Rugge Massimo, Buja Alessandra, Tropea Saveria, Girardi Giovanni, Cozzolino Claudia, Zorzi Manuel, Vecchiato Antonella, Stefano Antonella, Del Fiore Paolo, Brunello Antonella, Brazzale Alessandra, Sbaraglia Marta, Dei Tos Angelo Paolo, Baldo Vincenzo, Benini Patrizia, Bortolami Alberto, Rastrelli Marco, Dall'Olmo Luigi, Rossi Carlo Riccardo, Mocellin Simone
Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy.
Veneto Tumor Registry, Azienda Zero, Padua, Italy.
Front Med (Lausanne). 2023 Aug 8;10:1226090. doi: 10.3389/fmed.2023.1226090. eCollection 2023.
Soft tissue sarcomas (STS) are rare malignancies which prognosis varies significantly by primary site, histological subtype, and tumor stage. Their low incidence, and the complexity of their clinico-pathological characteristics demand standardized, cancer-tailored diagnostics and therapies managed at high-volume, multidisciplinary care centers. This study evaluates the quality of STS management in north-east Italy (Veneto Region) through a list of defined clinical indicators.
This population-based study concerns all incident cases of STS in 2018 (214 cases) recorded in the adult population censored by the Veneto's regional Cancer Registry. Based on the international literature, a multidisciplinary working group of experts identified a set of indicators for monitoring the quality of diagnostic, therapeutic, and end-of-life clinical interventions. The quality of care was assessed by comparing the reference thresholds with the indicators' values achieved in clinical practice.
Diagnostic procedures showed poor adherence to the thresholds, with a low percentage of histological diagnoses validated by a second opinion. The indicators relating to the surgical treatment of superficial, small, low-grade STS, or of medium, high-grade STS of the head-neck, trunk, or limbs were consistent with the thresholds, while for intermediate, high-grade (large-sized, deep) and retroperitoneal STS they fell significantly below the thresholds.
A critical evaluation of the clinical indicators allowed to uncover the procedures needing corrective action. Monitoring clinical care indicators improves cancer care, confirms the importance of managing rare cancers at highly specialized, high-volume centers, and promotes the ethical sustainability of the healthcare system.
软组织肉瘤（STS）是罕见的恶性肿瘤，其预后因原发部位、组织学亚型和肿瘤分期而有显著差异。它们发病率低，临床病理特征复杂，需要在大容量的多学科护理中心进行标准化的、针对癌症的诊断和治疗。本研究通过一系列明确的临床指标评估意大利东北部（威尼托地区）STS的管理质量。
这项基于人群的研究涉及2018年威尼托地区癌症登记处记录的成年人口中所有STS新发病例（214例）。基于国际文献，一个多学科专家工作组确定了一组用于监测诊断、治疗和临终临床干预质量的指标。通过将参考阈值与临床实践中指标的实际值进行比较来评估护理质量。
诊断程序对阈值的依从性较差，经二次诊断验证的组织学诊断比例较低。与浅表、小型、低级别STS或头颈、躯干或四肢的中级、高级别STS手术治疗相关的指标与阈值一致，而对于中级、高级别（大型、深部）和腹膜后STS，这些指标明显低于阈值。
对临床指标的批判性评估有助于发现需要采取纠正措施的程序。监测临床护理指标可改善癌症护理，证实了在高度专业化、大容量中心管理罕见癌症的重要性，并促进医疗保健系统的伦理可持续性。
