{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:52:18Z","timestamp":1782953538166,"version":"3.54.5"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,8,8]],"date-time":"2023-08-08T00:00:00Z","timestamp":1691452800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Soft tissue sarcomas (STS) are rare malignancies which prognosis varies significantly by primary site, histological subtype, and tumor stage. Their low incidence, and the complexity of their clinico-pathological characteristics demand standardized, cancer-tailored diagnostics and therapies managed at high-volume, multidisciplinary care centers. This study evaluates the quality of STS management in north-east Italy (Veneto Region) through a list of <jats:italic>ad hoc<\/jats:italic> defined clinical indicators.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This population-based study concerns all incident cases of STS in 2018 (214 cases) recorded in the adult population censored by the Veneto\u2019s regional Cancer Registry. Based on the international literature, a multidisciplinary working group of experts identified a set of indicators for monitoring the quality of diagnostic, therapeutic, and end-of-life clinical interventions. The quality of care was assessed by comparing the reference thresholds with the indicators\u2019 values achieved in clinical practice.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Diagnostic procedures showed poor adherence to the thresholds, with a low percentage of histological diagnoses validated by a second opinion. The indicators relating to the surgical treatment of superficial, small, low-grade STS, or of medium, high-grade STS of the head\u2013neck, trunk, or limbs were consistent with the thresholds, while for intermediate, high-grade (large-sized, deep) and retroperitoneal STS they fell significantly below the thresholds.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>A critical evaluation of the clinical indicators allowed to uncover the procedures needing corrective action. Monitoring clinical care indicators improves cancer care, confirms the importance of managing rare cancers at highly specialized, high-volume centers, and promotes the ethical sustainability of the healthcare system.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2023.1226090","type":"journal-article","created":{"date-parts":[[2023,8,8]],"date-time":"2023-08-08T07:25:59Z","timestamp":1691479559000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Indicators of clinical performance in monitoring soft tissue sarcoma management: a population-based perspective"],"prefix":"10.3389","volume":"10","author":[{"given":"Massimo","family":"Rugge","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra","family":"Buja","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saveria","family":"Tropea","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Girardi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Cozzolino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel","family":"Zorzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonella","family":"Vecchiato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonella","family":"Stefano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Del Fiore","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonella","family":"Brunello","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra","family":"Brazzale","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Sbaraglia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelo Paolo","family":"Dei Tos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo","family":"Baldo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrizia","family":"Benini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Bortolami","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Rastrelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luigi","family":"Dall'Olmo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo Riccardo","family":"Rossi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone","family":"Mocellin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,8,8]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"70","DOI":"10.32074\/1591-951X-213","article-title":"The 2020 WHO classification of soft tissue tumours: news and perspectives","volume":"113","author":"Sbaraglia","year":"2021","journal-title":"Pathologica"},{"key":"ref2","volume-title":"Classification of Tumours Editorial Board. Soft Tissue and Bone Tumours","year":"2020"},{"key":"ref3","volume-title":"World Health Organization Classification of Tumours of Soft Tissue and Bone","author":"Fletcher","year":"2013"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"200","DOI":"10.3322\/caac.21605","article-title":"Soft-tissue sarcoma in adults: an update on the current state of histiotype-specific management in an era of personalized medicine","volume":"70","author":"Gamboa","year":"2020","journal-title":"CA Cancer J Clin"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"7","DOI":"10.3322\/caac.21590","article-title":"Cancer statistics, 2020","volume":"70","author":"Siegel","year":"2020","journal-title":"CA Cancer J Clin"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"950","DOI":"10.1016\/j.cell.2017.10.014","article-title":"Comprehensive and integrated genomic characterization of adult soft tissue sarcomas","volume":"171","year":"2017","journal-title":"Cells"},{"key":"ref7","year":"2022"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"436","DOI":"10.1097\/COC.0b013e318173a54f","article-title":"The management of adult soft tissue sarcomas","volume":"32","author":"Mendenhall","year":"2009","journal-title":"Am J Clin Oncol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"119","DOI":"10.6004\/jnccn.2013.0018","article-title":"NCCN\u2019s value pathways: the drive for quality cancer care","volume":"11","author":"Goldsmith","year":"2013","journal-title":"J Natl Compr Cancer Netw"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1111\/ddg.12238","article-title":"Quality assurance for care of melanoma patients based on guideline-derived quality indicators and certification","volume":"12","author":"Follmann","year":"2014","journal-title":"J Dtsch Dermatol Ges"},{"key":"ref11","first-page":"1","article-title":"Italy: health system review","volume":"16","author":"Ferre","year":"2014","journal-title":"Health Syst Transit"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"iv51","DOI":"10.1093\/annonc\/mdy096","article-title":"ESMO guidelines committee and EURACAN. Soft tissue and visceral sarcomas: ESMO-EURACAN clinical practice guidelines for diagnosis, treatment and follow-up","volume":"29","author":"Casali","year":"2018","journal-title":"Ann Oncol"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"3279","DOI":"10.1245\/s10434-017-6003-3","article-title":"Adherence to guidelines for adult (non-GIST) soft tissue sarcoma in the Netherlands: a plea for dedicated sarcoma centers","volume":"24","author":"Hoekstra","year":"2017","journal-title":"Ann