Improved nationwide survival of sarcoma patients with a network of reference centers.

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 (netsarc.org) is a network of 26 reference sarcoma centers with specialized multidisciplinary tumor boards (MDTB), 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: 2010-12 (non-exhaustive), 2013-15, and 2016-20. 43,975 patients with sarcomas, GIST or connective tissue tumors of intermediate malignancy were included in the NETSARC+ database since 2010 (n=9,266 before 2013, n=12,274 between 2013-15, n=22,435 in 2016-2020). Median age was 56 years, 50.5% were women, 13.2% had metastasis at diagnosis. Overall survival was significantly superior in the period 2016-20 vs 2013-2015 vs 2010-12 for the entire population, for patients>18, and for both metastatic and non-metastatic patients in univariate and multivariate analyses (p<0.0001). Over the three periods, we observed a significantly improved compliance to clinical practice guidelines nationwide: the proportion of patients biopsied before surgery increased from 62.9% to 72.6%; the percentage of patients presented to NETSARC MDTB before first surgery increased from 31.7% to 44.4% (p<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 Clinical Practice Guidelines can still be achieved.

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