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Patients at high volume centres were generally younger, with a higher proportion of women, were more likely to have high-grade tumours and were more likely to receive radiation therapy and chemotherapy. When the authors looked at outcomes, they found that 30-day mortality rates were twice as high in low volume centres than in high volume institutions; there was a similar disparity with the 90-day mortality rate. Median 5-year and 10-year survival was significantly better for patients treated at high volume centres (40 months versus 37 months); however, survival of patients with extremity tumours was equal among the two groups of institutions. There was a slight selection bias in favour of the low volume centres because tumours managed at high volume places were higher grade and larger in size but despite this, higher volume centres achieved superior outcomes in patients with high grade lesions and those with tumours over 10 cm in size.

In an additional analysis, the researchers examined outcomes from treatment of extremity tumours alone to establish whether the volume of surgeries done at a centre affected the likelihood of patients keeping their limbs. A total of 1937 extremity tumours were analysed. At high volume centres, 90.6% of procedures for these tumours were limb sparing operations compared with 86.2% at low volume centres, suggesting that physicians at low-volume centres were more likely to resort to amputation to protect the patients survival chances.

This analysis reveals a direct correlation between hospital surgical volume and both short-term and long-term treatment outcomes for STS. While the observations reported here require confirmation with additional independent data sets they argue persuasively for exclusive referral of patients with STS to high volume specialised centres for optimal treatment, survival, and functional outcomes, conclude th
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Contact: Corinne Hall
mediaservice@esoncology.org
39-028-546-4522
European School of Oncology
9-Jul-2007