(P 205) CENTRALIZATION OF SARCOMA CARE IMPROVES OUTCOMES DESPITE POORER PRESENTATION: A SYSTEMATIC REVIEW AND META-ANALYSIS

Objective: Soft tissue sarcoma (STS) and bone sarcoma (BS) are rare, highly heterogeneous groups of malignancies of mesenchymal origin. With the recent emphasis on multidisciplinary approach to sarcoma treatment, centralization of treatment at high-volume centers (HVC) has been suggested to offer advantages over low-volume centers (LVC). The purpose of this systematic review was to report on the differences in tumor presentation, treatment, and outcomes of primary BS and STS patients treated at HVC and LVC.

Methods: PubMed and Embase databases were queried to conduct a systematic review of articles from inception to October 2024. A total of 16 studies were included: 4 BS, 12 STS. Study characteristics, HVC/LVC definition, tumor histology, primary anatomic location, tumor presentation (size, grade), treatment (surgery, amputation, chemotherapy, radiotherapy), margin status, and survival outcomes were analyzed.

Results: There was substantial heterogeneity in the definition of HVC and LVC applied in the included studies, generally left to the authors’ arbitrary discretion. While presenting tumor histology and primary anatomic location were comparable between HVC and LVC, HVC patients had substantially higher grade and larger size tumors. HVC more frequently utilized radiotherapy and chemotherapy and achieved negative margins at surgery. Treatment at HVC was associated with a 17% reduction in mortality (HR, 0.83; 95% CI, 0.78 to 0.89; p< 0.001; I2=78.5%). Subgroup analyses demonstrated a consistent and significant reduction in mortality within both the BS and STS cohorts.

Conclusion: Despite presenting with poorer prognosis, both BS and STS patients experienced superior outcomes at HVC, highlighting the importance and efficacy of centralization of sarcoma care. Furthermore, the need for standardization of HVC and LVC definitions is emphasized.