Integrated Care in Specialized Networks: Leveraging Early Referrals to Reduce Local Recurrence in Soft Tissue Sarcoma
Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Design and SSN
2.2. Subjects and Data Extraction
2.3. Definitions, Outcomes, Measurements, and Clinical Characteristics
2.4. Statistical Analysis
3. Results
3.1. Study Patient Population
3.2. Characteristics and Factors Associated with Local Recurrence
3.3. Comparative Analysis of Patient Treatment Pathways: Evaluating Factors Contributing to Increased Risk of LR in FCP vs. CCP
3.4. Differences Between Dedicated Sarcoma Centers
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
Variable | Local Recurrence | ||
---|---|---|---|
OR | 95% CI | p-Value | |
Gender | 0.95 | (0.56, 1.6) | 0.84 |
Institution | 0.69 | (0.41, 1.16) | 0.16 |
FCP | 3.2 | (1.83, 5.58) | <0.0001 |
Compartment | 0.48 | (0.21, 1.09) | 0.08 |
Tumor size | 1.32 | (1.04, 1.69) | 0.03 |
Tumor grading | 1.6 | (1.16, 2.19) | 0.004 |
Biological behavior | 3.6 | (1.59, 8.17) | 0.002 |
Anatomic region | 1.09 | (0.88, 1.35) | 0.41 |
Positive resection margins | 2.09 | (1.22–3.58) | 0.008 |
Radiotherapy part of first treatment | 0.86 | (0.5, 1.47) | 0.59 |
Chemotherapy part of first treatment | 1.11 | (0.49, 2.53) | 0.8 |
Whoops resection | 1.01 | (0.6, 1.85) | 0.9 |
Variable | Local Recurrence | ||
---|---|---|---|
aOR | 95% CI | p-Value | |
Gender | 1.004 | (0.56, 1.8) | 0.99 |
Institution | 0.9 | (0.49, 1.6) | 0.72 |
Compartment | 0.47 | (0.18, 1.24) | 0.13 |
FCP | 2.7 | (1.41, 5.12) | 0.003 |
Biological behavior | 5.84 | (1.8, 18.86) | 0.003 |
Size | 1.49 | (1.1, 2.02) | 0.01 |
Anatomic region | 0.89 | (0.69, 1.16) | 0.4 |
Tumor grading | 1.28 | (0.85, 1.9) | 0.23 |
Positive resection margins | 1.8 | (0.99, 3.35) | 0.05 |
Radiotherapy part of first treatment | 0.55 | (0.29, 1.05) | 0.07 |
Chemotherapy part of first treatment | 0.77 | (0.29, 1.88) | 0.57 |
Variable | Fragmented Care Pathway | ||
---|---|---|---|
OR | 95% CI | p-Value | |
Gender | 1.27 | (0.79, 2.04) | 0.32 |
Institution | 0.37 | (0.23, 0.6) | <0.0001 |
Compartment | 1.6 | (0.9, 2.86) | 0.11 |
Tumor size | 0.87 | (0.69, 1.09) | 0.22 |
Tumor grading | 1.03 | (0.79, 1.35) | 0.82 |
Biological behavior | 1.8 | (0.99, 3.27) | 0.05 |
Anatomic region | 0.96 | (0.79, 1.17) | 0.69 |
Resection margins | 3.57 | (2.17, 5.86) | <0.0001 |
Radiotherapy as part of first treatment | 0.96 | (0.6, 1.54) | 0.86 |
Chemotherapy as part of first treatment | 0.75 | (0.95, 2.68) | 0.08 |
Local recurrence | 3.2 | (1.83, 5.56) | <0.0001 |
Whoops resection | 4.93 | (2.95, 8.24) | <0.0001 |
Variable | Fragmented Care Pathway | ||
---|---|---|---|
aOR | 95% CI | p-Value | |
