Soft tissue sarcoma - a population-based, nationwide study with special emphasis on local control

Area of Science:

• Oncology
• Surgical Pathology
• Public Health

Background:

• A Scandinavian Sarcoma Group protocol for soft tissue sarcoma (STS) diagnostics and treatment was established in 1986 and adopted in Finland.
• The protocol was updated and detailed at Helsinki University Central Hospital.
• This study retrospectively evaluated STS diagnostics and treatment nationwide against the updated protocol, focusing on local control.

Purpose of the Study:

• To assess the adherence and effectiveness of a nationwide soft tissue sarcoma (STS) protocol.
• To compare diagnostics and treatment of STS in Finland with the established protocol.
• To evaluate factors influencing local control in STS patients.

Main Methods:

• Retrospective analysis of 219 STS extremity or trunk wall cases diagnosed 1998-2001 from the Finnish Cancer Registry.
• Histologic review of all cases.
• Classification of treatment centers into high-, intermediate-, and low-volume based on surgical case load.

Main Results:

• High-volume centers performed significantly more preoperative diagnoses.
• Inadequate surgical margins were common, with many patients not receiving adjuvant radiation therapy.
• Five-year local control rates were 82% in high-volume centers, 61% in intermediate-volume centers, and 69% in low-volume centers (p=0.046).
• Increased surgical volume correlated with improved local control.

Conclusions:

• This is the first nationwide population-based quality control study on STS diagnostics and treatment.
• Referral to specialized sarcoma centers can lead to good local control, even after suboptimal surgery.
• Centralizing STS treatment in Finland is recommended due to the rarity of the disease and the benefits of specialized care.