Improved survival for extremity soft tissue sarcoma treated in high-volume facilities

Tyler Abarca; Yubo Gao; Varun Monga; Munir R Tanas; Mohammed M Milhem; Benjamin J Miller

doi:10.1002/jso.25052

Back

Improved survival for extremity soft tissue sarcoma treated in high-volume facilities

Journal article

Peer reviewed

Improved survival for extremity soft tissue sarcoma treated in high-volume facilities

Tyler Abarca, Yubo Gao, Varun Monga, Munir R Tanas, Mohammed M Milhem and Benjamin J Miller

Journal of surgical oncology, Vol.117(7), pp.1479-1486

06/2018

DOI: 10.1002/jso.25052

PMCID: PMC6322682

PMID: 29633281

View Online

Abstract

The purpose of this investigation was to determine the effect of hospital volume on treatment decisions, treatment results, and overall patient survival in extremity soft tissue sarcoma. The National Cancer Database was used to identify patients ≥18 years of age with non-metastatic soft tissue sarcoma of the extremity treated with surgery. Patients in high- and low-volume centers were matched by propensity score and placed into two equal comparative groups of 2437 patients each. Chemotherapy was used at a higher rate in high-volume centers (22% vs 17%, P < 0.001) and external beam radiation usage was similar (55% vs 52%, P = 0.108). There was a lower incidence of positive margins in high-volume centers (12% vs 17%, P < 0.001). There was no significant difference in the rates of limb salvage surgery or readmissions at high-volume hospitals compared to low-volume. In a multivariate Cox proportional hazards model, low-volume facilities demonstrated diminished overall survival at all time points (hazard ratio at 5 years = 1.24, 95%CI 1.10-1.39). Treatment at high-volume hospitals was associated with fewer positive margins and increased overall survival at 2, 5, and 10 years. Continued efforts should focus on optimizing the balance between patient access to specialty care and experience of the treating center.

Extremities - surgery

Prognosis

Follow-Up Studies

Limb Salvage - mortality

Humans

Middle Aged

Extremities - pathology

Male

Survival Rate

Treatment Outcome

Sarcoma - pathology

Propensity Score

Sarcoma - surgery

Sarcoma - mortality

Female

Hospitals, High-Volume - statistics & numerical data

Cohort Studies

Databases, Factual

Details

Title: Subtitle: Improved survival for extremity soft tissue sarcoma treated in high-volume facilities
Creators: Tyler Abarca - Carver College of Medicine, University of Iowa, Iowa City, Iowa
Yubo Gao - Department of Internal Medicine, University of Iowa, Iowa City, Iowa
Varun Monga - Division of Hematology, Oncology, and Blood and Marrow Transplantation, Department of Internal Medicine, University of Iowa, Iowa City, Iowa
Munir R Tanas - Department of Pathology, University of Iowa, Iowa City, Iowa
Mohammed M Milhem - Division of Hematology, Oncology, and Blood and Marrow Transplantation, Department of Internal Medicine, University of Iowa, Iowa City, Iowa
Benjamin J Miller - Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, Iowa
Resource Type: Journal article
Publication Details: Journal of surgical oncology, Vol.117(7), pp.1479-1486
DOI: 10.1002/jso.25052
PMID: 29633281
PMCID: PMC6322682
NLM abbreviation: J Surg Oncol
ISSN: 0022-4790
eISSN: 1096-9098
Publisher: United States
Grant note: T35 HL007485 / NHLBI NIH HHS P30 CA086862 / NCI NIH HHS
Language: English
Date published: 06/2018
Academic Unit: Hematology, Oncology, and Blood & Marrow Transplantation; Pathology; Orthopedics and Rehabilitation; Internal Medicine
Record Identifier: 9984040396802771

Metrics

22 Record Views

74 Times Cited - Web of Science

See more details