This study evaluated the impact of care pathways on the incidence of local recurrence (LR) in patients with soft tissue sarcomas (STS) and identified factors predictive of LR. It compared outcomes between patients managed entirely within a comprehensive care pathway (CCP) at the Swiss Sarcoma Network (SSN) and those who experienced fragmented care pathways (FCPs), where initial treatment occurred outside specialized centers. This prospective study utilized real-world-time data from the SSN-Sarconnector, capturing quality indicators through weekly Multidisciplinary Team/Sarcoma-Board (MDT/SB) meetings. The overall incidence of LR was 17.6% (n = 68/386), higher than rates typically reported in sarcoma center-based studies due to the inclusion of patients with prior inadequate management from real-world referrals. In a univariable logistic regression analysis, the FCP was significantly associated with higher LR rates, unplanned “whoops” resections (25.4%, n = 96), and positive surgical margins, emphasizing the detrimental impact of suboptimal initial management outside of specialized centers. Multivariable analysis confirmed that the FCP (aOR 2.7, 95% CI [1.41, 5.12],p= 0.003), tumor size (aOR 1.49, 95% CI [1.1, 2.02],p= 0.01), and biological behavior (aOR 5.84 95% CI [1.8, 18.86],p= 0.0003) are independent predictors of LR. Notably, patients referred to sarcoma centers after an initial FCP presented with inadequately managed disease, such as incomplete resections and unplanned surgeries, leading to increased complexity of subsequent treatments. These findings underscore the critical role of referral patterns on sarcoma center outcomes, highlighting the significant disparity in LR rates between institutions. The need for improved education and standardized early referral strategies at the spoke level is paramount to optimize patient outcomes and reduce the burden of LR. Enhanced spoke-level education and standardized referral protocols are critical to ensuring effective initial management and optimizing patient outcomes within specialized sarcoma networks like the SSN.
本研究评估了诊疗路径对软组织肉瘤（STS）患者局部复发（LR）发生率的影响，并识别了预测LR的相关因素。研究比较了在瑞士肉瘤网络（SSN）内完全遵循综合诊疗路径（CCP）管理的患者与经历碎片化诊疗路径（FCPs）患者的结局，后者初始治疗在非专科中心进行。这项前瞻性研究利用SSN-Sarconnector的真实世界数据，通过每周多学科团队/肉瘤委员会（MDT/SB）会议收集质量指标。总体LR发生率为17.6%（n=68/386），高于肉瘤中心研究通常报道的比率，这是因为纳入了现实中转诊的既往治疗不当的患者。单变量逻辑回归分析显示，FCP与较高的LR率、计划外“意外”切除（25.4%，n=96）以及阳性手术切缘显著相关，凸显了在非专科中心进行次优初始治疗的不利影响。多变量分析证实，FCP（aOR 2.7，95% CI [1.41, 5.12]，p=0.003）、肿瘤大小（aOR 1.49，95% CI [1.1, 2.02]，p=0.01）和生物学行为（aOR 5.84，95% CI [1.8, 18.86]，p=0.0003）是LR的独立预测因素。值得注意的是，在初始FCP后转诊至肉瘤中心的患者，其疾病管理不当（如不完全切除和计划外手术），导致后续治疗复杂性增加。这些发现强调了转诊模式对肉瘤中心结局的关键影响，揭示了机构间LR率的显著差异。为优化患者结局并减轻LR负担，亟需在基层医疗机构层面加强教育和制定标准化的早期转诊策略。加强基层教育并建立标准化转诊方案，对于确保SSN等专科肉瘤网络内的有效初始管理和优化患者结局至关重要。
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