Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada; Department of Medical Oncology, King Hussein Cancer Centre, Queen Rania Al Abdullah St 202, Amman, Jordan.
Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada.
Cancer Treat Rev. 2018 Sep;69:1-10. doi: 10.1016/j.ctrv.2018.05.007. Epub 2018 May 19.
The prognostic role of tumor necrosis following neoadjuvant therapy is established in bone sarcomas but remains unclear in soft tissue sarcomas (STS).
We searched MEDLINE, MEDLINE in progress, EMBASE and Cochrane to identify studies that investigated neoadjuvant therapy in STS. Studies were required to report survival data based on extent of necrosis, or provided individual patient data allowing estimation thereof. Hazard ratios (HR) for relapse-free (RFS) and overall survival (OS) and odds ratios (OR) for recurrence at 3 years and for death at 5 years were pooled in a random effect meta-analysis. Associations between patient characteristics and attainment of ≥90% necrosis were explored.
21 studies comprising 1663 patients were included. Extremity tumors were most common (n = 1554; 93%). Induction regimens included chemotherapy with radiotherapy (n = 924; 56%), chemotherapy alone (n = 412; 25%), radiotherapy alone (n = 78; 5%), isolated limb perfusion (ILP) (n = 231; 14%), and targeted therapy/radiotherapy (n = 18; 1%). Patients with <90% necrosis had higher hazard of recurrence (hazard ratio [HR] 1.47; 95% CI: 1.06-2.04; p = 0.02) and death (HR 1.86; 95% CI: 1.41-2.46; p < 0.001). Risk of recurrence at 3 years (OR = 3.35; 95% CI: 2.27-4.92; p < 0.001) and of death at 5 years (OR 2.60; 95% CI: 1.59-4.26; p < 0.001) were similarly increased. Compared to other modalities, ILP was associated with higher odds of achieving ≥90% necrosis (OR 12.1; 95% CI: 3.69-39.88; p < 0.001).
Tumour necrosis <90% following neoadjuvant therapy is associated with increased recurrence risk and inferior OS in patients with STS.
新辅助治疗后肿瘤坏死的预后作用已在骨肉瘤中确立，但在软组织肉瘤（STS）中仍不清楚。
我们检索了 MEDLINE、正在进行的 MEDLINE、EMBASE 和 Cochrane，以确定研究新辅助治疗 STS 的研究。研究需要报告基于坏死程度的生存数据，或提供允许估计的个体患者数据。使用随机效应荟萃分析汇总无复发生存期（RFS）和总生存期（OS）的风险比（HR）以及 3 年时复发和 5 年时死亡的比值比（OR）。探讨了患者特征与达到≥90%坏死之间的关系。
纳入了 21 项研究，共 1663 名患者。最常见的是肢体肿瘤（n=1554；93%）。诱导方案包括放化疗（n=924；56%）、单纯化疗（n=412；25%）、单纯放疗（n=78；5%）、孤立肢体灌注（ILP）（n=231；14%）和靶向治疗/放疗（n=18；1%）。坏死<90%的患者复发风险更高（风险比 [HR] 1.47；95%CI：1.06-2.04；p=0.02）和死亡（HR 1.86；95%CI：1.41-2.46；p<0.001）。3 年时复发（OR=3.35；95%CI：2.27-4.92；p<0.001）和 5 年时死亡（OR 2.60；95%CI：1.59-4.26；p<0.001）的风险也类似增加。与其他方法相比，ILP 与更高的达到≥90%坏死的可能性相关（OR 12.1；95%CI：3.69-39.88；p<0.001）。
新辅助治疗后肿瘤坏死<90%与 STS 患者的复发风险增加和 OS 降低相关。
