Purpose: The purpose of this work was to analyse follow-up and prognostic factors in a series of patients treated for soft tissue tumours as a function of the type of facility providing initial care: a supra-regional referral centre (Royal Orthopaedic Hospital, Birmingham), and 38 regional hospitals in the referral area.

Material and methods: This series included 260 patients (111 women and 149 men) treated between 1994 and 1996. Mean age at diagnosis was 61 years. Primary care was given to 96 patients (37%) in the referral centre and 164 (63%) in other centres. Minimum follow-up was five years. The risk of local recurrence and survival prognosis were studied by risk factor: grade, localisation (supra versus infra aponeurotic), tumour size, quality of resection margins.

Results: High-grade tumours were found in 73% of patients with a supra-aponeurotic localisation in 59%. Mean tumour size was 8.6 cm. Tumours in patients treated in the referral centre were larger (10.3 cm versus 7.5 cm) (p< 0.05). Frequency of local recurrence was 20% for the referral centre versus 37% for the other centres. Overall five-year survival rate was 58% and was correlated with grade, tumour size, and localisation (p< à.05). Overall survival of patients given primary care in the referral centre was not statistically different from those treated in the other centres, but for high-grade tumours (UICC grade III), five-year survival was 41% for the referral centre and 14% for the other centres (p< 0.05).

Discussion: Soft tissue sarcomas are rare tumours. For high-grade sarcomas, the rate of recurrence after treatment and the survival rate were better for patients given primary care in the referral centre. The question of centralising patients with this type of disease in referral centres is raised.

“Cancer should be treated by cancer specialists” is often stated, but there is little proof that outcomes are different. We have investigated whether there is evidence that patients with soft tissue sarcomas (STS) do better if treated in a specialist centre compared with district general hospitals (DGH).

We analysed the outcomes for all patients with soft tissue sarcomas in one health authority of the UK over a 3 year period, with minimum follow up of 5 years. During this time one third of patients were treated at a specialist musculoskeletal oncology centre whilst the remainder had treatment centred in a DGH. We have investigated appropriateness of treatment, adequacy of surgery, and outcomes in terms of local control and overall survival. Data was obtained from the Cancer Intelligence Unit and the specialist centre. Results were stratified for known risk factors for local control and survival (grade, depth and size for survival).

260 patients were diagnosed as having STS over the 3 year period (incidence = 17.4 per million per year). 37% of patients had the majority of treatment at the specialist centre under the care of 2 surgeons, whilst the other 63% were treated at a total of 38 different hospitals. The most significant factor affecting survival was tumour grade (relative risk 5.5). Overall survival shows that patients treated for STS have greater chance of survival at the ROH. 5 year survival for Stage III tumours was 41% at the ROH, but only 14% at DGHs. Percentage of adequate margins achieved at the DGHs and ROH were approximately equal, but there were significantly more local recurrences at the DGHs (37% DGH vs 20% ROH), suggesting the margins at the ROH are in fact better achieved.

Soft tissue sarcomas are rare. Centralisation of treatment improves survival, local control and patients care.