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

Melissa Vos; Harriet G. T. Blaauwgeers; Vincent K. Y. Ho; Winan J. van Houdt; Jos A. van der Hage; Lukas B. Been; Johannes J. Bonenkamp; Marc H. A. Bemelmans; Thijs van Dalen; Rick L. Haas; Dirk J. Grunhagen; Cornelis Verhoef; Dutch Sarcoma Study Group (DSSG)

doi:10.1016/j.ejca.2019.01.005

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

Melissa Vos^*, Harriet G. T. Blaauwgeers, Vincent K. Y. Ho, Winan J. van Houdt, Jos A. van der Hage, Lukas B. Been, Johannes J. Bonenkamp, Marc H. A. Bemelmans, Thijs van Dalen, Rick L. Haas, Dirk J. Grunhagen, Cornelis Verhoef, Dutch Sarcoma Study Group (DSSG)

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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.

Original language	English
Pages (from-to)	98-106
Number of pages	9
Journal	European Journal of Cancer
Volume	110
DOIs	https://doi.org/10.1016/j.ejca.2019.01.005
Publication status	Published - Mar 2019

Keywords

Soft tissue sarcoma
Centralisation
Survival
Surgery
DIAGNOSIS

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Vos, M., Blaauwgeers, H. G. T., Ho, V. K. Y., van Houdt, W. J., van der Hage, J. A., Been, L. B., Bonenkamp, J. J., Bemelmans, M. H. A., van Dalen, T., Haas, R. L., Grunhagen, D. J., Verhoef, C., & Dutch Sarcoma Study Group (DSSG) (2019). 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. European Journal of Cancer, 110, 98-106. https://doi.org/10.1016/j.ejca.2019.01.005

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title = "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.",

keywords = "Soft tissue sarcoma, Centralisation, Survival, Surgery, DIAGNOSIS",

author = "Melissa Vos and Blaauwgeers, {Harriet G. T.} and Ho, {Vincent K. Y.} and {van Houdt}, {Winan J.} and {van der Hage}, {Jos A.} and Been, {Lukas B.} and Bonenkamp, {Johannes J.} and Bemelmans, {Marc H. A.} and {van Dalen}, Thijs and Haas, {Rick L.} and Grunhagen, {Dirk J.} and Cornelis Verhoef and {Dutch Sarcoma Study Group (DSSG)}",

note = "Publisher Copyright: {\textcopyright} 2019 Elsevier Ltd",

year = "2019",

month = mar,

doi = "10.1016/j.ejca.2019.01.005",

language = "English",

volume = "110",

pages = "98--106",

journal = "European Journal of Cancer",

issn = "0959-8049",

publisher = "Elsevier Ltd",

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Vos, M, Blaauwgeers, HGT, Ho, VKY, van Houdt, WJ, van der Hage, JA, Been, LB, Bonenkamp, JJ, Bemelmans, MHA, van Dalen, T, Haas, RL, Grunhagen, DJ, Verhoef, C & Dutch Sarcoma Study Group (DSSG) 2019, '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', European Journal of Cancer, vol. 110, pp. 98-106. https://doi.org/10.1016/j.ejca.2019.01.005

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. / Vos, Melissa; Blaauwgeers, Harriet G. T.; Ho, Vincent K. Y. et al.
In: European Journal of Cancer, Vol. 110, 03.2019, p. 98-106.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Increased survival of non low-grade and deep-seated soft tissue sarcoma after surgical management in high-volume hospitals

T2 - a nationwide study from the Netherlands

AU - Vos, Melissa

AU - Blaauwgeers, Harriet G. T.

AU - Ho, Vincent K. Y.

AU - van Houdt, Winan J.

AU - van der Hage, Jos A.

AU - Been, Lukas B.

AU - Bonenkamp, Johannes J.

AU - Bemelmans, Marc H. A.

AU - van Dalen, Thijs

AU - Haas, Rick L.

AU - Grunhagen, Dirk J.

AU - Verhoef, Cornelis

AU - Dutch Sarcoma Study Group (DSSG)

PY - 2019/3

Y1 - 2019/3

N2 - 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.

AB - 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.

KW - Soft tissue sarcoma

KW - Centralisation

KW - Survival

KW - Surgery

KW - DIAGNOSIS

U2 - 10.1016/j.ejca.2019.01.005

DO - 10.1016/j.ejca.2019.01.005

M3 - Article

C2 - 30776758

SN - 0959-8049

VL - 110

SP - 98

EP - 106

JO - European Journal of Cancer

JF - European Journal of Cancer

ER -

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

Keywords

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