Xu Yao, Feng Zhe, Liu YongHeng, Feng JinYan, Zhang Yan, Zhang Chao, Han XiuXin, Xu LiMing, Wang GuoWen
Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute &Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin 300060, China.
Department of Radiation Oncology, Tianjin Medical University Cancer Institute &Hospital National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin 300060, China.
J Cancer. 2025 Jan 1;16(1):135-145. doi: 10.7150/jca.100678. eCollection 2025.
The aim of our study was to explore the effect of IORT on survival outcome of patients with musculoskeletal malignancy. The prognostic factors of patients with IORT treatment were also identified in this study. The retrospective analysis was conducted based on the Surveillance, Epidemiology, and End Results (SEER) database spanning from 2000 to 2020. The musculoskeletal malignancy patients who received both surgery and radiation therapy (RT) treatment were included into the study. Survival differences between groups were explored by Kaplan-Meier method and log-rank test. Potential prognostic factors of patients with IORT treatment were identified by Cox proportional hazards regression analysis. A total of 24,297 patients were selected finally, including 23,877 cases with neoadjuvant/adjuvant RT alone, 190 cases with IORT alone, and other 230 cases received both neoadjuvant/adjuvant RT and IORT. The median survival time of these patients was 141.0 (95%CI: 101.1-180.9) months. Patients who received both IORT and neoadjuvant/adjuvant RT treatment presented the best survival outcome when compared with those underwent either IORT or neoadjuvant/adjuvant RT only. Further subgroup analyses verified the survival benefit of the combination of IORT and neoadjuvant/adjuvant RT in female patients with tumor located on limb and in patients who received the performance of chemotherapy. A series of variables, including age at diagnosis, gender, primary tumor site, tumor Grade, SEER stage, T stage, N stage, IORT only or the combination of IORT and neoadjuvant/adjuvant RT, the performance of chemotherapy, were identified as independent prognostic factors of patients with IORT treatment. The current study is distinguished by its large-scale analysis of the SEER database, encompassing a comprehensive cohort of musculoskeletal malignancy patients treated with IORT, as well as the rigorous subgroup analysis. We concluded that IORT during surgery procedure, accompanied with neoadjuvant/adjuvant RT, might confer a survival benefit for selected patients diagnosed with musculoskeletal malignancy.
我们研究的目的是探讨术中放疗（IORT）对肌肉骨骼恶性肿瘤患者生存结局的影响。本研究还确定了接受IORT治疗患者的预后因素。基于2000年至2020年的监测、流行病学和最终结果（SEER）数据库进行回顾性分析。纳入接受手术和放射治疗（RT）的肌肉骨骼恶性肿瘤患者。采用Kaplan-Meier法和对数秩检验探讨组间生存差异。通过Cox比例风险回归分析确定接受IORT治疗患者的潜在预后因素。最终共入选24297例患者，其中单纯新辅助/辅助放疗23877例，单纯IORT 190例，新辅助/辅助放疗联合IORT 230例。这些患者的中位生存时间为141.0（95%CI：101.1 - 180.9）个月。与仅接受IORT或新辅助/辅助放疗的患者相比，接受IORT和新辅助/辅助放疗联合治疗的患者生存结局最佳。进一步的亚组分析证实了IORT与新辅助/辅助放疗联合应用对肢体肿瘤女性患者和接受化疗患者的生存益处。一系列变量，包括诊断时年龄、性别、原发肿瘤部位、肿瘤分级、SEER分期、T分期、N分期、单纯IORT或IORT与新辅助/辅助放疗联合应用、化疗情况，被确定为接受IORT治疗患者的独立预后因素。本研究的特点在于对SEER数据库进行大规模分析，涵盖接受IORT治疗的肌肉骨骼恶性肿瘤患者的综合队列，以及严格的亚组分析。我们得出结论，手术过程中的IORT联合新辅助/辅助放疗可能为部分诊断为肌肉骨骼恶性肿瘤的患者带来生存益处。
