Adherence to treatment guidelines for primary sarcomas affects patient survival: a side study of the European CONnective TIssue CAncer NETwork (CONTICANET)

Ann Oncol. 2013 Jun;24(6):1685-91. doi: 10.1093/annonc/mdt031. Epub 2013 Feb 27.


Background: The impact of adherence to clinical practice guidelines (CPGs) for loco-regional treatment (i.e. surgery and radiotherapy) and chemotherapy on local disease control and survival in sarcoma patients was investigated in a European study conducted in an Italian region (Veneto).

Patients and methods: The completeness of the adherence to the Italian CPGs for sarcomas treatment was assessed by comparing the patient's charts and the CPGs. Propensity score-adjusted multivariate survival analysis was used to assess the impact of CPGs adherence on patient clinical outcomes.

Results: A total of 151 patients were included. Adherence to CPGs for loco-regional therapy and chemotherapy was observed in 106 out of 147 (70.2%) and 129 out of 139 (85.4%) patients, respectively. Non-adherence to CPGs for loco-regional treatment was independently associated with AJCC stage III disease [odds ratio (OR) 1.77, P = 0.011] and tumor-positive excision margin (OR 3.55, P = 0.003). Patients not treated according to the CPGs were at a higher risk of local recurrence [hazard ratio (HR) 5.4, P < 0.001] and had a shorter sarcoma-specific survival (HR 4.05, P < 0.001), independently of tumor stage.

Conclusions: Incomplete adherence to CPGs for loco-regional treatment of sarcomas was associated with worse prognosis in patients with non-metastatic tumors.

Keywords: clinical practice guidelines; prognosis; sarcomas.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Cohort Studies
  • Europe / epidemiology
  • Female
  • Follow-Up Studies
  • Guideline Adherence / standards*
  • Humans
  • Male
  • Middle Aged
  • Neoplasms, Connective Tissue / epidemiology*
  • Neoplasms, Connective Tissue / mortality
  • Neoplasms, Connective Tissue / therapy*
  • Practice Guidelines as Topic / standards*
  • Sarcoma / epidemiology*
  • Sarcoma / mortality
  • Sarcoma / therapy*
  • Survival Rate / trends
  • Treatment Outcome