Delisle Megan, Alshamsan Bader, Nagaratnam Kalki, Smith Denise, Wang Ying, Srikanthan Amirrtha
Division of General Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON K1N 6N5, Canada.
Department of Medicine, College of Medicine, Qassim University, Buraydah 52571, Saudi Arabia.
Cancers (Basel). 2022 Jun 21;14(13):3055. doi: 10.3390/cancers14133055.
This study assesses the survival in patients undergoing metastasectomy for leiomyosarcoma (LMS) and compares the outcomes by the site of metastasectomy. We conducted a systematic review and pooled survival analysis of patients undergoing metastasectomy for LMS. Survival was compared between sites of metastasectomy. We identified 23 studies including 573 patients undergoing metastasectomy for LMS. The pooled median survival was 59.6 months (95% CI 33.3 to 66.0). The pooled median survival was longest for lung metastasectomy (72.8 months 95% CI 63.0 to 82.5), followed by liver (34.8 months 95% CI 22.3 to 47.2), spine (14.1 months 95% CI 8.6 to 19.7), and brain (14 months 95% CI 6.7 to 21.3). Two studies compared the survival outcomes between patients who did, versus who did not undergo metastasectomy; both demonstrated a significantly improved survival with metastasectomy. We conclude that surgery is currently being utilized for LMS metastases to the lung, liver, spine, and brain with acceptable survival. Although low quality, comparative studies support a survival benefit with metastasectomy. In the absence of randomized studies, it is impossible to determine whether the survival benefit associated with metastasectomy is due to careful patient selection rather than a surgical advantage; limited data were included about patient selection.
本研究评估了接受平滑肌肉瘤（LMS）转移灶切除术患者的生存率，并比较了不同转移灶切除部位的预后情况。我们对接受LMS转移灶切除术的患者进行了系统评价和汇总生存分析。比较了不同转移灶切除部位的生存率。我们纳入了23项研究，共573例接受LMS转移灶切除术的患者。汇总后的中位生存期为59.6个月（95%可信区间33.3至66.0）。肺转移灶切除术的汇总中位生存期最长（72.8个月，95%可信区间63.0至82.5），其次是肝转移灶切除术（34.8个月，95%可信区间22.3至47.2）、脊柱转移灶切除术（14.1个月，95%可信区间8.6至19.7）和脑转移灶切除术（14个月，95%可信区间6.7至21.3）。两项研究比较了接受与未接受转移灶切除术患者的生存结局；两者均显示转移灶切除术可显著提高生存率。我们得出结论，目前手术可用于LMS转移至肺、肝、脊柱和脑的患者，其生存率尚可接受。尽管研究质量较低，但比较性研究支持转移灶切除术具有生存获益。由于缺乏随机对照研究，无法确定与转移灶切除术相关的生存获益是由于仔细的患者选择而非手术优势；关于患者选择的资料有限。
