N. G. Berger1, J. P. Silva1, K. K. Christians1, S. Tsai1, T. Gamblin1 1Medical College Of Wisconsin,Surgery, Division Of Surgical Oncology,Milwaukee, WI, USA
Introduction: Surgical resection remains the curative therapy for retroperitoneal sarcoma (RPS). Data recently published shows a correlation between improved outcomes for complex oncologic operations and treatment at academic centers. For large retroperitoneal sarcomas, surgical resection can be complex and require multidisciplinary care. The present study hypothesized that survival rates vary between treating center for patients undergoing resection for retroperitoneal sarcoma.
Methods: Patients with all-stage and all-size retroperitoneal sarcomas who underwent surgical resection were identified from the National Cancer Database (2004-2013). Treating centers were categorized as Academic Cancer Centers (ACC) or Community Cancer Centers (CCC). OS was analyzed by log-rank test and graphed using Kaplan-Meier method.
Results: A total of 5,106 patients were identified. Median age of diagnosis was 63. The majority of patients (58.2%, n=2,970) patients underwent resection at an ACC. Improved median OS was seen at ACCs across all stages compared to CCCs (79.1 months vs. 64.3 months; p=0.004). ACCs exhibited a higher rate of R0 resection (51.2% vs. 44.1%, p<0.001). No difference between cohorts was seen for 90-day mortality or 30-day readmission rates, though 30-day mortality at CCCs following resection did trend toward significance (1.9% vs. 2.9%, p=0.061). On Cox univariate regression, age, sex, ethnicity, Charlson Comorbidity Score, tumor size, tumor grade, and treating facility were identified as significant factors. Following multivariate regression, treatment at an academic center was associated with a significant hazard ratio (HR) for survival (HR= 0.91, IQR 0.82-1.00, p=0.045).
Conclusion: Resection for RPS performed at ACC is associated with improved survival compared to CCC, and an improved HR for survival on multivariate regression. This suggests that site of care plays a role in patient outcomes.
