Clinical and Epidemiological Research Unit, Institut Bergonié, Comprehensive Cancer Centre, Bordeaux.
Ann Oncol. 2014 Jan;25(1):225-31. doi: 10.1093/annonc/mdt407. Epub 2013 Nov 26.
Soft-tissue sarcomas (STSs) are rare tumors with varied histological presentations. Management and treatment are thus complex, but crucial for patient outcomes. We assess adherence to adult STS management guidelines across two French regions (10% of the French population). We also report standardized incidence.
STS patients diagnosed from 1 November 2006 to 31 December 2007 were identified from pathology reports, medical hospital records, and cancer registries. Guideline adherence was assessed by 23 criteria (validated by Delphi consensus method), and age and sex-standardized incidence rates estimated. Associations between patient, treatment, and institutional factors and adherence with three major composite criteria relating to diagnostic imaging and biopsy as well as multidisciplinary team (MDT) case-review are reported.
Two hundred and seventy-four patients were included (57.7% male, mean age 60.8 years). Practices were relatively compliant overall, with over 70% adherence for 10 criteria. Three criteria with perfect Delphi consensus had low adherence: receiving histological diagnosis before surgery, adequacy of histological diagnosis (adherence around 50% for both), and MDT discussion before surgery (adherence <30%). Treatment outside of specialized centers was associated with lower adherence for all three composite criteria, and specific tumor sites and/or features were associated with lower adherence for diagnostic imaging, methods, and MDT meetings. STS standardized incidence rates were 4.09 (European population) and 3.33 (World) /100 000 inhabitants.
Initial STS diagnosis and treatment across all stages (imaging, biopsy, and MDT meetings) need improving, particularly outside specialized centers. Educational interventions to increase surgeon's sarcoma awareness and knowledge and to raise patients' awareness of the importance of seeking expert care are necessary.
软组织肉瘤（STS）是一种罕见的肿瘤，具有多种组织学表现。因此，其管理和治疗非常复杂，但对患者的预后至关重要。我们评估了法国两个地区（占法国人口的 10%）对成人 STS 管理指南的遵守情况。我们还报告了标准化发病率。
从病理报告、医疗病历和癌症登记处确定了 2006 年 11 月 1 日至 2007 年 12 月 31 日期间诊断为 STS 的患者。通过 23 项标准评估指南的遵守情况（通过 Delphi 共识方法验证），并估计年龄和性别标准化发病率。报告了患者、治疗和机构因素与三个主要综合标准之间的关联，这些标准与诊断成像和活检以及多学科团队（MDT）病例审查有关。
共纳入 274 例患者（57.7%为男性，平均年龄 60.8 岁）。总体而言，实践相对符合规定，有 10 项标准的符合率超过 70%。有三项德尔菲共识标准的一致性很差：手术前获得组织学诊断、组织学诊断的充分性（两项标准的符合率均在 50%左右）和手术前 MDT 讨论（符合率<30%）。在专门中心之外进行治疗与所有三个综合标准的低符合率相关，特定的肿瘤部位和/或特征与诊断成像、方法和 MDT 会议的低符合率相关。STS 的标准化发病率为 4.09（欧洲人口）和 3.33（世界）/每 10 万居民。
所有阶段（成像、活检和 MDT 会议）的初始 STS 诊断和治疗都需要改进，特别是在专门中心之外。需要进行教育干预，以提高外科医生对肉瘤的认识和知识，并提高患者对寻求专家治疗的重要性的认识。
