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Blay JY, Casali P, Ray-Coquard I, Seckl MJ, Gietema J, de Herder WW, Caplin M, Klümpen HJ, Glehen O, Wyrwicz L, Peeters R, Licitra L, Girard N, Piperno-Neumann S, Kapiteijn E, Idbaih A, Franceschi E, Trama A, Frezza AM, Hohenberger P, Hindi N, Martin-Broto J, Schell J, Rogasik M, Lejeune S, Oliver K, de Lorenzo F, Weinman A. Management of patients with rare adult solid cancers: objectives and evaluation of European reference networks (ERN) EURACAN. Lancet Reg Health Eur 2024; 39:100861. [PMID: 38384730 PMCID: PMC10879812 DOI: 10.1016/j.lanepe.2024.100861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 01/16/2024] [Accepted: 01/22/2024] [Indexed: 02/23/2024]
Abstract
About 500,000 patients with rare adult solid cancers (RASC) are diagnosed yearly in Europe. Delays and unequal quality of management impact negatively their survival. Since 2017, European reference networks (ERN) aim to improve the quality of care of patients with rare disease. The steering committee of EURACAN, including physicians, researchers and patients review here the previous actions, present objectives of the ERN EURACAN dedicated to RASC. EURACAN promoted management in reference centres, and equal implementation of excellence and innovation in Europe and developed 22 clinical practice guidelines (CPGs). Additionally, fourteen information brochures translated in 24 EU languages were developed in collaboration with patient advocacy groups (ePAGs) and seventeen training session were organized. Nevertheless, connections to national networks in the 26 participating countries (106 centres), simplification of cross-border healthcare, international multidisciplinary tumour boards, registries and monitoring of the quality of care are still required. In this Health Policy, evaluation criteria of the performances of the network and of health care providers are proposed.
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Affiliation(s)
- Jean-Yves Blay
- Department of Medical Oncology, Centre Leon Berard & Centre de Recherche en Cancérologie de Lyon (CRCL) & Université Claude Bernard Lyon 1, Lyon, France
| | - Paolo Casali
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori and University of Milan, Milan, Italy
| | - Isabelle Ray-Coquard
- Department of Medical Oncology, Centre Leon Berard & Centre de Recherche en Cancérologie de Lyon (CRCL) & Université Claude Bernard Lyon 1, Lyon, France
| | - Michael J. Seckl
- Department of Medical Oncology, Imperial College Hospitals National Health Service (NHS) Trust (ICHNT), London, United Kingdom
| | - Jourik Gietema
- Department of Medical Oncology, University Medical Centre Groningen, Groningen, the Netherlands
- University of Groningen Groningen, the Netherlands
| | - Wouter W. de Herder
- Department of Internal Medicine, Sector of Endocrinology, Erasmus MC and Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Martyn Caplin
- Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Heinz-Josef Klümpen
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Olivier Glehen
- Department of Surgical Oncology, Centre Hospitalier Lyon Sud, Equipe CICLY & Université Claude Bernard Lyon 1, Lyon, France
| | - Lucjan Wyrwicz
- M Sklodowska Curie Memorial Cancer Centre, Warsaw, Poland
| | - Robin Peeters
- Department of Internal Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Lisa Licitra
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori and University of Milan, Milan, Italy
| | - Nicolas Girard
- Department of Medical Oncology, Institut Curie, Paris, France
| | | | - Ellen Kapiteijn
- Department of Medical Oncology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Ahmed Idbaih
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, Paris, France
| | - Enrico Franceschi
- Azienda USL / IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Annalisa Trama
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori and University of Milan, Milan, Italy
| | - Anna-Maria Frezza
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori and University of Milan, Milan, Italy
| | - Peter Hohenberger
- Div. of Surgical Oncology and Thoracic Surgery, Mannheim University Medical Centre, University of Heidelberg, Mannheim, Germany
| | - Nadia Hindi
- Fundación Jiménez Díaz University Hospital, Madrid, Spain
- Spanish Group for Research on Sarcoma (GEIS), Spain
