Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.
Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.
Ann Surg Oncol. 2022 Apr;29(4):2275-2285. doi: 10.1245/s10434-021-10908-z. Epub 2021 Oct 11.
Little level 1 evidence exists to guide multimodality treatment in retroperitoneal soft tissue sarcoma (RPS), which may lead to significant variation in therapeutic approaches. This analysis aimed to describe national RPS treatment trends and explore potential variability among low-/high-volume hospitals (LVH/HVHs).
In total, 5992 patients who underwent resection for primary RPS were retrospectively identified in the National Cancer Database (2004-2017). Time trend analyses examined rates of multivisceral resection (MVR), radiation, and chemotherapy use. LVHs were defined as those carrying out fewer than ten resections per year (N = 5433), whereas HVHs were defined as those carrying out ten or more (N = 559). Descriptive statistics and logistic regression models compared trends between groups.
MVR was more frequent at HVHs (63.7% versus 43.5%, p < 0.001). Use of radiation varied widely by hospital volume. HVHs more frequently employed preoperative radiation as compared with LVHs (14.7% versus 8.1%, p < 0.001). Throughout the study period, LVHs increased utilization of preoperative radiation (2.6% to 12.0%, p < 0.001) whereas rates at HVHs remained stable. Overall, LVHs utilized postoperative radiation significantly more frequently as compared with HVHs (14.7% versus 2.7%, respectively, p < 0.001). Postoperative radiation at LVHs remained stable until 2013 and sharply declined thereafter (16.7% to 6.9%, p < 0.001). Rates of postoperative radiation use at HVHs remained lower than those at LVHs at all time points.
Strategies for resection and radiation use at LVHs have trended towards those of HVHs. Current national implementation of preoperative radiation, MVR, and chemotherapy remains heterogeneous. These findings inform future trial design and support standardization of care.
腹膜后软组织肉瘤（RPS）的多模式治疗缺乏 1 级证据，这可能导致治疗方法存在显著差异。本分析旨在描述全国 RPS 治疗趋势，并探讨低/高容量医院（LVH/HVH）之间的潜在变异性。
共回顾性分析了国家癌症数据库（2004-2017 年）中 5992 例接受原发性 RPS 切除术的患者。时间趋势分析检查了多脏器切除术（MVR）、放疗和化疗的使用率。LVH 定义为每年行少于 10 例切除术的医院（N=5433），HVH 定义为每年行 10 例或以上切除术的医院（N=559）。描述性统计和逻辑回归模型比较了两组之间的趋势。
HVH 中 MVR 更为常见（63.7%比 43.5%，p<0.001）。放疗的使用因医院容量而异。HVH 比 LVH 更常采用术前放疗（14.7%比 8.1%，p<0.001）。在整个研究期间，LVH 术前放疗的使用率逐渐增加（从 2.6%增加到 12.0%，p<0.001），而 HVH 的使用率保持稳定。总体而言，LVH 术后放疗的使用率明显高于 HVH（分别为 14.7%和 2.7%，p<0.001）。LVH 术后放疗使用率一直保持稳定，直到 2013 年急剧下降（从 16.7%降至 6.9%，p<0.001）。HVH 术后放疗使用率一直低于 LVH。
LVH 切除和放疗策略的趋势与 HVH 相似。目前全国范围内术前放疗、MVR 和化疗的应用仍存在异质性。这些发现为未来的试验设计提供了信息，并支持了护理的标准化。