Gender | 1.57 | (0.9, 2.74) | 0.1 |
Institution | 0.32 | (0.18, 0.56) | <0.0001 |
Tumor size | 1.21 | (0.89, 1.63) | 0.22 |
Biological behavior | 2.61 | (1.1, 6.4) | 0.04 |
Tumor grading | 0.9 | (0.61, 1.32) | 0.58 |
Positive resection margins | 1.4 | (0.71, 2.79) | 0.34 |
Local recurrence | 2.96 | (1.5, 5.79) | 0.001 |
Whoops resection | 6.62 | (2.99, 14.7) | <0.0001 |
References
- Cormier, J.N.; Pollock, R.E. Soft Tissue Sarcomas. CA Cancer J. Clin. 2004, 54, 94–109. [Google Scholar] [CrossRef] [PubMed]
- Gronchi, A.; Miah, A.B.; Tos, A.P.D.; Abecassis, N.; Bajpai, J.; Bauer, S.; Biagini, R.; Bielack, S.; Blay, J.Y.; Bolle, S.; et al. Soft Tissue and Visceral Sarcomas: ESMO–EURACAN–GENTURIS Clinical Practice Guidelines for Diagnosis, Treatment and Follow-Up. Ann. Oncol. 2021, 32, 1348–1365. [Google Scholar] [CrossRef]
- Schärer, M.; Heesen, P.; Bode-Lesniewska, B.; Studer, G.; Fuchs, B. Benchmarking Time-to-Treatment Initiation in Sarcoma Care Using Real-World-Time Data. Cancers 2023, 15, 5849. [Google Scholar] [CrossRef] [PubMed]
- Melis, A.S.; Vos, M.; Schuurman, M.S.; van Dalen, T.; van Houdt, W.J.; van der Hage, J.A.; Schrage, Y.M.; Been, L.B.; Bonenkamp, J.B.; Bemelmans, M.H.A.; et al. Incidence of Unplanned Excisions of Soft Tissue Sarcomas in the Netherlands: A Population-Based Study. Eur. J. Surg. Oncol. 2022, 48, 994–1000. [Google Scholar] [CrossRef] [PubMed]
- Chandrasekar, C.R.; Wafa, H.; Grimer, R.J.; Carter, S.R.; Tillman, R.M.; Abudu, A. The Effect of an Unplanned Excision of a Soft-Tissue Sarcoma on Prognosis. J. Bone Jt. Surg. Br. 2008, 90, 203–208. [Google Scholar] [CrossRef]
- Andritsch, E.; Beishon, M.; Bielack, S.; Bonvalot, S.; Casali, P.; Crul, M.; Delgado-Bolton, R.; Donati, D.M.; Douis, H.; Haas, R.; et al. ECCO Essential Requirements for Quality Cancer Care: Soft Tissue Sarcoma in Adults and Bone Sarcoma. A Critical Review. Crit. Rev. Oncol./Hematol. 2017, 110, 94–105. [Google Scholar] [CrossRef]
- Goldberg, B.R. Soft Tissue Sarcoma: An Overview. Orthop. Nurs. 2007, 26, 4–11. [Google Scholar] [CrossRef]
- Blay, J.-Y.; Soibinet, P.; Penel, N.; Bompas, E.; Duffaud, F.; Stoeckle, E.; Mir, O.; Adam, J.; Chevreau, C.; Bonvalot, S.; et al. Improved Survival Using Specialized Multidisciplinary Board in Sarcoma Patients. Ann. Oncol. 2017, 28, 2852–2859. [Google Scholar] [CrossRef]
- von Mehren, M.; Kane, J.M.; Agulnik, M.; Bui, M.M.; Carr-Ascher, J.; Choy, E.; Connelly, M.; Dry, S.; Ganjoo, K.N.; Gonzalez, R.J.; et al. Soft Tissue Sarcoma, Version 2.2022, NCCN Clinical Practice Guidelines in Oncology. J. Natl. Compr. Cancer Netw. 2022, 20, 815–833. [Google Scholar] [CrossRef]
