Variations in surgical strategies and treatment allocation for retroperitoneal sarcomas across German-speaking sarcoma centres.
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Albertsmeier Markus, Tiefes Anna, Tirotta Fabio, Bauer Alexander, Lindner Lars H, Di Gioia Dorit, Schmidt-Hegemann Nina-Sophie, Kunz Wolfgang G, Knösel Thomas, Pink Daniel, Duprée Anna, Kaths Moritz, Hamacher Rainer, Fechner Katja, Grützmann Robert, Semrau Sabine, Zwirner Ulrich, Schwarzbach Matthias, Ardelt Michael, Engerer Cosima, Kirchberg Johanna, Bösch Florian, Steinbach Marcus, Schiffmann Lars, Maguire Nadia, Gaidzik Verena I, Wiegering Armin, Lock Johan, Kessler Torsten, Rau Daniel, Engel Lars, Hettler Madelaine, Breden Sebastian, Szkandera Joanna, Wilhelm Alexander, Werner Jens, Jakob Jens, DACH Sarcoma Centre Survey Collaborative
Аннотация
MATERIALS AND METHODS: In this multi-centre study, 24 German-speaking sarcoma MDTs independently reviewed pre-treatment imaging and clinical information from 20 anonymised primary RPS cases. Centres provided standardised assessments of resectability, surgical strategy, and treatment allocation. Inter-centre agreement was quantified using percentage agreement with the per-case consensus and Krippendorff's alpha statistic (α), interpreted using established reference values.
RESULTS: Review of the 20 cases resulted in up to 480 MDT assessments for each item. Across 468 assessments, 411 (88%) rated the tumour as resectable and 57 (12%) as non-resectable. Centre-level agreement with the per-case consensus was 90.2%, with fair inter-centre reliability (α = 0.21). Agreement was lower in large tumours (>20 cm: 79.6%, α = 0.27) compared with smaller tumours. Agreement on surgical strategy was 65.9% (284/431; α = 0.21), with marked variability in the extent of resection and the use of compartmental versus organ-sparing approaches. Agreement on treatment allocation was 75.6% (350/463; α = 0.24) with centres pursuing different subtype-specific treatment concepts. In 8 of 20 cases, at least one centre recommended palliative treatment while others proposed a potentially curative approach.
CONCLUSION: The majority of patients were offered curative treatment options in almost all centres. Substantial variability was observed in histology-specific surgical strategies and treatment allocation. These findings indicate that centre-level interpretive frameworks substantially influence MDT recommendations. Strengthening cross-centre collaboration and refining histology-specific guidance may improve consistency in RPS care without undermining expert judgment.