Division of Orthopedic Oncology, Rush University Medical Center, Chicago, IL, USA.
Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, IL, USA.
Interact Cardiovasc Thorac Surg. 2021 Nov 22;33(6):879-884. doi: 10.1093/icvts/ivab178.
This study investigated the outcomes of sarcoma patients with lung metastases who underwent pulmonary metastasectomy (PM), compared to patients who underwent medical management alone. The secondary objective was to compare survival after PM between variables of interest.
This was a retrospective review of 565 sarcoma patients with confirmed, isolated pulmonary metastasis identified from the Surveillance, Epidemiology and End Results database between 2010 and 2015. 1:4 propensity score matching was used to select PM and non-PM groups. The multivariable Cox proportional hazards model was used to analyse prognostic factors of disease-free survival (DFS).
Of the eligible 565 patients, 59 PM patients were matched to 202 non-PM patients in a final ratio of 3.4. After propensity matching, there were no significant differences in baseline characteristics between PM and non-PM patients. The median DFS after PM was 32 months (interquartile range 18-59), compared to 20 months (interquartile range 7-40) in patients without PM (P = 0.032). Using a multivariable Cox proportional hazards model, metastasectomy (hazard ratio 0.536, 95% confidence interval 0.33-0.85; P = 0.008) was associated with improved DFS. In a subset analysis of patients who underwent PM only, the median DFS was longer in males compared to females (P = 0.021), as well as in bone sarcoma compared to soft tissue sarcoma (P = 0.014).
For sarcoma patients with metastatic lung disease, PM appears to improve the prognosis compared to medical management. Furthermore, there may be a survival association with gender and tumour origin in patients who underwent PM. These data may be used to inform the surgical indications and eligibility criteria for metastasectomy in this setting.
本研究调查了接受肺转移瘤切除术（PM）的肉瘤患者与仅接受单纯药物治疗的患者的结局。次要目的是比较 PM 后与感兴趣变量相关的生存情况。
这是一项回顾性研究，纳入了 2010 年至 2015 年期间 Surveillance, Epidemiology and End Results 数据库中确诊的、孤立性肺转移肉瘤患者 565 例。使用 1:4 倾向评分匹配法选择 PM 组和非 PM 组。采用多变量 Cox 比例风险模型分析无病生存（DFS）的预后因素。
在符合条件的 565 例患者中，59 例 PM 患者与 202 例非 PM 患者进行最终匹配，最终比例为 3.4。在倾向评分匹配后，PM 组和非 PM 组患者的基线特征无显著差异。PM 后患者的中位 DFS 为 32 个月（四分位距 18-59），而未行 PM 者的中位 DFS 为 20 个月（四分位距 7-40）（P=0.032）。采用多变量 Cox 比例风险模型，切除术（风险比 0.536，95%置信区间 0.33-0.85；P=0.008）与改善 DFS 相关。在仅行 PM 的患者亚组分析中，男性患者的中位 DFS 长于女性（P=0.021），骨肉瘤患者的中位 DFS 长于软组织肉瘤患者（P=0.014）。
对于患有转移性肺疾病的肉瘤患者，PM 似乎比单纯药物治疗更能改善预后。此外，对于接受 PM 的患者，性别和肿瘤起源与生存相关。这些数据可能有助于为该治疗策略下的 PM 手术适应证和纳入标准提供信息。