- Voss, R.K.; Chiang, Y.-J.; Torres, K.E.; Guadagnolo, B.A.; Mann, G.N.; Feig, B.W.; Cormier, J.N.; Roland, C.L. Adherence to National Comprehensive Cancer Network Guidelines Is Associated with Improved Survival in Patients with Stage IIA and IIB/III Extremity and Superficial Trunk Soft Tissue Sarcoma. Ann. Surg. Oncol. 2017, 24, 3271–3278. [Google Scholar] [CrossRef]
- Venkataramanan, R.; Pradhan, A.; Kumar, A.; Alajlani, M.; Arvanitis, T.N. Role of Digital Health in Coordinating Patient Care in a Hub-and-Spoke Hierarchy of Cancer Care Facilities: A Scoping Review. Ecancermedicalscience 2023, 17, 1605. [Google Scholar] [CrossRef] [PubMed]
- Siebenrock, K.A.; Hertel, R.; Ganz, R. Unexpected Resection of Soft-Tissue Sarcoma. More Mutilating Surgery, Higher Local Recurrence Rates, and Obscure Prognosis as Consequences of Improper Surgery. Arch. Orthop. Trauma. Surg. 2000, 120, 65–69. [Google Scholar] [CrossRef] [PubMed]
- Serban, B.; Cretu, B.; Cursaru, A.; Nitipir, C.; Orlov-Slavu, C.; Cirstoiu, C. Local Recurrence Management of Extremity Soft Tissue Sarcoma. EFORT Open Rev. 2023, 8, 606–614. [Google Scholar] [CrossRef] [PubMed]
- Trovik, C.S.; Gustafson, P.; Bauer, H.C.; Saeter, G.; Klepp, R.; Berlin, O.; Erlanson, M.; Wahlström, O.; Raabe, N. Consequences of Local Recurrence of Soft Tissue Sarcoma: 205 Patients from the Scandinavian Sarcoma Group Register. Acta Orthop. Scand. 2000, 71, 488–495. [Google Scholar] [CrossRef] [PubMed]
- Zagars, G.K.; Ballo, M.T.; Pisters, P.W.T.; Pollock, R.E.; Patel, S.R.; Benjamin, R.S.; Evans, H.L. Prognostic Factors for Patients with Localized Soft-Tissue Sarcoma Treated with Conservation Surgery and Radiation Therapy. Cancer 2003, 97, 2530–2543. [Google Scholar] [CrossRef]
- Grimer, R.; Judson, I.; Peake, D.; Seddon, B. Guidelines for the Management of Soft Tissue Sarcomas. Sarcoma 2010, 2010, 506182. [Google Scholar] [CrossRef]
- Pasquali, S.; Bonvalot, S.; Tzanis, D.; Casali, P.G.; Trama, A.; Gronchi, A.; RARECARENet Working Group. Treatment Challenges in and Outside a Network Setting: Soft Tissue Sarcomas. Eur. J. Surg. Oncol. 2019, 45, 31–39. [Google Scholar] [CrossRef]
- Bonvalot, S.; Levy, A.; Terrier, P.; Tzanis, D.; Bellefqih, S.; Le Cesne, A.; Le Péchoux, C. Primary Extremity Soft Tissue Sarcomas: Does Local Control Impact Survival? Ann. Surg. Oncol. 2017, 24, 194–201. [Google Scholar] [CrossRef]
- Trovik, C.S. Local Recurrence of Soft Tissue Sarcoma. A Scandinavian Sarcoma Group Project. Acta Orthop. Scand. 2001, 72, 1–27. [Google Scholar]
- Eilber, F.C.; Brennan, M.F.; Riedel, E.; Alektiar, K.M.; Antonescu, C.R.; Singer, S. Prognostic Factors for Survival in Patients with Locally Recurrent Extremity Soft Tissue Sarcomas. Ann. Surg. Oncol. 2005, 12, 228–236. [Google Scholar] [CrossRef]
