Yu Kaixu, Chen Ying, Song Kehan, Xiong Fanxiu, Tian Yahao, Guan Hanfeng, Li Feng
Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Front Oncol. 2022 Jun 6;12:873323. doi: 10.3389/fonc.2022.873323. eCollection 2022.
Although clinicians and patients with extremity bone and soft tissue (EBST) are increasingly interested in limb salvage surgery (LSS), because of the minimal damage to physical appearance and function, however, there is still a lack of large-scale population studies on whether LSS improves the prognosis of patients.
The aim of this study was to compare the survival of patients with EBST sarcomas after receiving LSS and amputation.
To conduct the population-based study, we identified 6,717 patients with a histologically diagnosed bone sarcoma and 24,378 patients with a histologically diagnosed soft tissue sarcoma from the Surveillance, Epidemiology, and End Results database. We analyzed overall survival (OS), cancer-specific survival (CSS), and non-sarcoma survival (NSS) using the Kaplan-Meier method, log-rank test or Gray test, Cox regression model, propensity score-matched analysis, and landmark analysis.
LSS could improve the prognosis in patients with most EBST subtypes, except for Ewing sarcomas and MPNST. However, in the subgroup without distant metastases, limb salvage increased CSS only for patients with osteosarcoma, Ewing sarcoma, and leiomyosarcoma, as well as NSS for patients with chondrosarcoma and synovial sarcoma. Landmark analysis further demonstrated that sarcoma survivors surviving <10 years could benefit from LSS but not for long-term survivors ≥10 years. Moreover, for patients with distant metastases, LSS could improve survival of osteosarcoma patients but worsen CSS among patients with MPNST. Landmark analysis further demonstrated that LSS improved survival among osteosarcomas patients with distant metastases only within 1 year after surgery. Moreover, patients receiving LSS and those receiving amputation had a high risk of dying from different non-sarcoma diseases during the postoperative follow-up.
The impact of limb salvage on the prognosis of patients depends on the pathological subtype and stage of EBST sarcomas.
尽管肢体骨与软组织（EBST）疾病的临床医生和患者对保肢手术（LSS）的兴趣日益浓厚，因为该手术对外观和功能的损伤最小，然而，关于LSS是否能改善患者预后仍缺乏大规模的人群研究。
本研究旨在比较接受LSS和截肢术后EBST肉瘤患者的生存率。
为进行基于人群的研究，我们从监测、流行病学和最终结果数据库中识别出6717例经组织学诊断为骨肉瘤的患者和24378例经组织学诊断为软组织肉瘤的患者。我们使用Kaplan-Meier法、对数秩检验或Gray检验、Cox回归模型、倾向评分匹配分析和地标分析来分析总生存期（OS）、癌症特异性生存期（CSS）和非肉瘤生存期（NSS）。
LSS可改善大多数EBST亚型患者的预后，除尤文肉瘤和MPNST外。然而，在无远处转移的亚组中，保肢仅增加了骨肉瘤、尤文肉瘤和平滑肌肉瘤患者的CSS，以及软骨肉瘤和滑膜肉瘤患者的NSS。地标分析进一步表明，生存期<10年的肉瘤幸存者可从LSS中获益，但≥10年的长期幸存者则不然。此外对于有远处转移的患者，LSS可改善骨肉瘤患者的生存率，但会恶化MPNST患者的CSS。地标分析进一步表明，LSS仅在术后1年内改善了有远处转移的骨肉瘤患者的生存率。此外，接受LSS和接受截肢的患者在术后随访期间死于不同非肉瘤疾病的风险较高。
保肢对患者预后的影响取决于EBST肉瘤的病理亚型和分期。
