Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin.
Department of Surgery, Anne Arundel Medical Center, Annapolis, Maryland.
J Surg Res. 2024 Aug;300:559-566. doi: 10.1016/j.jss.2024.03.020. Epub 2024 Jun 25.
Up to half of patients with leiomyosarcoma (LMS) present with distant metastases, most commonly in the lungs. Despite guidelines around managing metachronous oligometastatic disease, limited evidence exists for synchronous isolated lung metastases (SILMs). Our histology-specific study describes management patterns and outcomes for patients with LMS and SILM across disease sites.
We used the National Cancer Database to analyze patients with LMS of the retroperitoneum, extremity, trunk/chest/abdominal wall, and pelvis with SILM. Patients with extra-pulmonary metastases were excluded. We identified factors associated with primary tumor resection and receipt of metastasectomy. Outcomes included median, 1-year, and 5-year overall survival (OS) across treatment approaches using log-rank tests, Kaplan-Meier curves, and Cox proportional hazard models.
We identified 629 LMS patients with SILM from 2004 to 2017. Patients were more likely to have resection of their primary tumor or lung metastases if treated at an academic center compared to a community cancer center. Five year OS for patients undergoing both primary tumor resection and metastasectomy was 20.9% versus 9.2% for primary tumor resection alone, and 2.6% for nonsurgical patients. Median OS for all-comers was 15.5 mo. Community treatment site, comorbidity score, and larger primary tumors were associated with worse survival. Chemotherapy, primary resection, and curative intent surgery predicted improved survival on multivariate Cox regression.
An aggressive surgical approach to primary LMS with SILM was undertaken for select patients in our population and found to be associated with improved OS. This approach should be considered for suitable patients at high-volume centers.
多达一半的平滑肌肉瘤（LMS）患者存在远处转移，最常见于肺部。尽管有关于处理异时性寡转移疾病的指南，但对于同步孤立性肺转移（SILM），证据有限。我们的组织学特异性研究描述了跨疾病部位的 LMS 和 SILM 患者的管理模式和结局。
我们使用国家癌症数据库分析了腹膜后、四肢、躯干/胸部/腹壁和骨盆的 LMS 患者伴 SILM。排除了有肺外转移的患者。我们确定了与原发肿瘤切除和转移灶切除术相关的因素。使用对数秩检验、Kaplan-Meier 曲线和 Cox 比例风险模型，根据治疗方法评估了中位、1 年和 5 年总生存率（OS）。
我们在 2004 年至 2017 年期间发现了 629 例伴有 SILM 的 LMS 患者。与社区癌症中心相比，如果在学术中心治疗，患者更有可能切除原发肿瘤或肺转移灶。接受原发肿瘤切除术和转移灶切除术的患者 5 年 OS 为 20.9%，仅接受原发肿瘤切除术的患者为 9.2%，非手术患者为 2.6%。所有患者的中位 OS 为 15.5 个月。社区治疗部位、合并症评分和更大的原发肿瘤与生存率较差相关。化疗、原发肿瘤切除和根治性手术切除预测多因素 Cox 回归的生存改善。
在我们的人群中，对于有选择的伴 SILM 的原发性 LMS 患者采取积极的手术治疗方法与 OS 改善相关。这种方法应在高容量中心适合的患者中考虑。