- Kruiswijk, A.A.; Kuhrij, L.S.; Dorleijn, D.M.J.; Van De Sande, M.A.J.; Van Bodegom-Vos, L.; Marang-van De Mheen, P.J. Follow-Up after Curative Surgical Treatment of Soft-Tissue Sarcoma for Early Detection of Recurrence: Which Patients Have More or Fewer Visits than Advised in Guidelines? Cancers 2023, 15, 4617. [Google Scholar] [CrossRef] [PubMed]
- Rossi, C.R.; Vecchiato, A.; Mastrangelo, G.; Montesco, M.C.; Russano, F.; Mocellin, S.; Pasquali, S.; Scarzello, G.; Basso, U.; Frasson, A.; et al. Adherence to Treatment Guidelines for Primary Sarcomas Affects Patient Survival: A Side Study of the European CONnective TIssue CAncer NETwork (CONTICANET). Ann. Oncol. 2013, 24, 1685–1691. [Google Scholar] [CrossRef] [PubMed]
- Blay, J.Y.; Penel, N.; Valentin, T.; Anract, P.; Duffaud, F.; Dufresne, A.; Verret, B.; Cordoba, A.; Italiano, A.; Brahmi, M.; et al. Improved Nationwide Survival of Sarcoma Patients with a Network of Reference Centers. Ann. Oncol. 2024, 35, 351–363. [Google Scholar] [CrossRef] [PubMed]
- Heesen, P.; Studer, G.; Bode, B.; Windegger, H.; Staeheli, B.; Aliu, P.; Martin-Broto, J.; Gronchi, A.; Blay, J.-Y.; Le Cesne, A.; et al. Quality of Sarcoma Care: Longitudinal Real-Time Assessment and Evidence Analytics of Quality Indicators. Cancers 2022, 15, 47. [Google Scholar] [CrossRef]
- Grimer, R.J. Size Matters for Sarcomas! Ann. R. Coll. Surg. Engl. 2006, 88, 519–524. [Google Scholar] [CrossRef]
- Enneking, W.F.; Spanier, S.S.; Goodman, M.A. A System for the Surgical Staging of Musculoskeletal Sarcoma. Clin. Orthop. Relat. Res. 1980, 153, 106–120. [Google Scholar] [CrossRef]
- Gundle, K.R.; Kafchinski, L.; Gupta, S.; Griffin, A.M.; Dickson, B.C.; Chung, P.W.; Catton, C.N.; O’Sullivan, B.; Wunder, J.S.; Ferguson, P.C. Analysis of Margin Classification Systems for Assessing the Risk of Local Recurrence After Soft Tissue Sarcoma Resection. J. Clin. Oncol. 2018, 36, 704–709. [Google Scholar] [CrossRef]
- Angervall, L.; Kindblom, L.G. Principles for Pathologic-Anatomic Diagnosis and Classification of Soft-Tissue Sarcomas. Clin. Orthop. Relat. Res. 1993, 289, 9–18. [Google Scholar] [CrossRef]
- Bonvalot, S.; Gaignard, E.; Stoeckle, E.; Meeus, P.; Decanter, G.; Carrere, S.; Honore, C.; Delhorme, J.B.; Fau, M.; Tzanis, D.; 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. 2019, 26, 2286–2293. [Google Scholar] [CrossRef]
- Kainhofer, V.; Smolle, M.A.; Szkandera, J.; Liegl-Atzwanger, B.; Maurer-Ertl, W.; Gerger, A.; Riedl, J.; Leithner, A. The Width of Resection Margins Influences Local Recurrence in Soft Tissue Sarcoma Patients. Eur. J. Surg. Oncol. (EJSO) 2016, 42, 899–906. [Google Scholar] [CrossRef]
