Survival Benefit of the Surgical Management of Retroperitoneal Sarcoma in a Reference Center: A Nationwide Study of the French Sarcoma Group from the NetSarc Database

Annals of Surgical Oncology volume 26, pages2286–2293(2019)Cite this article

Abstract

Background

Guidelines recommend that retroperitoneal sarcoma (RPS) be managed in a reference sarcoma center (RSC), but the benefit remains to be demonstrated. This study investigated the impact of initial surgery performed within the NetSarc network on overall survival (OS).

Methods

NetSarc is a network of 26 RSCs with specialized multidisciplinary tumor boards (MDTs) that is funded by the French NCI. Since 2010, presentation to an MDT and second pathological review are mandatory for sarcoma patients, and data have been collected in a nationwide database. We extracted data for all patients who received surgery in or outside the network and who presented at a NetSarc center (NSC) for primary nonmetastatic RPS between 2010 and 2017.

Results

A total of 2945 patients were included: 1078 (36.6%) underwent the first surgery in an NSC, and 1867 (63.4%) in an out-of-network center. The median number of operations at an NSC during the study period was 23 (range: 3–209), and the corresponding median was 1 (range: 1–2) at out-of-network centers. The diagnostic procedures followed significantly more clinical practice guidelines within NetSarc, where there were significantly more first R0 resections [452 (41.9%) vs. 230 (12.3%)]. The OS was significantly superior for patients treated within NetSarc, with a 2-year OS of 87% vs. 70% (p < 0.001). In the multivariate analysis, surgery within an NSC was an independent predictor of OS, with a twofold lower odds ratio of death.

Conclusions

In this national study, surgery for primary RPS within an NSC was associated with a better OS.

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Acknowledgement

Supported by NetSarc (INCA & DGOS) and RREPS (INCA & DGOS), RESOS (INCA & DGOS) and LYRICAN (INCA-DGOS-INSERM 12563), Association DAM’s, Ensemble contre Le GIST, Eurosarc (FP7-278742), la Fondation ARC, Infosarcome, InterSARC (INCA), LabEx DEvweCAN (ANR-10-LABX-0061), Ligue de L’Ain contre le Cancer, La Ligue contre le Cancer, EURACAN (EC 739521).

Author information

Affiliations

  1. Department of Surgery, Institut Curie, PSL University, Paris, France

    S. Bonvalot MD, PhD, E. Gaignard MD & D. Tzanis MD

  2. Department of Surgery, Institut Bergonié, Bordeaux, France

    E. Stoeckle MD

  3. Department of Surgery, Centre Léon Bérard, Lyon, France

    P. Meeus MD

  4. Department of Surgery, Centre Oscar Lambret, Lille, France

    G. Decanter MD

  5. Department of Surgery, Institut du Cancer Val d’Aurelle, Montpellier, France

    S. Carrere MD

  6. Department of Surgery, Gustave Roussy Cancer Campus, Villejuif, France

    C. Honore MD, PhD

  7. Department of Surgery, CHRU de Hautepierre, Strasbourg, France

    J. B. Delhorme MD

  8. Department of Surgery, Institut de Cancérologie de Lorraine, Nancy, France

    M. Fau MD

  9. Department of Surgery, Centre Georges-François Leclerc, Dijon, France

    S. Causeret MD

  10. Department of Surgery, Centre Jean Perrin, Clermont-Ferrand, France

    P. Gimbergues MD

  11. Department of Surgery, Centre François Baclesse, Caen, France

    J. M. Guillois MD

  12. Department of Surgery, CHU Pontchaillou, Rennes, France

    B. Meunier MD

  13. Department of Medical Oncology, Gustave Roussy Cancer Campus, Villejuif, France

    A. Le Cesne MD

  14. Equipe Evaluation Médicale et Sarcome (EMS), Centre Léon Bérard, Lyon, France

    F. Ducimetiere PhD

  15. Department of Medical Oncology, Institut Bergonié, Bordeaux, France

    M. Toulmonde MD, PhD

  16. Department of Medical Oncology, Centre Léon Bérard, Lyon, France

    J. Y. Blay MD, PhD

Authors
  1. S. Bonvalot MD, PhD
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  2. E. Gaignard MD
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  3. E. Stoeckle MD
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  6. S. Carrere MD
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  7. C. Honore MD, PhD
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  8. J. B. Delhorme MD
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  9. M. Fau MD
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  10. D. Tzanis MD
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  11. S. Causeret MD
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  12. P. Gimbergues MD
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  13. J. M. Guillois MD
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  14. B. Meunier MD
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  15. A. Le Cesne MD
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  16. F. Ducimetiere PhD
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  17. M. Toulmonde MD, PhD
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  18. J. Y. Blay MD, PhD
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Correspondence to S. Bonvalot MD, PhD.

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Bonvalot, S., Gaignard, E., Stoeckle, E. et al. Survival Benefit of the Surgical Management of Retroperitoneal Sarcoma in a Reference Center: A Nationwide Study of the French Sarcoma Group from the NetSarc Database. Ann Surg Oncol 26, 2286–2293 (2019). https://doi.org/10.1245/s10434-019-07421-9

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