TY - JOUR
T1 - Regional variation in the survival of patients with a soft-tissue sarcoma of the extremity and trunk wall under a centralized care system
T2 - what has been the impact of national policies in the UK?
AU - Fujiwara, Tomohiro
AU - Evans, Scott
AU - Stevenson, Jonathan
AU - Tsuda, Yusuke
AU - Gregory, Jonathan
AU - Grimer, Robert J.
AU - Abudu, Seggy
PY - 2021/9/1
Y1 - 2021/9/1
N2 - AIMS: While a centralized system for the care of patients with a sarcoma has been advocated for decades, regional variations in survival remain unclear. The aim of this study was to investigate regional variations in survival and the impact of national policies in patients with a soft-tissue sarcoma (STS) in the UK. METHODS: The study included 1,775 patients with a STS who were referred to a tertiary sarcoma centre. The geographical variations in survival were evaluated according to the periods before and after the issue of guidance by the National Institute for Health and Care Excellence (NICE) in 2006 and the relevant evolution of regional management. RESULTS: There had been a significant difference in survival between patients referred from the North East, North West, East Midlands, West Midlands, South West, and Wales in the pre-NICE era (five-year disease-specific survival (DSS); South West, 74% vs North East, 47% (p = 0.045) or West Midlands, 54% (p = 0.049)), which was most evident for patients with a high-grade STS. However, this variation disappeared in the post-NICE era, in which the overall DSS for high-grade STS improved from 47% to 68% at five years (p < 0.001). Variation in the size of the tumour closely correlated with the variation in DSS, and the overall size of the tumour and incidence of metastasis at the time of diagnosis also decreased after the national policies were issued. CONCLUSION: The survival of patients with a STS improved and regional variation corrected after the introduction of national policies, as a result of a decreasing size of tumour and incidence of metastasis at the time of diagnosis, particularly in patients with a high-grade STS. This highlights the positive impact of national guidelines on regional variation in the presentation, management, and outcome in patients with a STS. Cite this article: Bone Joint J 2021;103-B(9):1541-1549.
AB - AIMS: While a centralized system for the care of patients with a sarcoma has been advocated for decades, regional variations in survival remain unclear. The aim of this study was to investigate regional variations in survival and the impact of national policies in patients with a soft-tissue sarcoma (STS) in the UK. METHODS: The study included 1,775 patients with a STS who were referred to a tertiary sarcoma centre. The geographical variations in survival were evaluated according to the periods before and after the issue of guidance by the National Institute for Health and Care Excellence (NICE) in 2006 and the relevant evolution of regional management. RESULTS: There had been a significant difference in survival between patients referred from the North East, North West, East Midlands, West Midlands, South West, and Wales in the pre-NICE era (five-year disease-specific survival (DSS); South West, 74% vs North East, 47% (p = 0.045) or West Midlands, 54% (p = 0.049)), which was most evident for patients with a high-grade STS. However, this variation disappeared in the post-NICE era, in which the overall DSS for high-grade STS improved from 47% to 68% at five years (p < 0.001). Variation in the size of the tumour closely correlated with the variation in DSS, and the overall size of the tumour and incidence of metastasis at the time of diagnosis also decreased after the national policies were issued. CONCLUSION: The survival of patients with a STS improved and regional variation corrected after the introduction of national policies, as a result of a decreasing size of tumour and incidence of metastasis at the time of diagnosis, particularly in patients with a high-grade STS. This highlights the positive impact of national guidelines on regional variation in the presentation, management, and outcome in patients with a STS. Cite this article: Bone Joint J 2021;103-B(9):1541-1549.
KW - Kaplan-Meier curves
KW - Multivariate analysis
KW - NICE guideline
KW - Regional variation
KW - Regionalization
KW - Soft-tissue sarcomas
KW - Soft-tissue tumour
KW - Survival
KW - cancers
KW - chi-squared test
KW - extremity
KW - log-rank test
KW - malignant tumours
KW - sarcomas
KW - upper limb
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U2 - 10.1302/0301-620X.103B9.BJJ-2020-2554.R1
DO - 10.1302/0301-620X.103B9.BJJ-2020-2554.R1
M3 - Article
C2 - 34465152
AN - SCOPUS:85115280714
VL - 103-B
SP - 1541
EP - 1549
JO - Bone and Joint Journal
JF - Bone and Joint Journal
SN - 2049-4394
IS - 9
ER -