- Obergfell, T.T.A.F.; Nydegger, K.N.; Heesen, P.; Schelling, G.; Bode-Lesniewska, B.; Studer, G.; Fuchs, B. Improving Sarcoma Outcomes: Target Trial Emulation to Compare the Impact of Unplanned and Planned Resections on the Outcome. Cancers 2024, 16, 2443. [Google Scholar] [CrossRef] [PubMed]
- Lebas, A.; Le Fevre, C.; Waissi, W.; Chambrelant, I.; Brinkert, D.; Noel, G. Factors Influencing Long-Term Local Recurrence, Distant Metastasis, and Survival in Patients with Soft Tissue Sarcoma of the Extremities Treated with Radiotherapy. Cancers 2024, 16, 1789. [Google Scholar] [CrossRef] [PubMed]
- Rydholm, A.; Rööser, B. Surgical Margins for Soft-Tissue Sarcoma. J. Bone Jt. Surg. Am. 1987, 69, 1074–1078. [Google Scholar] [CrossRef]
- Nydegger, N.; Obergfell, T.; Heesen, P.; Schelling, P.; Studer, G.; Bode-Lesniewska, B.; Fuchs, B. Planned and Unplanned Sarcoma Resections: Comparative Analysis of Local Recurrence, Metastasis, and Mortality. Cancers, 2024; in print. [Google Scholar]
Characteristics | Overall (%) | No Local Recurrence (%) | Local Recurrence (%) | p-Value |
---|---|---|---|---|
n, (%) | 386 | 318 (82.4) | 68 (17.6) | |
Female, n (%) | 186 (48.2) | 154 (82.8/48.4) | 32 (17.2/47.1) | 0.84 |
Compartment | ||||
DST-S | 317 (82.1) | 256 (80.8/80.5) | 61 (19.2/89.7) | 0.03 |
SST-S | 69 (17.9) | 62 (89.9/19.5) | 7 (10.1/10.3) | |
Institution | 0.16/0.04 a | |||
1 | 158 (40.9) | 125 (79.1/39.3) | 33 (20.9/48.5) | |
2 | 228 (59.1) | 193 (84.6/60.6) | 35 (15.4/51.5) | |
Patient pathway | 0.0001 | |||
CCP | 297 (76.9) | 258 (86.9/81.1) | 39 (13.1/57.4) | |
FCP | 89 (23.1) | 60 (67.4/18.9) | 29 (32.6/42.7) | |
Biological behavior | 0.001 | |||
Malignant | 286 (74.1) | 225 (78.7/70.8) | 61 (21.3/89.7) | |
Intermediate | 100 (25.9) | 93 (93.0/29.3) | 7 (7.0/10.3) | |
Region, (%) | 0.0001 | |||
Face, Head, Neck | 13 (3.4) | 11 (84.6/3.5) | 2 (15.4/2.9) | 0.29 |
Upper extremity | 33 (8.6) | 22 (66.6/6.9) | 11 (33.3/16.2) | 0.01 |
Lower extremity | 161 (41.7) | 145 (90.1/45.8) | 16 (9.9/23.5) | 0.0008 |
Axial | 61 (15.8) | 51 (83.6/16.0) | 10 (16.4/14.7) | 0.79 |
Intra- and retroperitoneal | 87 (22.5) | 60 (69.0/18.9) | 27 (31.0/39.7) | 0.0002 |
Urogenital, perineal, and anal regions | 31 (8.0) | 29 (93.5/9.1) | 2 (6.5/2.9) | 0.09 |
Initial Size, mm | 0.12 | |||
0–50 mm | 108 (28.0) | 94 (84.3/29.6) | 14 (15.7/20.6) | 0.14 |
51–100 mm | 133 (34.5) | 111 (83.5/34.9) | 22 (16.5/32.4) | 0.69 |
101–150 mm | 74 (19.2) | 61 (82.4/19.2) | 13 (17.6/19.1) | 0.99 |
>150 mm | 71 (18.4) | 52 (73.2/16.4) | 19 (26.8/27.9) | 0.03 |
Tumor grading | d | c | b | 0.01 |
G1 | 138 (36.1) | 123 (89.1/39.1) | 15 (10.9/22.4) | 0.009 |
G2 | 70 (18.3) | 59 (84.3/18.7) | 11 (15.7/16.4) | 0.64 |
G3 | 174 (45.6) | 133 (76.4/42.2) | 41 (23.6/61.2) | 0.006 |
