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. NETSARC () is a network of 26 reference sarcoma centers with specialized multidisciplinary tumor boards (MDTBs), funded by the French (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. 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 ( < 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% ( < 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. 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.

中文翻译：

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通过参考中心网络提高全国肉瘤患者的生存率

我们调查了自 2010 年以来实施肉瘤参考中心网络 (NETSARC) 对法国肉瘤患者的护理和生存的影响。NETSARC () 是一个由 26 个参考肉瘤中心组成的网络，并设有专门的多学科肿瘤委员会 (MDTB) ，自 2010 年起由法国 (INCa) 资助。其目的是提高肉瘤患者的诊断和护理质量。患者的特征、治疗和结果都收集在全国数据库中。本分析的目的是比较三个时期患者的生存率：2010-2012 年（非详尽）、2013-2015 年和 2016-2020 年。自 2010 年以来，NETSARC+ 数据库中总共纳入了 43 975 例肉瘤、胃肠道间质瘤 (GIST) 或中度恶性肿瘤结缔组织肿瘤患者（2013 年之前 n = 9266 例，2013 年至 2015 年期间 n = 12 274 例，22 例） 2016-2020 年为 435）。中位年龄为 56 岁，50.5% 为女性，13.2% 诊断时已发生转移。在单变量和多变量分析中，2016-2020 年期间整个人群、18 岁以上患者以及转移性和非转移性患者的总生存率明显优于 2013-2015 年和 2010-2012 年（< 0.0001） 。在这三个时期内，我们观察到全国范围内对临床实践指南（CPG）的依从性显着提高：手术前进行活检的患者比例从 62.9% 增加到 72.6%；首次手术前接受 NETSARC MDTB 治疗的患者比例从 31.7% 增加到 44.4% (< 0.0001)。首次手术时 R0 切除的患者比例增加（从 36.1% 至 46.6%），而 R2 切除率下降（从 10.9% 至 7.9%），NETSARC 中心的依从性和改善程度更好。国家肉瘤参考网络的实施与肉瘤患者总体生存率和全国指南依从性的改善相关。应鼓励将肉瘤患者转诊至专家网络，但仍可实现更好的 CPG 依从性。