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NETSARC (netsarc.org) is a network of 26 sarcoma reference centers with specialized multidisciplinary tumor boards (MDT aiming to improve the outcome of sarcoma patients. Since 2010, presentation to an MDTB and expert pathological review are mandatory for sarcoma patients nationwide. In the present work, the impact of surgery in a reference center on the survival of sarcoma patients investigated using this national NETSARC registry.
In this nationwide study, management of patients with sarcoma and aggressive mesenchymal tumors within a network of reference centers endorsed by the National cancer institute was found associated with an improved adherence to international clinical practice guidelines, improvement quality of surgical management and reduced risk of relapse and death.
The French National Cancer Institute (INCa) funded a clinical network for sarcoma (called NETSARC) in 2009, to improve the management and outcome of sarcoma patients. Twenty-six reference centers throughout the nation were identified. A Network for expert pathology diagnosis in sarcoma (RRePS) gathering 23 reference centers for pathology in charge of the second histological review for each suspected case was also created. A common database (netsarc.org) gathering all cases of sarcoma presented to MDTB was created and implemented, collected data on the diagnostic, therapeutic management, and the clinical outcome in terms of relapse and survival.
The aim of the present study was to evaluate (i) the impact of predisposing conditions and patient history and (ii) the impact of surgery carried out in a NETSARC reference center on relapse and survival in the population of patients included in the NETSARC database.
Each NETSARC center organizes an MDTB gathering sarcoma specialized pathologist(s), radiologist(s), surgeon(s), radiation oncologist(s), medical oncologist(s), and often molecular biologist(s), orthopedist(s), and pediatrician(s). All sarcoma or suspected sarcoma patient cases presented to the MDTB of all 26 centers were recorded in the database, by a dedicated team of Clinical research assistant, supervised by three coordinating centers (Centre Leon Brard, Gustave Roussy, Institut Bergoni). Patient files may be presented before any diagnostic procedure, before initial biopsy, before primary surgery, after primary surgery, at relapse, and/or in case of a possible inclusion in a clinical trial. Patients and treatment data were prospectively included and regularly updated by the dedicated study coordinators. A monitoring of the centers activity is carried out by the three coordinating centers on a regular basis. The contribution of the different centers is presented in supplementary Table S1 (available at Annals of Oncology online).
DDLPS, dedifferentiated liposarcoma; GIST, gastrointestinal stromal tumor; HR, hazard ratio; NF1, neurofibromatosis type 1; UPS, undifferentiated pleomorphic sarcoma; WDLPS, well differentiated liposarcoma.
In multivariate analysis, LRFS, EFS, and OS were influenced by patient related factors (gender, age), tumor presentation (site, size, location, metastases at diagnosis), histotypes, and grade. In addition, previous RT negatively correlated to LRFS. Importantly, NF1 condition was the strongest negative prognostic factor for LRFS, EFS, and OS (Table 5). Surgery in a NETSARC center was found consistently associated with a reduction in the risk of local relapse, progression, and death, with hazard ratio of 0.64, 0.83, and 0.68 for LRFS, EFS, and OS (Table 5). The favorable prognostic value of surgery in a NETSARC center was retained in addition to the presentation to a NETSARC MDTB. The later also r