Resection margin | e | c | c | 0.02 |
R0 wide margin/R0 | 232 (61.1) | 202 (87.1/64.1) | 30 (12.9/46.2) | 0.003 |
R1 marginal margin/R1 | 122 (32.1) | 92 (75.4/29.2) | 30 (24.6/46.2) | 0.01 |
R2 intralisional margin/R2 | 26 (6.8) | 21 (80.8/6.7) | 5 (19.2/7.7) | 0.2 |
Radiotherapy part of first treatment | 159 (41.2) | 133 (83.7/41.8) | 26 (16.3/38.2) | 0.58 |
Chemotherapy as part of first treatment | 42 (10.9) | 34 (81.0/10.7) | 8 (19.0/11.8) | 0.8 |
Whoops resection | 96 (25.8) | 79 (82.3/24.8) | 17 (17.37/25.0) | 0.94 |
Characteristics | Overall (%) | CCP (%) | FCP (%) | p-Value |
---|---|---|---|---|
n, (%) | 386 | 297 (76.9) | 89 (23.1) | na |
Female, n (%) | 186 (48.2) | 139 (74.7/46.8) | 47 (25.3/52.8) | 0.32 |
Institution | ||||
1 | 158 (40.9) | 105 (66.5/35.4) | 53 (33.5/59.6) | 0.001 |
2 | 228 (59.1) | 192 (84.2/64.7) | 36 (15.8/40.5) | |
Biological behavior | 0.05 | |||
Malignant | 286 (74.1) | 213 (74.5/71.7) | 73 (25.5/82.0) | |
Intermediate | 100 (25.9) | 84 (84.0/28.3) | 16 (16.0/18.0) | |
Compartment | 0.04 | |||
DST-S | 317 (82.1) | 249 (78.5/83.8) | 68 (21.5/76.4) | |
SST-S | 69 (17.9) | 48 (69.6/16.2) | 21 (30.4/23.6) | |
Region, n % | 0.02 | |||
Face, Head, Neck | 13 (3.4) | 10 (76.9/3.4) | 3 (23.1/3.4) | 0.99 |
Upper extremity | 33 (8.6) | 19 (57.6/6.4) | 14 (42.4/15.7) | 0.006 |
Lower extremity | 161 (41.7) | 134 (83.2/45.1) | 27 (16.8/30.3) | 0.01 |
Axial | 61 (15.8) | 45 (73.8/15.2) | 16 (26.2/18.0) | 0.52 |
Intra- and retroperitoneal | 87 (22.5) | 62 (71.3/20.9) | 25 (28.7/28.1) | 0.15 |
Urogenital, perineal, and anal regions | 31 (8.0) | 27 (87.1/9.1) | 4 (12.9/4.5) | 0.16 |
Initial Size, mm | 0.6 | |||
0–50 mm | 108 (28.0) | 81 (75.0/27.3) | 27 (25.0/30.3) | 0.57 |
51–100 mm | 133 (34.5) | 99 (74.4/33.3) | 34 (25.6/38.2) | 0.4 |
101–150 mm | 74 (19.2) | 59 (79.7/19.9) | 15 (20.3/16.9) | 0.53 |
>150 mm | 71 (18.4) | 58 (81.7/19.5) | 13 (18.3/14.6) | 0.29 |
Tumor grading | c | b | a | 0.78 |
G1 | 138 (36.1) | 106 (76.8/36.1) | 32 (23.2/36.4) | 0.96 |
G2 | 70 (18.3) | 56 (80.0/19.1) | 14 (20.0/15.9) | 0.5 |
G3 | 174 (45.6) | 132 (75.9/44.9) | 42 (24.1/47.7) | 0.65 |
Resection margin | e | d | a | 0.001 |
R0 wide margin/R0 | 232 (61.1) | 199 (85.8/68.2) | 33 (14.2/37.5) | 0.0001 |
Positive resection margins (R1 + R2) | 148 (38.9) | 93 (62.8/31.3) | 55 (37.2/61.8) | 0.0001 |
Chemotherapy part of first treatment | 42 (10.9) | 33 (78.6/11.1) | 9 (21.4/10.1) | 0.08 |
Radiotherapy part of first treatment | 159 (41.2) | 128 (80.5/43.1) | 31 (19.5/34.8) | 0.9 |
Whoops resections | 96 (24.8) | 51 (53.1/17.2) | 45 (46.9/50.6) | <0.0001 |
Local recurrence n, % | 68 (17.6) | 39 (57.4/13.1) | 29 (43.6/32.6) | <0.0001 |
