Department of Thoracic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Department of Orthopedic Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Guangzhou, China.
J Thorac Cardiovasc Surg. 2022 Feb;163(2):469-479.e8. doi: 10.1016/j.jtcvs.2020.10.137. Epub 2020 Nov 24.
The purpose of this study was to evaluate the postrelapse survival of relapsed osteosarcoma with pulmonary metastases in patients who received pulmonary metastasectomy using intent to treat and propensity score analysis.
Patients with osteosarcoma who relapsed with pulmonary metastases between 2004 and 2018 who were treated in a hospital affiliated with a medical school were included. All the enrolled patients were evaluated as operable with assessment algorithm at the time of diagnosis of pulmonary relapse and intent to treat analysis was done. Multiple propensity score methods (eg, matching, stratification, covariate adjustment, and inverse probability of treatment weighting) were performed to balance confounding bias. Cox proportional hazards regression and the Kaplan-Meier method were used to evaluate patient survival.
A total of 125 patients met the study criteria. Of these, 59 (47.2%) patients received pulmonary metastasectomy combined with chemotherapy and 66 (52.8%) received chemotherapy alone. The 2-year and 5-year postrelapse survival rate of metastasectomy group and nonmetastasectomy group were 68.4% versus 25.0% and 41.0% versus 0%, respectively. The median postrelapse survival was 24.9 versus 13.5 months, respectively. Pulmonary metastasectomy was independently associated with improved survival (hazard ratio, 0.185; 95% confidence interval, 0.103-0.330; P < .001). These results were confirmed by multiple propensity score analyses. Further stratified analysis revealed that the survival advantage associated with metastasectomy was not significant in patients with metastases involving ≥3 lung lobes and patients with very high pretreatment serum alkaline phosphatase (more than twice the upper limit).
Pulmonary metastasectomy is associated with improved survival in patients with recurrent osteosarcoma.
本研究旨在通过意向治疗和倾向评分分析，评估接受肺转移切除术的复发性骨肉瘤伴肺转移患者的再复发后生存情况。
纳入 2004 年至 2018 年期间在医学院附属医院治疗的复发性骨肉瘤伴肺转移患者。所有入组患者在肺转移复发时均根据评估算法评估为可手术，并进行意向治疗分析。采用多种倾向评分方法（如匹配、分层、协变量调整和逆概率治疗加权）来平衡混杂偏差。采用 Cox 比例风险回归和 Kaplan-Meier 方法评估患者生存情况。
共有 125 例患者符合研究标准。其中，59 例（47.2%）患者接受了肺转移切除术联合化疗，66 例（52.8%）患者仅接受了化疗。手术组和非手术组的 2 年和 5 年再复发后生存率分别为 68.4%比 25.0%和 41.0%比 0%。再复发后中位生存时间分别为 24.9 个月和 13.5 个月。肺转移切除术与生存改善独立相关（风险比，0.185；95%置信区间，0.103-0.330；P<0.001）。这些结果在多次倾向评分分析中得到了证实。进一步的分层分析显示，在转移灶累及≥3 个肺叶的患者和术前血清碱性磷酸酶非常高（超过上限的两倍）的患者中，肺转移切除术的生存优势并不显著。
肺转移切除术与复发性骨肉瘤患者的生存改善相关。
