Abstract

OBJECTIVES

This study investigated the outcomes of sarcoma patients with lung metastases who underwent pulmonary metastasectomy (PM), compared to patients who underwent medical management alone. The secondary objective was to compare survival after PM between variables of interest.

METHODS

This was a retrospective review of 565 sarcoma patients with confirmed, isolated pulmonary metastasis identified from the Surveillance, Epidemiology and End Results database between 2010 and 2015. 1:4 propensity score matching was used to select PM and non-PM groups. The multivariable Cox proportional hazards model was used to analyse prognostic factors of disease-free survival (DFS).

RESULTS

Of the eligible 565 patients, 59 PM patients were matched to 202 non-PM patients in a final ratio of 3.4. After propensity matching, there were no significant differences in baseline characteristics between PM and non-PM patients. The median DFS after PM was 32 months (interquartile range 18–59), compared to 20 months (interquartile range 7–40) in patients without PM (P = 0.032). Using a multivariable Cox proportional hazards model, metastasectomy (hazard ratio 0.536, 95% confidence interval 0.33–0.85; P = 0.008) was associated with improved DFS. In a subset analysis of patients who underwent PM only, the median DFS was longer in males compared to females (P = 0.021), as well as in bone sarcoma compared to soft tissue sarcoma (P = 0.014).

CONCLUSIONS

For sarcoma patients with metastatic lung disease, PM appears to improve the prognosis compared to medical management. Furthermore, there may be a survival association with gender and tumour origin in patients who underwent PM. These data may be used to inform the surgical indications and eligibility criteria for metastasectomy in this setting.

中文翻译：

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骨和软组织肉瘤的肺转移灶切除术伴肺转移

摘要

目标

本研究调查了接受肺转移瘤切除术 (PM) 的肺转移肉瘤患者与仅接受药物治疗的患者的结果。次要目标是比较感兴趣变量之间的 PM 后生存率。

方法

这是对 2010 年至 2015 年间从监测、流行病学和最终结果数据库中确定的 565 例确诊的孤立性肺转移肉瘤患者的回顾性研究。使用 1:4 倾向评分匹配来选择 PM 和非 PM 组。多变量 Cox 比例风险模型用于分析无病生存 (DFS) 的预后因素。

结果

在符合条件的 565 名患者中，59 名 PM 患者与 202 名非 PM 患者匹配，最终比例为 3.4。倾向匹配后，PM 和非 PM 患者的基线特征没有显着差异。PM 后的中位 DFS 为 32 个月（四分位距 18-59），而没有 PM 的患者为 20 个月（四分位距 7-40）（P = 0.032）。使用多变量 Cox 比例风险模型，转移瘤切除术（风险比 0.536，95% 置信区间 0.33-0.85；P = 0.008）与改善的 DFS 相关。在仅接受 PM 的患者的子集分析中，男性与女性相比，中位 DFS 更长（P = 0.021），与软组织肉瘤相比，骨肉瘤中位 DFS 更长（P= 0.014)。

结论

对于患有转移性肺病的肉瘤患者，与药物治疗相比，PM 似乎可以改善预后。此外，接受 PM 的患者的生存率可能与性别和肿瘤起源有关。在这种情况下，这些数据可用于告知转移切除术的手术指征和资格标准。