| | - Javier Martin-Broto
- Fundación Jiménez Díaz University Hospital, Madrid, Spain
- Spanish Group for Research on Sarcoma (GEIS), Spain
| | | | | | - Stephane Lejeune
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Kathy Oliver
- The International Brain Tumour Alliance (IBTA), Tadworth, United Kingdom
| | | | - Ariane Weinman
- European Patient Organisation for Rare Diseases (EURORDIS-Rare Diseases Europe), Brussels, Belgium
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Savoye I, Silversmit G, Bourgeois J, De Gendt C, Leroy R, Peacock HM, Stordeur S, de Sutter P, Goffin F, Luyckx M, Orye G, Van Dam P, Van Gorp T, Verleye L. Association between hospital volume and outcomes in invasive ovarian cancer in Belgium: A population-based study. Eur J Cancer 2023; 195:113402. [PMID: 37922631 DOI: 10.1016/j.ejca.2023.113402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/28/2023] [Accepted: 10/25/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES To study the association between hospital volume and outcomes in patients with invasive epithelial ovarian cancer (EOC). METHODS This study included 3988 patients diagnosed with invasive EOC between 2014 and 2018, selected from the population-based database of the Belgian Cancer Registry (BCR), and coupled with health insurance and vital status data. The associations between hospital volume and observed survival since diagnosis were assessed with Cox proportional hazard models, while volume associations with 30-day post-operative mortality and complicated recovery were evaluated using logistic regression models. RESULTS Treatment for EOC was very dispersed with half of the 100 centres treating fewer than six patients per year. The median survival of patients treated in centres with the highest-volume quartile was 2.5 years longer than in those with the lowest-volume quartile (4.2 years versus 1.7 years). When taking the case-mix of hospitals into account, patients treated in the lowest volume centres had a 47% higher hazard to die than patients treated in the highest volume centres (HR: 1.47, 95% CI: 1.11-1.93, p = 0.006) over the first five years after incidence. A similar association was found when focussing on the surgical volume of the hospitals and considering only operated patients with invasive EOC. Lastly, the 30-day post-operative mortality decreased significantly with increasing surgical volume. CONCLUSIONS The large dispersion of care and expertise within Belgium and the volume-outcome associations observed in this study support the implementation of the concentration of care for patients with invasive EOC in reference centres.
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Affiliation(s)
- Isabelle Savoye
- Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium.
| | | | | | | | - Roos Leroy
- Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium
| | | | - Sabine Stordeur
- Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium
| | | | - Frédéric Goffin
- Obstetrics and Gynecology, University of Liege, Liege, Belgium
| | - Mathieu Luyckx
- Service de gynécologie et Andrologie and Institut Roi Albert II, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Guy Orye
- Department of Obstetrics and Gynecology, Jessa Hospital, Hasselt, Belgium
| | - Peter Van Dam
- Division of Gynecologic Oncology, Multidisciplinary Oncologic Center, Antwerp University Hospital, Edegem, Belgium
| | - Toon Van Gorp
- University Hospital Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - Leen Verleye
- Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium
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Blay JY, Piperno-Neumann S, Watson S, Dufresne A, Valentin T, Duffaud F, Toulmonde M, Italiano A, Bertucci F, Tlemsani C, Firmin N, Bompas E, Perrin C, Ropars M, Saada-Bouzid E, Dubray-Longeras P, Hervieu A, Lebbe C, Gantzer J, Chaigneau L, Fiorenza F, Rios M, Isambert N, Soibinet P, Boudou-Roquette P, Verret B, Ferron G, Ryckewaert T, Lebellec L, Brahmi M, Gouin F, Meeus P, Vaz G, Le Loarer F, Karanian M, De Pinieux G, Ducimetiere F, Chemin C, Morelle M, Le Cesne A, Penel N. Epithelioid hemangio-endothelioma (EHE) in NETSARC: The nationwide series of 267 patients over 12 years. Eur J Cancer 2023; 192:113262. [PMID: 37625241 DOI: 10.1016/j.ejca.2023.113262] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/07/2023] [Accepted: 07/24/2023] [Indexed: 08/27/2023]