Surg Oncol"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1348","DOI":"10.1016\/j.annonc.2021.07.006","article-title":"ESMO-EURACAN-GENTURIS Clinical Practice Guidelines for diagnosis, treatment and follow-up","volume":"32","author":"Gronchi","year":"2021","journal-title":"Ann Oncol"},{"key":"ref15","year":""},{"key":"ref16","year":"2015"},{"key":"ref17","year":"2020"},{"key":"ref18","year":"2018"},{"key":"ref19","year":"2018"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"135","DOI":"10.3802\/jgo.2009.20.3.135","article-title":"International Federation of Gynecology and Obstetrics (FIGO) staging system revised: what should be considered critically for gynecologic cancer?","volume":"20","author":"Kim","year":"2009","journal-title":"J Gynecol Oncol"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"523","DOI":"10.1093\/intqhc\/mzg081","article-title":"Defining and classifying clinical indicators for quality improvement","volume":"15","author":"Mainz","year":"2003","journal-title":"Int J Qual Health Care"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1523","DOI":"10.1016\/j.socscimed.2009.08.026","article-title":"Performance management in healthcare: performance indicator development, task uncertainty, and types of performance indicators","volume":"69","author":"van der Geer","year":"2009","journal-title":"Soc Sci Med"},{"key":"ref23","year":"2014"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1093\/annonc\/mdt407","article-title":"Adherence to consensus-based diagnosis and treatment guidelines in adult soft-tissue sarcoma patients: a French prospective population-based study","volume":"25","author":"Mathoulin-P\u00e9lissier","year":"2014","journal-title":"Ann Oncol"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1291","DOI":"10.2106\/JBJS.K.01271","article-title":"Simple guidelines for efficient referral of soft-tissue sarcomas: a population-based evaluation of adherence to guidelines and referral patterns","volume":"94","author":"Styring","year":"2012","journal-title":"J Bone Joint Surg Am"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"2442","DOI":"10.1093\/annonc\/mdr610","article-title":"Sarcoma: concordance between initial diagnosis and centralized expert review in a population-based study within three European regions","volume":"23","author":"Ray-Coquard","year":"2012","journal-title":"Ann Oncol"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1097\/PAP.0000000000000284","article-title":"The 2020 WHO classification of tumors of soft tissue: selected changes and new entities","volume":"28","author":"Choi","year":"2021","journal-title":"Adv Anat Pathol"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"266","DOI":"10.1007\/s11547-018-0882-7","article-title":"The pathology of soft tissue sarcomas","volume":"124","author":"Sbaraglia","year":"2019","journal-title":"Radiol Med"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1016\/j.annpat.2014.11.002","article-title":"La concordance du diagnostic histopathologique des sarcomes osseux et des tissus mous entre deux centres anticanc\u00e9reux de l\u2019Europe de l\u2019Est et de l\u2019Ouest: une exp\u00e9rience de collaboration [Histopathological diagnostic concordance in bone and soft tissue sarcomas between two comprehensive cancer centers from eastern and western Europe: a collaborative experience]","volume":"35","author":"Somcutian","year":"2015","journal-title":"Ann Pathol"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"1277","DOI":"10.1002\/1878-0261.12950","article-title":"Analysing the attributes of comprehensive cancer centres and cancer centres across Europe to identify key hallmarks","volume":"15","author":"Kehrloesser","year":"2021","journal-title":"Mol Oncol"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"339","DOI":"10.1136\/jclinpath-2020-206793","article-title":"Ethics in clinical autopsy","volume":"74","author":"Rugge","year":"2020","journal-title":"J Clin Pathol"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"1002","DOI":"10.1097\/SLA.0000000000001447","article-title":"Variability in patterns of recurrence after resection of primary retroperitoneal sarcoma (RPS): a report on 1007 patients from the multi-institutional collaborative RPS working group","volume":"263","author":"Gronchi","year":"2016","journal-title":"Ann Surg"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"831","DOI":"10.1016\/j.surg.2020.05.031","article-title":"Radical excision for retroperitoneal soft tissue sarcoma: a national propensity-matched outcomes analysis","volume":"168","author":"Villano","year":"2020","journal-title":"Surgery"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1016\/j.ejso.2018.06.032","article-title":"Impact of centralization of services on outcomes in a rare tumour: retroperitoneal sarcomas","volume":"45","author":"Kalaiselvan","year":"2019","journal-title":"Eur J Surg Oncol"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1200\/JCO.2008.17.8871","article-title":"Aggressive surgical policies in a retrospectively reviewed single-institution case series of retroperitoneal soft tissue sarcoma patients","volume":"27","author":"Gronchi","year":"2009","journal-title":"J Clin Oncol"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"3109","DOI":"10.3390\/cancers14133109","article-title":"Direct costs of care for adults with soft tissue sarcomas: a population-based study","volume":"14","author":"Rugge","year":"2022","journal-title":"Cancer"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"e035546","DOI":"10.1136\/bmjopen-2019-035546","article-title":"Quality of life and added value of a tailored palliative care intervention in patients with soft tissue sarcoma undergoing treatment with trabectedin: a multicentre, cluster-randomised trial within the German interdisciplinary sarcoma group (GISG)","volume":"10","author":"Hentschel","year":"2020","journal-title":"BMJ Open"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"563","DOI":"10.1017\/S1478951520001388","article-title":"Hope in end-of-life cancer patients: a cross-sectional analysis","volume":"19","author":"Bovero","year":"2021","journal-title":"Palliat Support Care"},{"key":"ref39","year":""},{"key":"ref40","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1097\/CCO.0000000000000085","article-title":"Narrative ethics in the field of oncology","volume":"26","author":"Lossignol","year":"2014","journal-title":"Curr Opin Oncol"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2023.1226090\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,8]],"date-time":"2023-08-08T07:26:07Z","timestamp":1691479567000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2023.1226090\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,8]]},"references-count":40,"alternative-id":["10.3389\/fmed.2023.1226090"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2023.1226090","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,8]]},"article-number":"1226090"}}