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 This paucity leaves most health care institutions with low case volumes and outdated or inadequate resources, which impede the ability to offer optimal treatment of these rare and often complicated tumours,” the authors explain.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 Minimising risks of transplants
22.02.2018 | Friedrich-Alexander-Universität Erlangen-Nürnberg

nachricht FAU researchers demonstrate that an oxygen sensor in the body reduces inflammation
22.02.2018 | Friedrich-Alexander-Universität Erlangen-Nürnberg

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: Developing reliable quantum computers

International research team makes important step on the path to solving certification problems

Quantum computers may one day solve algorithmic problems which even the biggest supercomputers today can’t manage. But how do you test a quantum computer to...

Im Focus: In best circles: First integrated circuit from self-assembled polymer

For the first time, a team of researchers at the Max-Planck Institute (MPI) for Polymer Research in Mainz, Germany, has succeeded in making an integrated circuit (IC) from just a monolayer of a semiconducting polymer via a bottom-up, self-assembly approach.

In the self-assembly process, the semiconducting polymer arranges itself into an ordered monolayer in a transistor. The transistors are binary switches used...

Im Focus: Demonstration of a single molecule piezoelectric effect

Breakthrough provides a new concept of the design of molecular motors, sensors and electricity generators at nanoscale

Researchers from the Institute of Organic Chemistry and Biochemistry of the CAS (IOCB Prague), Institute of Physics of the CAS (IP CAS) and Palacký University...

Im Focus: Hybrid optics bring color imaging using ultrathin metalenses into focus

For photographers and scientists, lenses are lifesavers. They reflect and refract light, making possible the imaging systems that drive discovery through the microscope and preserve history through cameras.

But today's glass-based lenses are bulky and resist miniaturization. Next-generation technologies, such as ultrathin cameras or tiny microscopes, require...

Im Focus: Stem cell divisions in the adult brain seen for the first time

Scientists from the University of Zurich have succeeded for the first time in tracking individual stem cells and their neuronal progeny over months within the intact adult brain. This study sheds light on how new neurons are produced throughout life.

The generation of new nerve cells was once thought to taper off at the end of embryonic development. However, recent research has shown that the adult brain...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

VideoLinks
Industry & Economy
Event News

2nd International Conference on High Temperature Shape Memory Alloys (HTSMAs)

15.02.2018 | Event News

Aachen DC Grid Summit 2018

13.02.2018 | Event News

How Global Climate Policy Can Learn from the Energy Transition

12.02.2018 | Event News

 
Latest News

Stiffness matters

22.02.2018 | Life Sciences

Magnetic field traces gas and dust swirling around supermassive black hole

22.02.2018 | Physics and Astronomy

First evidence of surprising ocean warming around Galápagos corals

22.02.2018 | Earth Sciences

VideoLinks
Science & Research
Overview of more VideoLinks >>>