Characteristics | Overall (%) | Sarcoma Center Institution 1 (%) | Sarcoma Center Institution 2 (%) | p-Value |
---|---|---|---|---|
n, (%) | 386 | 158 (40.9) | 228 (59.1) | |
Female, n (%) | 186 (48.2) | 71 (38. 2/44.9) | 115 (61.8/50.4) | 0.29 |
Treatment pathway | 0.0001 | |||
CCP | 297 (76.9) | 105 (35.4/66.5) | 192 (64.6/84.2) | |
FCP | 89 (23.1) | 53 (59.6/33.5) | 36 (40.4/15.8) | |
Biological behavior | 0.63 | |||
Malignant | 286 (74.1) | 115 (40.2/72.8) | 171 (59.8/75.0) | |
Intermediate | 100 (25.9) | 43 (43.0/27.2) | 57 (57.0/25.0) | |
Compartment | 0.74 | |||
DST-S | 317 (82.1) | 131 (41.3/82.9) | 186 (58.6/81.6) | |
SST-S | 69 (17.9) | 27 (39.1/17.1) | 42 (60.9/18.4) | |
Initial Size, mm (IQR) | 80 (50–130) | 81 (50–130) | 80 (50–133) | 0.8 |
Tumor grading | d | a | a | |
G1 | 138 (36.1) | 62 (44.9/39.2) | 76 (55.1/33.3) | 0.23 |
G2 | 70 (18.3) | 30 (42.9/19.0) | 40 (57.1/17.5) | 0.72 |
G3 | 174 (45.6) | 64 (36.8/40.5) | 110 (63.2/48.3) | 0.13 |
Whoops resections | 96 (24.8) | 41 (42.7/26.0) | 55 (57.3/24.1) | 0.68 |
Positive resection margins | 148 (39.0) c | 68 (45.9/43.7) b | 80 (54.1/35.6) b | 0.1 |
Local recurrence n, % | 68 (17.6) | 33 (48.5/20.9) | 35 (51.5/15.3) | 0.0001 |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Schärer, M.; Hösli, P.; Heesen, P.; Schelling, G.; Obergfell, T.; Nydegger, K.N.; Studer, G.; Bode-Lesniewska, B.; Fuchs, B., on behalf of the Swiss Sarcoma Network. Integrated Care in Specialized Networks: Leveraging Early Referrals to Reduce Local Recurrence in Soft Tissue Sarcoma. Cancers 2024, 16, 3616. https://doi.org/10.3390/cancers16213616
Schärer M, Hösli P, Heesen P, Schelling G, Obergfell T, Nydegger KN, Studer G, Bode-Lesniewska B, Fuchs B on behalf of the Swiss Sarcoma Network. Integrated Care in Specialized Networks: Leveraging Early Referrals to Reduce Local Recurrence in Soft Tissue Sarcoma. Cancers. 2024; 16(21):3616. https://doi.org/10.3390/cancers16213616
Chicago/Turabian StyleSchärer, Markus, Pascale Hösli, Philip Heesen, Georg Schelling, Timothy Obergfell, Kim N. Nydegger, Gabriela Studer, Beata Bode-Lesniewska, and Bruno Fuchs on behalf of the Swiss Sarcoma Network. 2024. "Integrated Care in Specialized Networks: Leveraging Early Referrals to Reduce Local Recurrence in Soft Tissue Sarcoma" Cancers 16, no. 21: 3616. https://doi.org/10.3390/cancers16213616
APA StyleSchärer, M., Hösli, P., Heesen, P., Schelling, G., Obergfell, T., Nydegger, K. N., Studer, G., Bode-Lesniewska, B., & Fuchs, B., on behalf of the Swiss Sarcoma Network. (2024). Integrated Care in Specialized Networks: Leveraging Early Referrals to Reduce Local Recurrence in Soft Tissue Sarcoma. Cancers, 16(21), 3616. https://doi.org/10.3390/cancers16213616