Abstract
EPITHELIOID HEMANGIOENDOTHELIOMA A NATIONWIDE STUDY: Epithelioid hemangioendothelioma (EHE) is an ultrarare sarcoma whose natural history and treatment is not well defined. We report on the presentation and outcome of 267 patients with EHE in the NETSARC+ network since 2010 in France. PATIENTS AND METHODS NETSARC (netsarc.org) is a network of 26 reference sarcoma centres with specialised multidisciplinary tumour boards (MDTB), funded by the French National Cancer Institute (NCI), Institut National du Cancer (INCA). Since 2010, presentation to an MDTB and second pathological review are mandatory for sarcoma patients. Patients' characteristics are collected in a nationwide database regularly monitored with stable incidence since 2013. The characteristics of patients with EHE at diagnosis are presented as well as progression-free survival (PFS), overall survival (OS), and outcome under treatment. RESULTS Two hundred and sixty-seven patients with EHE were included in the NETSARC+ database since 2010. Median age in the series was 51 (range 10-90) years, 58% were women. Median tumour size was 37 mm (4-220). Forty-eight percent, 42%, and 10% were visceral, soft parts, or bone primaries. The most frequent sites were liver (28%), lung (13%). 40% were reported to have systemic (i.e. multifocal or metastatic disease) at diagnosis. With a median follow-up of 20 months, OS and PFS rates at 24 months were 82% and 67%, with 10-year projected OS and PFS of 62% and 21% respectively. Male and M+ patients at diagnosis had a significantly worse OS, but not PFS. Local treatment was associated with a favourable survival in localised but not in patients with advanced stage at diagnosis. For 23 patients receiving medical treatment, PFS and OS were 50.2% and 33.2% at 60 months were respectively. CONCLUSIONS EHE is a frequently metastatic sarcoma at diagnosis with a unique natural history. This study shows in a nationwide series over 12 years that most patients progressed but are still alive at 10 years, both in localised and metastatic stages.
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Affiliation(s)
- J Y Blay
- Department of Medical oncology, Centre Léon Bérard and Université Claude Bernard, Lyon, France.
| | - S Piperno-Neumann
- Department of Medical Oncology, Institut Curie and INSERM U830, Institut Curie Research Center, Paris, France
| | - S Watson
- Department of Medical Oncology, Institut Curie and INSERM U830, Institut Curie Research Center, Paris, France
| | - A Dufresne
- Department of Medical oncology, Centre Léon Bérard and Université Claude Bernard, Lyon, France
| | - T Valentin
- Department of Medical oncology, Institut Claudius Regaud and Institut Universitaire de Cancerologie, Oncopole, Toulouse, France
| | - F Duffaud
- Department of Medical oncology, La Timone University Hospital, Marseille, France
| | - M Toulmonde
- Departement of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - A Italiano
- Departement of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - F Bertucci
- Department of Medical oncology, Institut Paoli-Calmettes, Marseille, France
| | - C Tlemsani
- Department of Medical oncology, Hôpital Cochin-Saint-Vincent de Paul, Paris, France
| | - N Firmin
- Department of Medical oncology, Institut de Cancérologie de Montpellier, Montpellier, France
| | - E Bompas
- Department of Medical Oncology, Institut de Cancerologie Ouest, Nantes, France
| | - C Perrin
- Department of Medical oncology, Eugene Marquis Comprehensive Cancer Center and CHU, Rennes, France
| | - M Ropars
- Department of Medical oncology, Eugene Marquis Comprehensive Cancer Center and CHU, Rennes, France
| | - E Saada-Bouzid
- Department of Medical oncology, Centre Antoine-Lacassagne, Nice, France
| | - P Dubray-Longeras
- Department of Medical oncology, Centre Georges François Leclerc, Dijon, France
| | - A Hervieu
- Department of Medical oncology, Centre Jean Perrin/ERTICa EA 4677, Clermont-Ferrand, France
| | - C Lebbe
- Department of Medical oncology, Oncology Unit, Saint Louis Hospital, Paris, France
| | - J Gantzer
- Department of Medicine, ICANS, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - L Chaigneau
- Department of Medical oncology, CHU Besancon, Besançon, France
| | - F Fiorenza
- Department of Medical oncology, CHU Limoges, Limoges, France
| | - M Rios
