Poster, Podium & Video Sessions
Presentation Authors: Jessica Yih*, Matthew Maurice, Robert Abouassaly, John Ammori, Cleveland, OH
Introduction: Retroperitoneal sarcoma (RPS) is a rare malignancy. Principles of management include surgical management (SM) and complete resection (CR) with negative microscopic margins (NMM). We aimed to evaluate the role of provider characteristics on RPS outcomes.
Methods: Adult patients diagnosed with non-metastatic RPS from 2004-2013 were identified from the National Cancer Database. Volume was classified based on average annual number of RPS cases as low (<5) or high (>=5), with high-volume hospitals (HVH) corresponding to top 10th percentile. Univariate and multivariable statistical methods were used to examine the association between hospitals volume and academic status on SM, CR, NMM and OS, adjusted for other covariates.
Results: We identified 3,093 patients with RPS (median age 61 years). Histologic subtypes included liposarcoma (49.6%), leiomyosarcoma (26.3%), and other subtypes (24.1%). SM offered improved overall survival (OS) compared to non-surgical management (84.2 vs. 43.2 months, p<.001). CR improved OS compared to incomplete resection (85.9 vs. 39.9 months, p<.01). In patients who had CR, achieving NMM improved OS (97.6 vs. 71.1 months, p<.01). Surgery was used to treat 2,168 (70.0%) patients, and the odds of SM were 1.5-fold higher at academic hospitals (OR 1.5, 95%CI 1.2-1.7) and 2-fold higher at HVH (OR 2, 95%CI 1.4-2.8). CR was achieved in 2,058 (95.0%) of surgical patients, with odds of CR 1.8-fold higher at academic hospitals (OR 1.8, 95% CI 1.2-2.7) and 3.8-fold higher at HVH (OR 3.8, 95%CI 1.2-12.4). NMM was obtained in 1,361 (33.9%) patients with CR, with 1.8-fold higher odds of NMM at HVH (OR 1.8, 95%CI 1.3-2.4).
Conclusions: Quality measures (SM, CR, NMM) associated with improved OS are achieved more readily at academic and high-volume hospitals. Consideration should be given to centralization of RPS care.
Source Of Funding: none
University Hospitals Cleveland Medical Center
Jessica Yih, MD is a 4th year urology resident at University Hospitals Cleveland Medical Center. She received her MD from Wayne State Unversity School of Medicine in Detroit, Michigan. She received her Masters in Mental Health Counseling and Behavior Medicine at Boston University, and her BS in Brain, Behavior and Cognitive Science at University of Michigan Ann Arbor. Her hobbies include oil painting, listening to podcasts, bicycling, practicing yoga, backpacking, and camping.