New research funded by Sarcoma UK shows that survival outcomes for people with retroperitoneal sarcoma are better at specialist sarcoma centres than non-specialist centres and in addition, specialist sarcoma centres performing high volumes of retroperitoneal surgeries have better survival outcomes thanthose performing lower volumes of surgeries.
Retroperitoneal sarcoma occurs in the retroperitoneum, deep in the abdomen and pelvis. It can include lots of sarcoma subtypes, such as liposarcoma and leiomyosarcoma. The researchers, based at the University Hospital Birmingham NHS Foundation Trust and University College London, analysed data collected for the 1,878 patients in England diagnosed with a retroperitoneal sarcoma between 2013 and 2018.
The research, published recently in the European Journal of Cancer, showed that for retroperitoneal sarcoma surgery performed at a specialist centre, five-year overall survival (the percentage of people who are alive five years after treatment) was 62%, compared to 46% for surgeries performed in a non-specialist centre.Although the majority of retroperitoneal sarcoma surgeries take place in specialist centres, 24% of people diagnosed with primary retroperitoneal sarcoma were managed elsewhere.
The importance of specialist centres and high volumes
A specialist centre is a hospital or clinic with the specialist expertise needed to diagnose and treat sarcomas. This includes hosting a sarcoma multi-disciplinary team (MDT). There are over 15 specialist centres in England, where the study was carried out, including 12 MDTs for retroperitoneal sarcoma.
The Service Specification for Sarcoma states that retroperitoneal sarcomas should be managed in ‘high-volume’ specialist centres. In this study, there were three centres that performed surgery for 50% of the cases; these were defined as ‘high-volume centres’.
This study went on to compare survival outcomes for patients treated at ‘high-volume’ and ‘low-volume’ centres. The analysis showed that the 5-year survival for ‘high-volume’ specialist centres was 63%, compared to 52% at low-volume centres. This means that people with retroperitoneal sarcoma who have their surgery at a centre that performs higher numbers of surgeries per year have significantly better overall chance of survival five years after their surgery.
As a result of these important findings, the Sarcoma Advisory Group (SAG) Chairs and Sarcoma UK recommend that the retroperitoneal sarcoma service should be reorganised to ensure all centres performing retroperitoneal sarcoma surgery reach a minimum threshold for numbers of cases managed a year. This will help ensure that retroperitoneal sarcoma patients receive the best treatment and care.
Dr Fabio Tirotta, Sarcoma Surgical Oncologist at Queen Elizabeth Hospital Birmingham and study lead author said:
“This is the first population-based study comparing outcomes between specialist sarcoma centres and non-specialist sarcoma centres SSC for patients with primary retroperitoneal sarcoma undergoing surgical resection in England. In addition, to the best of our knowledge, this is the only study analysing the association between case volume within specialist sarcoma centres and survival outcomes.”
Dr Sorrel Bickley, Director of Research, Policy and Support at Sarcoma UK, said:
“We want to ensure that everyone with sarcoma receives the best possible care, and part of that is ensuring that patients receive surgery at a centre with the specialist expertise to manage their cancer. That’s why Sarcoma UK is now working with the SAG Chairs and NHS England to ensure these important findings are actioned.”
You can read the full scientific analysis here.