- Department of Medical oncology, Institut Cancerologie Lorraine, Centre Alexis Vautrin, Nancy, France
| | - N Isambert
- Department of Medical oncology, CHU, Poitiers, France
| | - P Soibinet
- Department of Medical oncology, Institut J Godinot Reims, Reims, France
| | - P Boudou-Roquette
- Department of Medical oncology, Hôpital Cochin-Saint-Vincent de Paul, Paris, France
| | - B Verret
- Department of Medical oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - G Ferron
- Department of Medical oncology, Institut Claudius Regaud and Institut Universitaire de Cancerologie, Oncopole, Toulouse, France
| | - T Ryckewaert
- Department of Medical oncology, Centre Oscar Lambret, and Université de Lille ULR 2694, Lille, France
| | - L Lebellec
- Department of Medical oncology, Centre Oscar Lambret, and Université de Lille ULR 2694, Lille, France
| | - M Brahmi
- Department of Medical oncology, Centre Léon Bérard and Université Claude Bernard, Lyon, France
| | - F Gouin
- Department of Medical oncology, Centre Léon Bérard and Université Claude Bernard, Lyon, France
| | - P Meeus
- Department of Medical oncology, Centre Léon Bérard and Université Claude Bernard, Lyon, France
| | - G Vaz
- Department of Medical oncology, Centre Léon Bérard and Université Claude Bernard, Lyon, France
| | - F Le Loarer
- Departement of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - M Karanian
- Department of Medical oncology, Centre Léon Bérard and Université Claude Bernard, Lyon, France
| | - G De Pinieux
- Department of Medical oncology, CHU Tours, Tours, France
| | - F Ducimetiere
- Department of Medical oncology, Centre Léon Bérard and Université Claude Bernard, Lyon, France
| | - C Chemin
- Department of Medical oncology, Centre Léon Bérard and Université Claude Bernard, Lyon, France
| | - M Morelle
- Department of Medical oncology, Centre Léon Bérard and Université Claude Bernard, Lyon, France
| | - A Le Cesne
- Department of Medical oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - N Penel
- Department of Medical oncology, Centre Oscar Lambret, and Université de Lille ULR 2694, Lille, France
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Zulet P, Olmos C, López J, Vilacosta I, Sáez C, Cabezón G, Gómez D, Jerónimo A, Pérez-Serrano J, San Román JA. Impact of transfer to reference centres and surgical timing on the prognosis of surgically treated patients with infective endocarditis: a prospective multi-centre cohort study. Clin Microbiol Infect 2023; 29:1197.e1-1197.e7. [PMID: 37302571 DOI: 10.1016/j.cmi.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/03/2023] [Accepted: 06/05/2023] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To compare outcomes in patients with infective endocarditis (IE) first treated in secondary hospitals and then transferred to reference centres for surgery with those in patients diagnosed in reference centres, and to evaluate the impact of surgery timing on prognosis. METHODS Analysis of a prospective cohort of patients with active IE admitted to three reference centres between 1996 and 2022 who underwent cardiac surgery in the first month after diagnosis. Multi-variable analysis was performed to evaluate the impact of transfer to reference centres and time to surgery on 30-day mortality. Adjusted ORs with 95% CIs were calculated. RESULTS Amongst 703 patients operated on for IE, 385 (54.8%) were referred cases. All-cause 30-day mortality did not differ significantly between referred patients and those diagnosed at reference centres (102/385 [26.5%] vs. 78/385 [24.5%], respectively; p 0.552). Variables independently associated with 30-day mortality in the whole cohort were diabetes (OR, 1.76 [95% CI, 1.15-2.69]), chronic kidney disease (OR, 1.83 [95% CI, 1.08-3.10]), Staphylococcus aureus (OR, 1.88 [95% CI, 1.18-2.98]), septic shock (OR, 2.76 [95% CI, 1.67-4.57]), heart failure (OR, 1.41 [95% CI, 0.85-2.11]), acute renal failure before surgery (OR, 1.76 [95% CI, 1.15-2.69]), and the interaction between transfer to reference centres and surgery timing (OR, 1.18 [95% CI, 1.03-1.35]). Amidst referred patients, time from diagnosis to surgery longer than a week was independently associated with 30-day mortality (OR, 2.19 [95% CI, 1.30-3.69]; p 0.003). CONCLUSION Among referred patients, surgery performed >7 days after diagnosis was associated with two-fold higher 30-day mortality.
