Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Patients with soft tissue sarcomas should be treated at centres that see most cases to get best outcomes

10.07.2007
Soft tissue sarcomas -rare tumours of the connective tissue- should be treated at the few centres which see most cases, in order to give patients the best chance of good outcomes, concludes an analysis of sarcoma management in Florida, published in the Annals of Surgery last month.

“STS [soft tissue sarcomas] are rare. This paucity leaves most health care institutions with low case volumes and outdated or inadequate resources, which impede the ability to offer optimal treatment of these rare and often complicated tumours,” the authors explain.

Using an analysis of a large population-based state cancer registry in Florida, the Juan Gutierrez and colleagues tested the hypothesis that soft tissue sarcomas are better treated at institutions with higher volumes of cases. They used the Florida cancer data system, a prospective database of all cancer cases in the state of Florida since 1981, to identify all records of soft tissue sarcomas up to 2001. A total of 6259 cases were extracted and, after duplicates were removed, the researchers arrived at a total of 5564 unique cases. A final study sample of 4205 cases was created by excluding individuals who had non-surgical treatments.

Next, the researchers looked at the medical facilities where each person’s treatment was done. A total of 256 institutions in Florida performed at least one resection of a soft tissue sarcoma between 1981 and 2001; these were grouped into percentile ranges by surgical procedure volume. Of 4673 surgical procedures recorded (including repeat procedures, which were excluded from the main analysis), 7 institutions performed 1504 cases (32.2%) and were classified as high volume centres. The remaining two thirds of institutions did 3169 cases (67.8% of the total) and were classed as low volume. “Our analysis of 20 years’ surgical management of STS in Florida…[showed that] volumes in 213 facilities amounted to less than 1 case per year and less than 2 cases per year were managed at an additional 79 health care institutions,” reported the authors.

Patients at high volume centres were generally younger, with a higher proportion of women, were more likely to have high-grade tumours and were more likely to receive radiation therapy and chemotherapy. When the authors looked at outcomes, they found that 30-day mortality rates were twice as high in low volume centres than in high volume institutions; there was a similar disparity with the 90-day mortality rate. Median 5-year and 10-year survival was significantly better for patients treated at high volume centres (40 months versus 37 months); however, survival of patients with extremity tumours was equal among the two groups of institutions. There was a slight selection bias in favour of the low volume centres because tumours managed at high volume places were higher grade and larger in size but despite this, higher volume centres achieved superior outcomes in patients with high grade lesions and those with tumours over 10 cm in size.

In an additional analysis, the researchers examined outcomes from treatment of extremity tumours alone to establish whether the volume of surgeries done at a centre affected the likelihood of patients keeping their limbs. A total of 1937 extremity tumours were analysed. At high volume centres, 90.6% of procedures for these tumours were limb sparing operations compared with 86.2% at low volume centres, suggesting that physicians at low-volume centres were more likely to resort to amputation to protect the patient’s survival chances.

“This analysis reveals a direct correlation between hospital surgical volume and both short-term and long-term treatment outcomes for STS. While the observations reported here require confirmation with additional independent data sets they argue persuasively for exclusive referral of patients with STS to high volume specialised centres for optimal treatment, survival, and functional outcomes,” conclude the authors.

Corinne Hall | alfa
Further information:
http://www.cancerworld.org/CancerWorld/moduleStaticPage.aspx?id=4588&id_sito=10&id_stato=1

More articles from Health and Medicine:

nachricht Plasmonic biosensors enable development of new easy-to-use health tests
14.12.2017 | Aalto University

nachricht ASU scientists develop new, rapid pipeline for antimicrobials
14.12.2017 | Arizona State University

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Long-lived storage of a photonic qubit for worldwide teleportation

MPQ scientists achieve long storage times for photonic quantum bits which break the lower bound for direct teleportation in a global quantum network.

Concerning the development of quantum memories for the realization of global quantum networks, scientists of the Quantum Dynamics Division led by Professor...

Im Focus: Electromagnetic water cloak eliminates drag and wake

Detailed calculations show water cloaks are feasible with today's technology

Researchers have developed a water cloaking concept based on electromagnetic forces that could eliminate an object's wake, greatly reducing its drag while...

Im Focus: Scientists channel graphene to understand filtration and ion transport into cells

Tiny pores at a cell's entryway act as miniature bouncers, letting in some electrically charged atoms--ions--but blocking others. Operating as exquisitely sensitive filters, these "ion channels" play a critical role in biological functions such as muscle contraction and the firing of brain cells.

To rapidly transport the right ions through the cell membrane, the tiny channels rely on a complex interplay between the ions and surrounding molecules,...

Im Focus: Towards data storage at the single molecule level

The miniaturization of the current technology of storage media is hindered by fundamental limits of quantum mechanics. A new approach consists in using so-called spin-crossover molecules as the smallest possible storage unit. Similar to normal hard drives, these special molecules can save information via their magnetic state. A research team from Kiel University has now managed to successfully place a new class of spin-crossover molecules onto a surface and to improve the molecule’s storage capacity. The storage density of conventional hard drives could therefore theoretically be increased by more than one hundred fold. The study has been published in the scientific journal Nano Letters.

Over the past few years, the building blocks of storage media have gotten ever smaller. But further miniaturization of the current technology is hindered by...

Im Focus: Successful Mechanical Testing of Nanowires

With innovative experiments, researchers at the Helmholtz-Zentrums Geesthacht and the Technical University Hamburg unravel why tiny metallic structures are extremely strong

Light-weight and simultaneously strong – porous metallic nanomaterials promise interesting applications as, for instance, for future aeroplanes with enhanced...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

See, understand and experience the work of the future

11.12.2017 | Event News

Innovative strategies to tackle parasitic worms

08.12.2017 | Event News

AKL’18: The opportunities and challenges of digitalization in the laser industry

07.12.2017 | Event News

 
Latest News

New type of smart windows use liquid to switch from clear to reflective

14.12.2017 | Physics and Astronomy

BigH1 -- The key histone for male fertility

14.12.2017 | Life Sciences

Guardians of the Gate

14.12.2017 | Life Sciences

VideoLinks
B2B-VideoLinks
More VideoLinks >>>