Department of Sarcoma and General Surgery, Midlands Abdominal and Retroperitoneal Sarcoma Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Department of HPB Surgery, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom.
Department of Medical Statistics, Institute of Translational Medicine, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom.
Eur J Surg Oncol. 2020 Oct;46(10 Pt A):1807-1813. doi: 10.1016/j.ejso.2020.05.024. Epub 2020 Jun 4.
Studies reporting outcomes of liver resection for sarcoma metastases (LRSM) typically include gastrointestinal stromal tumours (GIST), or pooled analyses of "non-colorectal liver metastases", which do not reflect the subgroup of patients with sarcomatous liver metastases. This study aimed to perform a systematic review to evaluate oncological and surgical outcomes in patients undergoing LRSM, and to report new data from two tertiary institutions.
MEDLINE and the Cochrane Library were searched for studies reporting oncological and surgical outcomes after LRSM, following PRISMA guidelines. Studies reporting liver resection for GIST were excluded. The resulting studies were pooled, with data from two European centres.
Six studies of LSRM were included, comprising 212 patients from previously reported series and 24 patients from ours, with median follow-up times of 18-53 months. Postoperative mortality rates ranged from 0 to 9%, and the pooled overall survival (OS) was 89% (95% CI: 83-96%), and 31% (95% CI: 14-47%) at one and five years, respectively (median: 36 months). The presence of synchronous extra-hepatic metastases was found to be a significant risk factor for shorter OS in two cohorts, with hazard ratios of 3.7 (p < 0.001) and 9.1 (p = 0.016), respectively. The largest reported series also found larger metastases (≥100 mm), lack of response to chemotherapy and a shorter disease-free interval to be associated with significantly shorter OS after LSRM.
Patients undergoing LRSM with negative prognostic factors such as the presence of extra-hepatic metastases are unlikely to benefit from surgery. Acceptable medium- and long-term survival may be achievable in highly selected patients.
报道肝切除术治疗肉瘤转移（LRSM）结果的研究通常包括胃肠道间质瘤（GIST），或“非结直肠肝转移”的汇总分析，但并未反映出肉瘤性肝转移患者的亚组情况。本研究旨在进行系统评价，评估接受 LRSM 的患者的肿瘤学和手术结果，并报告来自两个三级医疗机构的新数据。
根据 PRISMA 指南，在 MEDLINE 和 Cochrane 图书馆中搜索报道 LRSM 后肿瘤学和手术结果的研究。排除报道 GIST 肝切除术的研究。对来自先前报道的系列研究和我们的 24 例患者的研究进行汇总，中位随访时间为 18-53 个月。术后死亡率范围为 0-9%，汇总的总生存率（OS）为 89%（95%CI：83-96%），分别为 1 年和 5 年的 31%（95%CI：14-47%）（中位数：36 个月）。两个队列发现同步肝外转移的存在是 OS 较短的显著危险因素，风险比分别为 3.7（p<0.001）和 9.1（p=0.016）。最大的报道系列还发现较大的转移灶（≥100mm）、对化疗无反应和较短的无病间隔与 LRSM 后 OS 显著缩短相关。
存在肝外转移等不良预后因素的患者行 LRSM 获益可能性不大。在高度选择的患者中可能实现可接受的中、长期生存。