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Affiliation(s)
- Pablo Zulet
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Carmen Olmos
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain.
| | - Javier López
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico, Valladolid, Spain; Ciber de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Isidre Vilacosta
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Carmen Sáez
- Hospital Universitario La Princesa, Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa (IIS-IP), Madrid, Spain
| | - Gonzalo Cabezón
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico, Valladolid, Spain; Ciber de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Daniel Gómez
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Adrián Jerónimo
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Javier Pérez-Serrano
- Hospital Universitario La Princesa, Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa (IIS-IP), Madrid, Spain
| | - J Alberto San Román
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico, Valladolid, Spain; Ciber de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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Trama A, Badalamenti G, Baldi GG, Brunello A, Caira M, Drove N, Marrari A, Palmerini E, Vincenzi B, Dei Tos AP, Grignani G. Soft tissue sarcoma in Italy: From epidemiological data to clinical networking to improve patient care and outcomes. Cancer Epidemiol 2019; 59:258-264. [PMID: 30870746 DOI: 10.1016/j.canep.2019.02.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 02/07/2019] [Accepted: 02/10/2019] [Indexed: 12/19/2022]
Abstract
Sarcomas are rare malignant neoplasms that develop from mesenchymal cells and include a heterogeneous and large group of histological subtypes that may occur at any anatomical site. Soft tissue sarcomas (STS), the focus of this review, account for ≈70‒80% of sarcomas and represent <1% of all cancers. The heterogeneity of STS applies to both their topography and morphology, and 5-year survival can vary widely depending on disease stage and the complex interplay between anatomical site and histology for different STS subtypes. The rarity and heterogeneity of STS, together with other factors, such as the lack of clinical expertise often lead to difficulties and delays in making an accurate diagnosis and to the inappropriate management of each STS subtype. Therefore, this group of cancers requires special attention and approaches to diagnosis and treatment. Epidemiological data on STS are limited, and concerns have been raised regarding accurate registration of STS in cancer registries, including issues related to details of the histotypes. This review provides an overview of the epidemiology of STS in Italy, focusing on data from the Italian Association of Cancer Registries (AIRTUM), and compares findings with those from other European countries. Based on these data, and considering that STS is among the most common group of rare cancers, the relevance of multidisciplinary care for STS patients through reference centres, clinical networks and collaborative disease-specific groups is discussed.
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Affiliation(s)
- Annalisa Trama
- Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Giuseppe Badalamenti
- Section of Medical Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Giacomo Giulio Baldi
- 'Sandro Pitigliani' Department of Medical Oncology, Hospital of Prato, Prato, Italy
| | - Antonella Brunello
- Department of Clinical and Experimental Oncology, Medical Oncology 1 Unit, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | | | | | - Andrea Marrari
- Department of Medical Oncology and Hematology, Humanitas Cancer Center and Research Hospital, IRCCS, Rozzano, Milan, Italy
| | | | - Bruno Vincenzi
- University Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy.
| | | | - Giovanni Grignani
- Division of Medical Oncology Candiolo Cancer Institute - FPO, IRCCS, Strada Provinciale 142, 10060 Candiolo, Torino, Italy
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Penel N, Coindre JM, Bonvalot S, Italiano A, Neuville A, Le Cesne A, Terrier P, Ray-Coquard I, Ranchere-Vince D, Robin YM, Isambert N, Ferron G, Duffaud F, Bertucci F, Rios M, Stoeckle E, Le Pechoux C, Guillemet C, Courreges JB, Blay JY. Management of desmoid tumours: A nationwide survey of labelled reference centre networks in France. Eur J Cancer 2016; 58:90-6. [PMID: 26974708 DOI: 10.1016/j.ejca.2016.02.008] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 02/09/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE The optimal management of rare tumours (i.e. from accurate diagnosis to management in reference centres) is a public health challenge. In 2009, the French National Cancer Institute (INCa) identified and financially supported the two expert networks for pathological and clinical diagnosis and management of soft tissue tumours. METHODS The activities of both networks were prospectively collected using a nationwide database (rreps.org). Data describing the diagnosis management of 863 successive cases of desmoids tumours (DT) were prospectively collected from 2010 to 2013 and analysed. RESULTS The number of confirmed DT constantly improved from January 2010 to December 2013 (from 173 to 273 cases per year); the expected incidence ranged from 132 to 330 cases/year. The rate of cases diagnosed with core-needle biopsies and CTNNB1 mutational status analysis increased from 30.6 to 40.7% and from 87.8 to 94.1%, respectively. The mean delay for pathological diagnosis confirmation constantly decreased from 107 to 47 d. Among the 846 adult patients, 414 (48.9%) patients were treated by reference centres. The rate of patients managed by reference centres constantly increased with time from 36.9 to 49.5% since 2010. The median management time of the referral centres constantly decreased from 440 to 67 d. CONCLUSION The two expert networks worked synergistically and improved diagnosis modalities of rare desmoid tumours at a national level. The impact of management by expert networks on the outcome will be prospectively analysed in the future.
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