Department of Surgery, University of Texas School of Medicine at Houston, Houston, TX 77030, USA.
J Pediatr Surg. 2011 Feb;46(2):332-5. doi: 10.1016/j.jpedsurg.2010.11.013.
Ewing sarcoma (ES) is the second most common bone tumor in children, and survival of those with metastatic ES has not improved. Previous studies have shown a survival benefit to whole lung irradiation in patients with pulmonary metastases and may be given either before, after, or instead of surgical pulmonary metastasectomy (PM). The contribution of surgery compared with irradiation in ES has not previously been studied.
A retrospective review of patients younger than 21 years (median age, 16 years) treated at a single institution (1990-2006) was performed. Kaplan-Meier survival curves were compared using log-rank test and a multivariate Cox proportional hazards model. P ≤ .05 was regarded as significant.
Eighty patients with ES were identified. Of these, 31 (39%) had pulmonary metastases. Nine patients had incomplete details of their full treatment regimen, but the following groups could be defined from the remainder: resection alone (n = 5), radiation alone (n = 3), radiation and resection (n = 3), or chemotherapy alone (n = 11). There were 24 deaths overall, with a median overall survival (OS) of 2.7 (95% confidence interval [CI], 1.7-5.2) years. Patients who had PM had the best OS (80%), whereas those who underwent radiation to the lung without PM compared with chemotherapy only for pulmonary metastasis both had similar OS of 0% at 5 years (P = .002). Patients who had radiation followed by PM for lung metastasis had a 5-year OS of 65%. Patients with PM had a longer OS compared with those without lung resection (P < .0001).
These data suggest a possible benefit for ES patients who undergo surgical resection of lung metastases.
尤因肉瘤（ES）是儿童中第二常见的骨肿瘤，转移性 ES 患者的生存率并未提高。先前的研究表明，全肺照射对肺转移患者有生存获益，可在手术肺转移切除（PM）之前、之后或代替手术进行。以前没有研究过手术与 ES 照射相比的作用。
对一家机构（1990-2006 年）治疗的 21 岁以下（中位年龄 16 岁）患者进行了回顾性研究。使用对数秩检验和多变量 Cox 比例风险模型比较 Kaplan-Meier 生存曲线。P≤0.05 被认为有统计学意义。
共确定了 80 例 ES 患者，其中 31 例（39%）有肺部转移。9 例患者的完整治疗方案不完整，但可从其余患者中定义以下几组：单纯切除术（n=5）、单纯放疗（n=3）、放疗联合切除术（n=3）或单纯化疗（n=11）。共有 24 例患者死亡，总生存率（OS）中位数为 2.7（95%置信区间[CI]，1.7-5.2）年。行 PM 的患者 OS 最好（80%），而未行 PM 仅行肺部放疗的患者与单纯化疗治疗肺转移的患者 5 年 OS 均为 0%（P=0.002）。行肺转移放疗后 PM 的患者 5 年 OS 为 65%。有 PM 的患者 OS 长于无肺切除术的患者（P<0.0001）。
这些数据表明，手术切除肺转移可能对 ES 患者有益。
