Department of Sarcoma and General Surgery, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK.
National Cancer Registration and Analysis Service, NHS Digital, Wellington Place, Leeds LS1 4AP, UK.
Eur J Cancer. 2023 Jul;188:20-28. doi: 10.1016/j.ejca.2023.04.004. Epub 2023 Apr 17.
Consensus guidelines outline that patients with primary retroperitoneal sarcoma (RPS) should be managed within specialist sarcoma centres (SSC). There is, however, a paucity of population-based data detailing incidence and outcomes in these patients. Hence, we aimed to evaluate patterns of care among RPS patients in England and compare outcomes for those undergoing surgery in high-volume specialist sarcoma centres (HV-SSC), low-volume SSC (LV-SSC), and non-SSC (N-SSC).
Data on patients diagnosed with primary RPS between 2013 and 2018 were extracted from NHS Digital's National Cancer Registration and Analysis Service using the national cancer registration dataset. Diagnostic pathways, treatment, and survival outcomes were compared between HV-SSC, LV-SSC, and N-SSC. Uni- and multivariate analyses were calculated.
Of 1878 patients diagnosed with RPS, 1120 (60%) underwent surgery within 12 months of diagnosis, with 847 (76%) operated on at SSC; of these, 432 patients (51%) were operated on in HV-SSC, and 415 (49%) in LV-SSC. One- and 5-year estimated overall survival (OS) rates for patients undergoing surgery in N-SSC were 70.6% (95% confidence interval [CI]: 64.8-75.7) and 42.0% (CI: 35.9-47.9), compared to 85.0% (CI: 81.1-88.1) and 51.7% (CI: 46.6-56.6) in LV-SSC (p < 0.01), and 87.4% (CI: 83.9-90.2) and 62.8% (CI: 57.9-67.4) in HV-SSC, (p < 0.01). After adjusting for patient- and treatment-related factors, patients treated in HV-SSC were found to have significantly longer OS than those treated at LV-SSC, with an adjusted hazard ratio of 0.78 (CI: 0.62-0.96, p < 0.05).
Patients with RPS undergoing surgery in HV-SSC have significantly better survival outcomes than those treated in N-SSC and L-SSC.
共识指南概述了原发性腹膜后肉瘤（RPS）患者应在肉瘤专科中心（SSC）进行管理。然而，缺乏详细描述这些患者发病率和结局的基于人群的数据。因此，我们旨在评估英国 RPS 患者的治疗模式，并比较在高容量肉瘤专科中心（HV-SSC）、低容量 SSC（LV-SSC）和非 SSC（N-SSC）接受手术的患者的结局。
从 NHS Digital 的国家癌症登记和分析服务中提取了 2013 年至 2018 年间诊断为原发性 RPS 的患者数据，使用国家癌症登记数据集。比较 HV-SSC、LV-SSC 和 N-SSC 之间的诊断途径、治疗和生存结局。计算单变量和多变量分析。
在 1878 名诊断为 RPS 的患者中，1120 名（60%）在诊断后 12 个月内接受了手术，其中 847 名（76%）在 SSC 接受了手术；其中，432 名（51%）在 HV-SSC 接受了手术，415 名（49%）在 LV-SSC 接受了手术。在 N-SSC 接受手术的患者的 1 年和 5 年估计总生存率（OS）分别为 70.6%（95%置信区间 [CI]：64.8-75.7）和 42.0%（CI：35.9-47.9），而在 LV-SSC 则分别为 85.0%（CI：81.1-88.1）和 51.7%（CI：46.6-56.6）（p<0.01），在 HV-SSC 中分别为 87.4%（CI：83.9-90.2）和 62.8%（CI：57.9-67.4）（p<0.01）。调整患者和治疗相关因素后，发现 HV-SSC 治疗的患者 OS 明显长于 LV-SSC 治疗的患者，调整后的风险比为 0.78（CI：0.62-0.96，p<0.05）。
在 HV-SSC 接受手术治疗的 RPS 患者的生存结局明显优于在 N-SSC 和 L-SSC 接受治疗的患者。
