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Adherence to National Comprehensive Cancer Network Guidelines is Associated with Improved Survival for Patients with Stage 2A and Stages 2B and 3 Extremity and Superficial Trunk Soft Tissue Sarcoma

  • Bone and Soft Tissue Sarcomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The National Comprehensive Cancer Network (NCCN) has instituted treatment guidelines for stage 2A and stages 2B and 3 extremity and superficial trunk soft tissue sarcomas (ETSTS). This study examined adherence to the NCCN guidelines and factors associated with nonadherent treatment and survival outcomes.

Methods

Patients with stage 2A and stages 2B and 3 ETSTS (n = 15,957) were categorized as undergoing adherent or nonadherent treatment based on the 2014 NCCN guidelines. Multivariate logistic regression models were used to determine factors associated with nonadherent treatment. Overall survival (OS) and disease-specific survival (DSS) were calculated, and Cox models were used to generate adjusted survival curves and hazard ratios (HRs).

Results

The findings showed that 87.2% of the patients with stage 2A disease and 58.3% of the patients with stage 2B or 3 disease received adherent treatment. Community treatment facilities and uninsured or unknown insurance status were associated with nonadherent treatment for both stage groups. Adherent treatment was associated with higher 5-year adjusted OS and DSS for stage 2A and stage 2B or 3 patients. In Cox models, nonadherent treatment was associated with worse survival for both stage 2A disease (HR, 2.31; 95% confidence interval [CI], 2.02–2.63) and stages 2B and 3 disease (HR, 1.63; 95% CI, 1.53–1.73). Increasing age and non-private insurance were associated with poorer outcomes. For stages 2B and 3 disease, treatment at a community center and African American race were associated with worse survival.

Conclusions

Adherence to NCCN guidelines is excellent for stage 2A and poor for stages 2B and 3 ETSTS. Adherent treatment was associated with improved survival outcomes, highlighting the importance of adherence to NCCN guidelines.

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Acknowledgement

This work was supported in part by National Institutes of Health grant T32 CA009599 (RV) and the K12 Paul Calabresi Career Development Award for Clinical Oncology (CLR), as well as a cancer center support grant for The University of Texas MD Anderson Cancer Center (P30CA016672).

Disclosures

There are no conflicts of interest.

Author information

Author notes

  1. Janice N. Cormier, Christina L. Roland have contributed equally to this work.

Authors and Affiliations

  1. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Rachel K. Voss MD, Yi-Ju Chiang MSPH, Keila E. Torres MD, PhD, Gary N. Mann MD, Barry W. Feig MD, Janice N. Cormier MD, MPH & Christina L. Roland MD

  2. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    B. Ashleigh Guadagnolo MD, MPH

Authors
  1. Rachel K. Voss MD
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  2. Yi-Ju Chiang MSPH
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Corresponding author

Correspondence to Christina L. Roland MD.

Electronic supplementary material

Below is the link to the electronic supplementary material.

10434_2017_6015_MOESM1_ESM.tif

Supplementary Fig. 1: Flow chart demonstrating how the final cohort of 15,957 patients with extremity and superficial trunk soft tissue sarcoma was obtained. Supplementary material 1 (TIFF 21262 kb)

10434_2017_6015_MOESM2_ESM.tif

Supplementry Fig. 2: Distribution of all treatment regimens for adherent and nonadherent treatment for stage 2A and stage 2B/3 extremity and superficial trunk soft tissue sarcoma. RT radiation therapy, chemo chemotherapy. Supplementary material 2 (TIFF 20825 kb)

Supplementary material 3 (DOCX 14 kb)

Supplementary material 4 (DOCX 91 kb)

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Voss, R.K., Chiang, YJ., Torres, K.E. et al. Adherence to National Comprehensive Cancer Network Guidelines is Associated with Improved Survival for Patients with Stage 2A and Stages 2B and 3 Extremity and Superficial Trunk Soft Tissue Sarcoma. Ann Surg Oncol 24, 3271–3278 (2017). https://doi.org/10.1245/s10434-017-6015-z

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  • DOI: https://doi.org/10.1245/s10434-017-6015-z

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