Increased survival of non low-grade and deep-seated soft tissue sarcoma after surgical management in high-volume hospitals: a nationwide study from the Netherlands

Abstract

Background: Diagnosing and treating soft tissue sarcomas (STSs) remains challenging, stressing the urgency for centralisation. This nationwide survey aimed to evaluate the centralisation of STS surgery and its effect on survival.Methods: Patients operated for primary STS from 2006 to 2015 were queried from the Netherlands Cancer Registry. Hospitals in which STS surgery was performed were allocated into three categories: low-volume (1-9 resections per year), medium-volume (10-19 resections) or high-volume (>= 20 resections). Differences in tumour characteristics and outcome were calculated. A multivariable regression analysis was performed to adjust for case-mix.Results: Of the 5282 identified patients, 42% was treated in low-volume hospitals, 7.7% in medium-volume hospitals and 51% in high-volume hospitals, with a significant trend over time towards treatment in a high-volume hospital (p < 0.01). In high-volume hospitals, more often patients with non low-grade, large and deep-seated tumours were treated than in low-volume hospitals. For the whole group, there was no survival benefit for patients treated in high-volume hospitals, with 10-year net survival rates of 76% (low-volume), 68% (medium-volume) and 68% (high-volume). However, subgroup analysis for patients with non low-grade and deep-seated tumours did reveal a benefit from treatment in a high-volume hospitals with 10-year survival rates of 54% (high-volume), 49% (low-volume) and 42% (medium-volume) and a relative risk of 1.3 (high-volume versus low-volume, p = 0.03).Conclusion: Centralisation of STS surgery has increased in the past decade. Surgery in a highvolume hospital improved survival of patients with non low-grade and deep-seated tumours, and therefore these patients should be referred to such a hospital. (C) 2019 Elsevier Ltd. All rights reserved.