基于人群的转移性骨肉瘤患者局部解剖的倾向评分匹配研究。
A population-based propensity-matched study of regional dissections in patients with metastatic osteosarcoma.
机构信息
Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
出版信息
J Orthop Surg Res. 2020 Mar 13;15(1):107. doi: 10.1186/s13018-020-01592-y.
BACKGROUND
The survival rates of patients with metastatic osteosarcoma are poor, and the prognosis is closely related to the choice of treatment, especially surgery. This study aimed to evaluate the survival outcomes of patients with metastatic osteosarcoma undergoing regional dissections.
METHODS
We collected data on patients with metastatic osteosarcoma between 2004 and 2014 from the Surveillance, Epidemiology, and End Results (SEER) database. Kaplan-Meier curves were used to compare overall survival (OS) and cancer-specific survival (CSS), while univariate and multivariate Cox regression analyses were used to evaluate outcomes. Propensity score matching (PSM) was used to minimize the effects of confounding factors.
RESULTS
The SEER database had records of 2768 patients diagnosed with osteosarcoma, of whom 398 were included in our study. Of the included patients, 116 (29.15%) underwent regional dissections, while 282 (70.85%) underwent non-regional dissections. The univariate and multivariate Cox regression analyses, prior to PSM, showed that OS (hazard ratio (HR): 0.34, 95% confidence interval (CI): 0.26-0.44, P<0.001 and HR: 0.47, 95% CI: 0.35-0.64, P<0.001, respectively) and CSS (HR: 0.33, 95% CI: 0.25-0.43, P<0.001 and HR: 0.46, 95% CI: 0.34-0.63, P<0.001, respectively) were better in patients who underwent regional dissections than those who underwent non-regional dissections. Compared with non-regional dissections, regional dissections, which included both primary tumour resection (PTR) and primary tumour and metastatic site resection (PTMR), were associated with better OS (P<0.001) and CSS (P<0.001) . However, the survival outcomes following PTR and PTMR showed no significant difference. After PSM, patients in the regional dissection group still had a higher OS (P<0.001) and CSS (P<0.001) than those in the non-regional dissection group.
CONCLUSIONS
Compared with non-regional dissection, regional dissection resulted in better survival in patients with metastatic osteosarcoma.
背景
转移性骨肉瘤患者的生存率较差，预后与治疗选择密切相关，尤其是手术。本研究旨在评估接受区域切除术的转移性骨肉瘤患者的生存结局。
方法
我们从监测、流行病学和最终结果（SEER）数据库中收集了 2004 年至 2014 年间患有转移性骨肉瘤的患者数据。Kaplan-Meier 曲线用于比较总生存率（OS）和癌症特异性生存率（CSS），而单变量和多变量 Cox 回归分析用于评估结果。采用倾向评分匹配（PSM）来最小化混杂因素的影响。
结果
SEER 数据库记录了 2768 例骨肉瘤患者，其中 398 例纳入本研究。纳入的患者中，116 例（29.15%）接受了区域切除术，282 例（70.85%）接受了非区域切除术。在进行 PSM 之前，单变量和多变量 Cox 回归分析显示，OS（风险比（HR）：0.34，95%置信区间（CI）：0.26-0.44，P<0.001 和 HR：0.47，95% CI：0.35-0.64，P<0.001）和 CSS（HR：0.33，95% CI：0.25-0.43，P<0.001 和 HR：0.46，95% CI：0.34-0.63，P<0.001）均在接受区域切除术的患者中更好。与非区域切除术相比，包括原发肿瘤切除术（PTR）和原发肿瘤及转移部位切除术（PTMR）的区域切除术与更好的 OS（P<0.001）和 CSS（P<0.001）相关。然而，PTR 和 PTMR 后的生存结局无显著差异。PSM 后，区域切除术组的患者 OS（P<0.001）和 CSS（P<0.001）仍高于非区域切除术组。
结论
与非区域切除术相比，区域切除术可改善转移性骨肉瘤患者的生存结局。
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