Department of Surgery, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.
Department of Clinical Epidemiology and Trial Organisation, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.
Eur J Cancer. 2018 Dec;105:19-27. doi: 10.1016/j.ejca.2018.09.028. Epub 2018 Oct 29.
The role of radiotherapy (RTx) and chemotherapy (CTx) in primary extremity soft tissue sarcoma (eSTS) patients is not precisely defined.
All consecutive primary eSTS patients treated within three European and one North American reference centres in a 20-year time span were included. The tendency to perform chemotherapy/radiotherapy (CTx/RTx) was explored using multivariable binary logistic models. Five and 10-year overall survival (OS) and crude cumulative incidence (CCI) of local recurrence (LR) and distant metastasis (DM) were estimated. Multivariable analyses of OS, CCI of LR and CCI of DM were performed. The effect of CTx administration was explored with a propensity score matching analysis.
Overall, 3752 patients were included. Median follow-up was 79 months (interquartile range 44-119). Ten-year OS, CCI of LR and CCI of DM were 66.3% (64.3-68.2%), 8.2% (7.2-9.2%) and 28.2% (26.6-30.0%), respectively. Centre and histology significantly influenced administration of RTx/CTx. RTx was associated with a better local outcome, especially in myxoid liposarcoma, vascular sarcoma and myxofibrosarcoma, without being associated with survival. Chemotherapy was not an independent prognostic factor for OS in all patients (p = 0.73). In a propensity score-matched analysis, patients treated with CTx had longer survival although this difference did not reach statistical significance (p = 0.054). The use of perioperative CTx in patients with primary localised eSTS was not associated with worse survival after occurrence of DM.
Some histologies gain a greater benefit from perioperative RTx in terms of LR risk reduction. The trend towards a 5% survival benefit associated with CTx administration is consistent with the published literature, but definitive conclusions are awaited from ongoing randomised controlled trials. Perioperative CTx for primary eSTS does not hamper post-DM survival.
在原发性肢体软组织肉瘤（eSTS）患者中，放疗（RTx）和化疗（CTx）的作用尚未明确。
纳入了 20 年间在三个欧洲和一个北美参考中心连续治疗的所有原发性 eSTS 患者。使用多变量二项逻辑模型探讨了进行化疗/放疗（CTx/RTx）的倾向。估计了 5 年和 10 年总生存率（OS）和局部复发（LR）和远处转移（DM）的粗累积发生率（CCI）。对 OS、LR CCI 和 DM CCI 进行了多变量分析。通过倾向评分匹配分析探讨了 CTx 给药的效果。
共纳入 3752 例患者。中位随访时间为 79 个月（四分位距 44-119）。10 年 OS、LR CCI 和 DM CCI 分别为 66.3%（64.3-68.2%）、8.2%（7.2-9.2%）和 28.2%（26.6-30.0%）。中心和组织学显著影响 RTx/CTx 的应用。RTx 与更好的局部疗效相关，尤其是黏液样脂肪肉瘤、血管肉瘤和黏液纤维肉瘤，与生存无关。在所有患者中，化疗并非 OS 的独立预后因素（p=0.73）。在倾向评分匹配分析中，接受 CTx 治疗的患者生存时间更长，但差异无统计学意义（p=0.054）。在发生 DM 后，原发性局限性 eSTS 患者使用围手术期 CTx 与生存质量下降无关。
某些组织学类型在降低 LR 风险方面从围手术期 RTx 中获益更大。与 CTx 给药相关的 5%生存获益趋势与已发表的文献一致，但仍需等待正在进行的随机对照试验的明确结论。原发性 eSTS 的围手术期 CTx 不会影响 DM 后的生存。
