Improved nationwide survival of sarcoma patients with a network of reference centers
J.Y. Blay
(1, 2)
,
N. Penel
(3)
,
T. Valentin
(4, 5)
,
P. Anract
(6)
,
F. Duffaud
(7)
,
A. Dufresne
(1, 2)
,
B. Verret
(8)
,
A. Cordoba
(3)
,
A. Italiano
(9)
,
M. Brahmi
(1, 2)
,
C. Henon
(8)
,
T. Amouyel
(3)
,
I. Ray-Coquard
(1)
,
G. Ferron
(5, 4)
,
P. Boudou-Rouquette
(6)
,
C. Tlemsani
(6)
,
S. Salas
(7)
,
R. Rochwerger
(7)
,
M. Faron
(8, 10)
,
E. Bompas
(6, 11)
,
A. Ducassou
(4, 5)
,
D. Gangloff
(5, 4)
,
F. Gouin
(1, 2, 12)
,
N. Firmin
(13, 14)
,
S. Piperno-Neumann
(15, 16)
,
M. Rios
(17)
,
M. Ropars
(18)
,
J.E. Kurtz
(19)
,
L.R. Le Nail
(20)
,
F. Bertucci
(21)
,
S. Carrere
(12)
,
C. Llacer
(12)
,
S. Watson
(14)
,
S. Bonvalot
(14)
,
A. Leroux
(16)
,
C. Perrin
(22)
,
J. Gantzer
(23)
,
M. Pracht
(22)
,
B. Narciso
(20)
,
A. Monneur
(21)
,
C. Lebbe
(24, 25)
,
A. Hervieu
(26)
,
E. Saada-Bouzid
(27)
,
P. Dubray-Longeras
(28)
,
F. Fiorenza
(29)
,
L. Chaigneau
(30)
,
Z.-M. Nevieres
(30)
,
P. Soibinet
(31)
,
O. Bouché
(32)
,
C. Guillemet
(33)
,
J.P. Spano
(34)
,
J.C. Ruzic
(35)
,
N. Isambert
(36)
,
G. Vaz
(1, 2)
,
P. Meeus
(1, 2)
,
M. Karanian
(1, 2)
,
C. Ngo
(8)
,
J.M. Coindre
(9)
,
G. de Pinieux
(9)
,
F. Le Loarer
(9)
,
F. Ducimetiere
(1, 2)
,
C. Chemin
(1, 2)
,
M. Morelle
(1, 2)
,
M. Toulmonde
(9)
,
A. Le Cesne
(8)
1
Centre Léon Bérard [Lyon]
2 UCBL - Université Claude Bernard Lyon 1
3 UNICANCER/Lille - Centre Régional de Lutte contre le Cancer Oscar Lambret [Lille]
4 ICR - Institut Claudius Regaud
5 IUCT Oncopole - UMR 1037 - Institut Universitaire du Cancer de Toulouse - Oncopole
6 Hôpital Cochin [AP-HP]
7 TIMONE - Hôpital de la Timone [CHU - APHM]
8 Département de médecine oncologique [Gustave Roussy]
9 Institut Bergonié [Bordeaux]
10 U1018 (Équipe 2) - Oncostat
11 UNICANCER/ICO - Institut de Cancérologie de l'Ouest [Angers/Nantes]
12 CHU Nantes - Centre Hospitalier Universitaire de Nantes = Nantes University Hospital
13 MCD - Unité de biologie Moléculaire, Cellulaire et du Développement
14 ICM - Institut régional de Cancérologie de Montpellier
15 Institut Curie [Paris]
16 IRCM - U1194 Inserm - UM - Institut de Recherche en Cancérologie de Montpellier
17 UNICANCER/ICL - Institut de Cancérologie de Lorraine - Alexis Vautrin [Nancy]
18 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Pontchaillou]
19 ICANS - Institut de Cancérologie de Strasbourg Europe
20 CHU Trousseau [Tours]
21 IPC - Institut Paoli-Calmettes
22 CRLCC - CRLCC Eugène Marquis
23 Service d'oncologie médicale [ICL Alexis Vautrin]
24 HIPI (UMR_S_976 / U976) - Immunologie humaine, physiopathologie & immunothérapie
25 AP-HP - Hopital Saint-Louis [AP-HP]
26 Département d'oncologie médicale [Centre Georges-François Leclerc]
27 Department of Oncology, Antoine Lacassagne Comprehensive Cancer Center
28 UNICANCER/CJP - Centre Jean Perrin [Clermont-Ferrand]
29 CHU Limoges
30 CHRU Besançon - Centre Hospitalier Régional Universitaire de Besançon
31 UNICANCER/CRLC - Centre Régional de Lutte contre le Cancer François Baclesse [Caen]
32 CHU Reims - Hôpital universitaire Robert Debré [Reims]
33 Institut Jean Godinot [Reims]
34 CHU Pitié-Salpêtrière [AP-HP]
35 CHU La Réunion - Centre Hospitalier Universitaire de La Réunion
36 CHU de Poitiers [La Milétrie] - Centre hospitalier universitaire de Poitiers = Poitiers University Hospital
2 UCBL - Université Claude Bernard Lyon 1
3 UNICANCER/Lille - Centre Régional de Lutte contre le Cancer Oscar Lambret [Lille]
4 ICR - Institut Claudius Regaud
5 IUCT Oncopole - UMR 1037 - Institut Universitaire du Cancer de Toulouse - Oncopole
6 Hôpital Cochin [AP-HP]
7 TIMONE - Hôpital de la Timone [CHU - APHM]
8 Département de médecine oncologique [Gustave Roussy]
9 Institut Bergonié [Bordeaux]
10 U1018 (Équipe 2) - Oncostat
