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Original Article Plastic and Aesthetic Research

The infl uence of national guidelines on soft

tissue sarcoma patient outcome: a single

center experience

Annu Nummi, Taina A. Partanen, Ylermi Soini, Leena Berg, Leena Setälä, Paula Mustonen
Department of Plastic Surgery and Pathology, Kuopio University Hospital, PL 100, 70029 KYS Kuopio, Uusimaa, Finland.
Address for correspondence: Dr. Annu Nummi, Uudenmaankatu 31 F 26, 00120 Helsinki, Uusimaa, Finland. E-mail: annu.nummi@hus.fi

ABSTRACT
Aim: The aim was to study the impact of nationwide clinical practice guidelines for soft tissue
sarcomas (STS), introduced in 1994 and again in 2005 in North Savo, Finland. Methods: We
retrospectively reviewed all the patients whose sarcoma was treated by a multidisciplinary team
between the years 2000 and 2009 with mean follow-up time of 68 months. The patients were divided
into 2 groups according to years: Group A (2000–2005, 72 patients) and Group B (2006–2009, 64
patients). Primary outcomes were local recurrence, metastases, and overall survival. Results: Fifty-fi ve
percent were men with an average age of 59 years. The most common sarcomas were pleomorphic
sarcoma (37%) and liposarcoma (26%). Although there were signifi cantly less amputations in
Group B (A: 15%, B: 3%), there were more metastases (A: 10%, B: 23%) with an overall lower overall
survival rate (A: 70%, B: 58%) than in Group A. Conversely, Group A had a higher 1st year survival
rate (A: 100%, B: 87%). We found that upper limb sarcomas were more likely to be diagnosed with
incisional biopsies, but there was no correlation between incisional biopsy and recurrence, metastases
or survival. Conclusion: Due to nonadherence of the 2005 national treatment recommendations, there
has been no improvement either in management or survival. The importance of educating guidelines
to doctors referring patients to specialized units cannot be overemphasized to affect successful
management in the treatment of STS.

Key words:
Clinical guidelines, follow-up, incisional biopsy, soft tissue sarcoma

INTRODUCTION neoadjuvant and adjuvant therapy has improved the
management of STS. [1]
Soft tissue sarcomas (STSs) are a rare group of The Hospital District of North Savo is comprised of 7
heterogeneous malignant tumors derived from hospital areas and 855,000 (year 2000) and 843,000 (year
[1]
mesenchymal cell lines. They represent approximately 2009) inhabitants. The multidisciplinary STS group of
1% of all malignancies. [2-4] STS can occur at any age, Kuopio University Hospital was established in 1994.
but the peak of incidence is in the late adult life. The group meets on a weekly basis to discuss the
Introduction of multidisciplinary teams and referral best approach for each patient with STS utilizing a
of patients to specialized care units with diagnostic multidisciplinary team.
radiology, histopathology, surgical expertise and
In this study, we analyzed all patients whose sarcoma was
Access this article online evaluated by this multidisciplinary team over a 10 years
Quick Response Code: period: 2000–2009. At the beginning of the study, the
Website: algorithm for examination and treatment in primary
www.parjournal.net
health care for STS was not what it is today. To increase
awareness regarding tumor diagnostics, accurate biopsy
methodology and imagining, the current clinical practice
DOI:
10.4103/2347-9264.143554 guidelines were introduced to the primary care units
and tertiary centers by lectures and bulletins. Guidelines

98 Plast Aesthet Res || Vol 1 || Issue 3 || Dec 2014