Improved survival for extremity soft tissue sarcoma treated in high-volume facilities

Background and ObjectivesThe purpose of this investigation was to determine the effect of hospital volume on treatment decisions, treatment results, and overall patient survival in extremity soft tissue sarcoma. MethodsThe National Cancer Database was used to identify patients 18 years of age with non-metastatic soft tissue sarcoma of the extremity treated with surgery. Patients in high- and low-volume centers were matched by propensity score and placed into two equal comparative groups of 2437 patients each. ResultsChemotherapy was used at a higher rate in high-volume centers (22% vs 17%, P<0.001) and external beam radiation usage was similar (55% vs 52%, P=0.108). There was a lower incidence of positive margins in high-volume centers (12% vs 17%, P<0.001). There was no significant difference in the rates of limb salvage surgery or readmissions at high-volume hospitals compared to low-volume. In a multivariate Cox proportional hazards model, low-volume facilities demonstrated diminished overall survival at all time points (hazard ratio at 5 years=1.24, 95%CI 1.10-1.39). ConclusionsTreatment at high-volume hospitals was associated with fewer positive margins and increased overall survival at 2, 5, and 10 years. Continued efforts should focus on optimizing the balance between patient access to specialty care and experience of the treating center.