11 UNICANCER/ICO - Institut de Cancérologie de l'Ouest [Angers/Nantes]
12 CHU Nantes - Centre Hospitalier Universitaire de Nantes = Nantes University Hospital
13 MCD - Unité de biologie Moléculaire, Cellulaire et du Développement
14 ICM - Institut régional de Cancérologie de Montpellier
15 Institut Curie [Paris]
16 IRCM - U1194 Inserm - UM - Institut de Recherche en Cancérologie de Montpellier
17 UNICANCER/ICL - Institut de Cancérologie de Lorraine - Alexis Vautrin [Nancy]
18 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Pontchaillou]
19 ICANS - Institut de Cancérologie de Strasbourg Europe
20 CHU Trousseau [Tours]
21 IPC - Institut Paoli-Calmettes
22 CRLCC - CRLCC Eugène Marquis
23 Service d'oncologie médicale [ICL Alexis Vautrin]
24 HIPI (UMR_S_976 / U976) - Immunologie humaine, physiopathologie & immunothérapie
25 AP-HP - Hopital Saint-Louis [AP-HP]
26 Département d'oncologie médicale [Centre Georges-François Leclerc]
27 Department of Oncology, Antoine Lacassagne Comprehensive Cancer Center
28 UNICANCER/CJP - Centre Jean Perrin [Clermont-Ferrand]
29 CHU Limoges
30 CHRU Besançon - Centre Hospitalier Régional Universitaire de Besançon
31 UNICANCER/CRLC - Centre Régional de Lutte contre le Cancer François Baclesse [Caen]
32 CHU Reims - Hôpital universitaire Robert Debré [Reims]
33 Institut Jean Godinot [Reims]
34 CHU Pitié-Salpêtrière [AP-HP]
35 CHU La Réunion - Centre Hospitalier Universitaire de La Réunion
36 CHU de Poitiers [La Milétrie] - Centre hospitalier universitaire de Poitiers = Poitiers University Hospital
Résumé
Background: We investigated the impact of the implementation of a network of reference centers for sarcomas (NETSARC) on the care and survival of sarcoma patients in France since 2010.
Patients and methods: NETSARC (netsarc.org) is a network of 26 reference sarcoma centers with specialized multidisciplinary tumor boards (MDTBs), funded by the French National Cancer Institute (INCa) since 2010. Its aims are to improve the quality of diagnosis and care of sarcoma patients. Patients' characteristics, treatments, and outcomes are collected in a nationwide database. The objective of this analysis was to compare the survival of patients in three periods: 2010-2012 (non-exhaustive), 2013-2015, and 2016-2020.
Results: A total of 43 975 patients with sarcomas, gastrointestinal stromal tumors (GISTs), or connective tissue tumors of intermediate malignancy were included in the NETSARC+ database since 2010 (n = 9266 before 2013, n = 12 274 between 2013 and 2015, n = 22 435 in 2016-2020). Median age was 56 years, 50.5% were women, and 13.2% had metastasis at diagnosis. Overall survival was significantly superior in the period 2016-2020 versus 2013-2015 versus 2010-2012 for the entire population, for patients >18 years of age, and for both metastatic and non-metastatic patients in univariate and multivariate analyses (P < 0.0001). Over the three periods, we observed a significantly improved compliance to clinical practice guidelines (CPGs) nationwide: the proportion of patients biopsied before surgery increased from 62.9% to 72.6%; the percentage of patients presented to NETSARC MDTBs before first surgery increased from 31.7% to 44.4% (P < 0.0001). The proportion of patients with R0 resection on first surgery increased (from 36.1% to 46.6%), while R2 resection rate decreased (from 10.9% to 7.9%), with a better compliance and improvement in NETSARC centers.
Conclusions: The implementation of the national reference network for sarcoma was associated with an improvement of overall survival and compliance to guidelines nationwide in sarcoma patients. Referral to expert networks for sarcoma patients should be encouraged, though a better compliance to CPGs can still be achieved.
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