肉瘤环形试验：基于病例对21个德语区肉瘤中心之间的中心间一致性进行的分析。
The sarcoma ring trial: a case-based analysis of inter-center agreement across 21 German-speaking sarcoma centers.
作者信息
Roohani Siyer, Handtke Jolina, Hummedah Kamal, Albertsmeier Markus, Andreou Dimosthenis, Apostolidis Leonidas, Augustin Marinela, Bauer Sebastian, Billner Moritz, Bösch Florian, Deinzer Christoph K W, Deventer Niklas, Duprée Anna, Eckert Franziska, Engel Lars, Fechner Katja, Fritzsche Hagen, Gaidzik Verena, Ghani Saeed, Grützmann Robert, Guder Wiebke K, Hamacher Rainer, Hecker Judith S, Hendricks Anne, Hillmann Axel, Houben Philipp, Hübner Georg, Ivanyi Philipp, Jentsch Christina, Jordan Maren, Kappl Peter, Kaths Moritz, Kessler Torsten, Kirchberg Johanna, Knebel Carolin, Krempien Robert, Lehner Burkhard, Lenze Ulrich, Lindner Lars H, Lörsch Alisa Martina, Maguire Nadia, Müller Sophie, Piso Pompiliu, Potkrajcic Vlatko, Reichardt Peter, Richter Stephan, Schewe Simone, Schiffmann Lars M, Scholten Felicitas, Striefler Jana Käthe, Schwarzbach Matthias, Seidensaal Katharina, Semrau Sabine, Szkandera Joanna, Szuszies Christoph J, Timmermann Beate, Tuchscherer Armin, Wiegering Armin, Winkelmann Moritz T, Kaul David, Jakob Jens
机构信息
Department of Radiation Oncology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
Berlin Institute of Health at Charité-Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité (Junior) Clinician Scientist Program, Berlin, Germany.
出版信息
J Cancer Res Clin Oncol. 2025 Jan 4;151(1):30. doi: 10.1007/s00432-024-06063-z.
PURPOSE
The management of soft tissue sarcoma (STS) at reference centers with specialized multidisciplinary tumor boards (MTB) improves patient survival. The German Cancer Society (DKG) certifies sarcoma centers in German-speaking countries, promoting high standards of care. This study investigated the variability in treatment recommendations for localized STS across different German-speaking tertiary sarcoma centers.
METHODS
In this cross-sectional case-based survey study, 5 anonymized patient cases with imaging data of localized STS were presented to MTBs of 21 German-speaking tertiary referral hospitals. Centers provided recommendations on treatment sequence and modalities, along with the consensus level within their MTB. Agreement percentages were calculated, and consensus levels were rated on a scale of 1 to 10.
RESULTS
Five patient cases were discussed resulting in 105 recommendations. Agreement percentages for case 1 to 5 were 14.3%, 61.9%, 33.3%, 52.4% and 9.3%, with a median agreement percentage of 33.3%. Grouping pre- and postoperative therapies as "perioperative" and including recommendations with and without regional hyperthermia raised the median agreement to 47.6%. The mean consensus level within each center across all 5 cases was 9.5.
CONCLUSION
This first case-based analysis of inter-center agreement for STS management in German-speaking countries reveals low inter-center agreement but high intra-center consensus. Our study includes nearly all tertiary sarcoma centers in German-speaking countries, affirming its strong external validity. These findings suggest potential and clinically very relevant differences in treatment standards among sarcoma centers. Enhanced case-based exchanges and collaborative efforts are needed to reduce discrepancies and standardize the management of STS patients.
目的
在设有专门的多学科肿瘤委员会（MTB）的参考中心对软组织肉瘤（STS）进行管理可提高患者生存率。德国癌症协会（DKG）对德语国家的肉瘤中心进行认证，以促进高标准的医疗服务。本研究调查了德语区不同三级肉瘤中心对局限性STS治疗建议的差异。
方法
在这项基于病例的横断面调查研究中，向21家德语区三级转诊医院的MTB展示了5例具有局限性STS影像数据的匿名患者病例。各中心提供了关于治疗顺序和方式的建议，以及其MTB内部的共识水平。计算了一致率，并将共识水平按1至10分进行评分。
结果
讨论了5例患者病例，共产生105条建议。病例1至5的一致率分别为14.3%、61.9%、33.3%、52.4%和9.3%，一致率中位数为33.3%。将术前和术后治疗归为“围手术期”，并纳入有或无区域热疗的建议后，一致率中位数提高到47.6%。所有5例病例中各中心的平均共识水平为9.5。
结论
这项对德语国家STS管理中心间一致性的首次基于病例的分析显示，中心间一致性较低，但中心内共识较高。我们的研究涵盖了德语国家几乎所有的三级肉瘤中心，证实了其强大的外部有效性。这些发现表明肉瘤中心之间在治疗标准上存在潜在且临床相关性很强的差异。需要加强基于病例的交流与合作，以减少差异并规范STS患者的管理。
Zotero 插件