Multidisciplinary team care and outcomes in FNCLCC grade 3 soft tissue sarcoma: a propensity score–matched and weighted cohort study

Background Multidisciplinary team (MDT) care is widely advocated for soft tissue sarcoma (STS), yet real-world evidence in high-grade disease remains limited and subject to confounding. We investigated whether pre-treatment MDT care was associated with improved outcomes in FNCLCC grade 3 STS. Methods This retrospective cohort study included consecutive adults with pathologically confirmed FNCLCC grade 3 STS treated at the Department of Orthopaedics, Cancer Hospital, Chinese Academy of Medical Sciences (2010–2022). MDT care was defined as formal discussion after pathological diagnosis and before definitive treatment. Primary endpoints were 3-year local recurrence and distant metastasis from diagnosis (administrative censoring at 36 months). Propensity scores were estimated using logistic regression; confounding was addressed using 1:1 propensity score matching (PSM) and stabilized inverse probability of treatment weighting (IPTW). Odds ratios (ORs) and Kaplan–Meier analyses were applied. Results Among 338 patients (MDT, n=88; non-MDT, n=250), MDT care was associated with lower 3-year local recurrence (6.8% vs 21.2%; unadjusted OR = 0.272, P = 0.002), with consistent results after PSM (paired OR = 0.259, P = 0.021) and IPTW (OR = 0.296, P = 0.008). By contrast, 3-year distant metastasis did not differ significantly between groups in unadjusted, matched, or weighted analyses (weighted OR = 0.846, 95% CI 0.418–1.714; P = 0.643), although the confidence interval did not exclude a potentially moderate clinically meaningful benefit. Conclusions In FNCLCC grade 3 STS, pre-treatment MDT care was associated with improved 3-year local control but not with a significant reduction in 3-year distant metastasis.