Thorn Andrea, Seem Kristoffer Michael, Talman Maj-Lis, Engelmann Bodil E, Sørensen Michala Skovlund, Aggerholm-Pedersen Ninna, Baad-Hansen Thomas, Petersen Michael Mørk
Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark.
Department of Pathology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark.
Cancers (Basel). 2024 Dec 5;16(23):4077. doi: 10.3390/cancers16234077.
Soft-tissue sarcomas (STSs) are rare and challenging to diagnose due to their heterogeneous presentation. In 2009, Denmark introduced the Cancer Patient Pathways for sarcomas (CPPs) to improve sarcoma treatment by streamlining diagnostic and therapeutic processes. The primary objective of this study is to evaluate the impact of the CPPs on the overall survival of patients with deep-seated, high-grade STSs, comparing outcomes from before and after CPP implementation.
A retrospective cohort study was conducted using data from 712 patients diagnosed with high-grade STSs in the extremities or trunk wall between 2000 and 2018. Patients were grouped into pre-CPP (2000-2008) and post-CPP (2010-2018) cohorts. Overall survival was analyzed using Kaplan-Meier estimates.
The five-year overall survival improved from 43% in the pre-CPP cohort to 52% post-CPP ( = 0.05). Time-to-treatment was significantly reduced in the post-CPP cohort, with a median decrease of 3 days (18 vs. 15 days, < 0.001). We found only a very weak tendency toward larger tumor sizes in the pre-CPP cohort and no difference regarding the percentage of patients that had distant metastases at diagnosis between cohorts. In the post-CPP cohort, the percentage of whoops operations decreased and the use of oncological services increased.
After the introduction of the CPPs for the sarcoma patients, overall survival improved and time to treatment was reduced. This study highlights the importance of efficient referral pathways in improving cancer outcomes but cannot exclude that other factors could also have contributed.
软组织肉瘤（STSs）较为罕见，因其表现各异，诊断颇具挑战性。2009年，丹麦推出了肉瘤癌症患者诊疗路径（CPPs），旨在通过简化诊断和治疗流程来改善肉瘤治疗。本研究的主要目的是评估CPPs对深部、高级别STSs患者总生存期的影响，比较CPPs实施前后的结果。
采用2000年至2018年间712例被诊断为四肢或躯干壁高级别STSs患者的数据进行回顾性队列研究。患者被分为CPP实施前（2000 - 2008年）和CPP实施后（2010 - 2018年）队列。使用Kaplan - Meier估计法分析总生存期。
五年总生存率从CPP实施前队列的43%提高到CPP实施后的52%（P = 0.05）。CPP实施后队列的治疗时间显著缩短，中位数减少了3天（18天对15天，P < 0.001）。我们发现CPP实施前队列中肿瘤尺寸仅呈现非常微弱的增大趋势，且队列间诊断时发生远处转移的患者百分比无差异。在CPP实施后队列中，失误手术的百分比降低，肿瘤学服务的使用增加。
在为肉瘤患者引入CPPs后，总生存期得到改善，治疗时间缩短。本研究强调了高效转诊路径在改善癌症治疗结果中的重要性，但不能排除其他因素也可能起到了作用。
