Regional variation in the survival of patients with a soft-tissue sarcoma of the extremity and trunk wall under a centralized care system: what has been the impact of national policies in the UK?

Tomohiro Fujiwara, Scott Evans, Jonathan Stevenson, Yusuke Tsuda, Jonathan Gregory, Robert J. Grimer, Seggy Abudu

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)1541-1549
Number of pages9
JournalBone and Joint Journal
Volume103-B
Issue number9
DOIs
Publication statusPublished - Sep 1 2021
Externally publishedYes

Keywords

  • Kaplan-Meier curves
  • Multivariate analysis
  • NICE guideline
  • Regional variation
  • Regionalization
  • Soft-tissue sarcomas
  • Soft-tissue tumour
  • Survival
  • cancers
  • chi-squared test
  • extremity
  • log-rank test
  • malignant tumours
  • sarcomas
  • upper limb

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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