcoma center; MDT: Multidisciplinary; STS: soft-tissue sarcoma; LR: local relapse: DFR: disease-free survival.

 

  1. Martin-Broto J, Hindi N, Cruz J, Martinez-Trufero J, Valverde C, De Sande LM, Sala A, Bellido L, De Juan A, Rubió-Casadevall J, Diaz-Beveridge R, Cubedo R, Tendero O, Salinas D, Gracia I, Ramos R, Baguè S, Gutierrez A, Duran-Moreno J, Lopez-Pousa A. Relevance of Reference Centers in Sarcoma Care and Quality Item Evaluation: Results from the Prospective Registry of the Spanish Group for Research in Sarcoma (GEIS). Oncologist. 2018 Nov 8. pii: theoncologist.2018-0121. doi: 10.1634/theoncologist.2018-0121.
  2. Blay JY, 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 JE, Lebbe C, Isambert N, Bertucci F, Toumonde M, Thyss A, Piperno-Neumann S, Dubray-Longeras P, Meeus P, Ducimetière F, Giraud A, Coindre JM, Ray-Coquard I, Italiano A, Le Cesne A; NETSARC/RREPS and French Sarcoma Group–Groupe d’Etude des Tumeurs Osseuses (GSF-GETO) networks. Improved survival using specialized multidisciplinary board in sarcoma patients. Ann Oncol. 2017 Nov 1;28(11):2852-2859. doi: 10.1093/annonc/mdx484.
  3. Bhangu AA, Beard JA, Grimer RJ. Should Soft Tissue Sarcomas be Treated at a Specialist Centre? Sarcoma. 2004;8(1):1-6. doi: 10.1080/13577140410001679185.
  4. Ray-Coquard I, Thiesse P, Ranchère-Vince D, Chauvin F, Bobin JY, Sunyach MP, Carret JP, Mongodin B, Marec-Bérard P, Philip T, Blay JY. Conformity to clinical practice guidelines, multidisciplinary management and outcome of treatment for soft tissue sarcomas. Ann Oncol. 2004 Feb;15(2):307-15.
  5. Paszat L, O’Sullivan B, Bell R, Bramwell V, Groome P, Mackillop W, Bartfay E, Holowaty E. Processes and outcomes of care for soft tissue sarcoma of the extremities. Sarcoma. 2002;6(1):19-26. doi: 10.1080/13577140220127521.
  6. Bauer HC, Trovik CS, Alvegård TA, Berlin O, Erlanson M, Gustafson P, Klepp R, Möller TR, Rydholm A, Saeter G, Wahlström O, Wiklund T. Monitoring referral and treatment in soft tissue sarcoma: study based on 1,851 patients from the Scandinavian Sarcoma Group Register. Acta Orthop Scand. 2001 Apr;72(2):150-9.
  7. Wiklund T, Huuhtanen R, Blomqvist C, Tukiainen E, Virolainen M, Virkkunen P, Asko-Seljavaara S, Björkenheim JM, Elomaa I. The importance of a multidisciplinary group in the treatment of soft tissue sarcomas. Eur J Cancer. 1996 Feb;32A(2):269-73

 

Which are the results of managing patients in expert centers?

  • Better accomplishment of Clinical Practice Guidelines.
  • Better surgical quality: more complete resections.
  • Better local control.
  • Prolonged relapse-free survival and disease-free survival.
  • Prolonged overall survival.
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