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Surgery for metachronous metastasis of soft tissue sarcoma - A magnitude of benefit analysis using propensity score methods.
Smolle, Maria A; van Praag, Veroniek M; Posch, Florian; Bergovec, Marko; Leitner, Lukas; Friesenbichler, Jörg; Heregger, Ronald; Riedl, Jakob M; Pichler, Martin; Gerger, Armin; Szkandera, Joanna; Stöger, Herbert; Smolle-Jüttner, Freyja-Maria; Liegl-Atzwanger, Bernadette; Fiocco, Marta; van de Sande, Michiel Aj; Leithner, Andreas.
Afiliação
  • Smolle MA; Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria; Comprehensive Cancer Centre Graz, Graz, Austria. Electronic address: maria.smolle@medunigraz.at.
  • van Praag VM; Department of Orthopaedic Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands. Electronic address: v.m.van_praag@lumc.nl.
  • Posch F; Comprehensive Cancer Centre Graz, Graz, Austria; Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria. Electronic address: florian.posch@medunigraz.at.
  • Bergovec M; Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria; Comprehensive Cancer Centre Graz, Graz, Austria. Electronic address: marko.bergovec@medunigraz.at.
  • Leitner L; Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria; Comprehensive Cancer Centre Graz, Graz, Austria. Electronic address: lukas.leitner@medunigraz.at.
  • Friesenbichler J; Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria; Comprehensive Cancer Centre Graz, Graz, Austria. Electronic address: joerg.friesenbichler@medunigraz.at.
  • Heregger R; Comprehensive Cancer Centre Graz, Graz, Austria; Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria. Electronic address: Ronald.heregger@stud.medunigraz.at.
  • Riedl JM; Comprehensive Cancer Centre Graz, Graz, Austria; Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria. Electronic address: j.riedl@stud.medunigraz.at.
  • Pichler M; Comprehensive Cancer Centre Graz, Graz, Austria; Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria; Department of Experimental Therapeutics, The UT MD Anderson Cancer Center, Sout Campus Research Building 4, 1901 East Road, Ho
  • Gerger A; Comprehensive Cancer Centre Graz, Graz, Austria; Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria. Electronic address: armin.gerger@medunigraz.at.
  • Szkandera J; Comprehensive Cancer Centre Graz, Graz, Austria; Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria. Electronic address: Joanna.szkandera@medunigraz.at.
  • Stöger H; Comprehensive Cancer Centre Graz, Graz, Austria; Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria. Electronic address: Herbert.stoeger@medunigraz.at.
  • Smolle-Jüttner FM; Comprehensive Cancer Centre Graz, Graz, Austria; Division of Thoracic and Hyperbaric Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036, Austria. Electronic address: freyja.smolle@medunigraz.at.
  • Liegl-Atzwanger B; Comprehensive Cancer Centre Graz, Graz, Austria; Institute of Pathology, Medical University of Graz, Auenbruggerplatz 25, 8036, Graz, Austria. Electronic address: Bernadette.liegl-atzwanger@medunigraz.at.
  • Fiocco M; Department of Orthopaedic Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands; Department of Medical Statistics and Bioinformatics, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands; Mathematical Institute Leiden University, Al
  • van de Sande MA; Department of Orthopaedic Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands. Electronic address: m.a.j.van_de_Sande@lumc.nl.
  • Leithner A; Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria; Comprehensive Cancer Centre Graz, Graz, Austria. Electronic address: andreas.leithner@medunigraz.at.
Eur J Surg Oncol ; 45(2): 242-248, 2019 02.
Article em En | MEDLINE | ID: mdl-30031674
INTRODUCTION: Metastasectomy is hypothesised to improve OS in metastatic STS, but evidence in favour of this approach derives from non-controlled single-arm cohorts affected by selection bias. The objective was to quantify the effect of metastasectomy vs. non-surgical management on overall survival (OS) in patients with metachronous metastases from extremity- and trunk soft tissue sarcoma (STS). MATERIALS AND METHODS: From a population of 1578 STS patients, 135 patients who underwent surgery for localised STS at two European centres between 1998 and 2015 and developed metachronous STS metastases were included. Propensity score analyses with inverse-probability-of-treatment-weights (IPTW) and landmark analyses were performed to control for selection and immortal time bias, respectively. RESULTS: OS was significantly longer in the 68 patients undergoing metastasectomy than in the 67 patients who were treated non-invasively for their metastasis (10-year OS: 23% vs. 4%; hazard ratio (HR) = 0.34, 95% CI: 0.22-0.53, p < 0.0001). This association prevailed after IPTW-weighting of the data to control for the higher prevalence of favourable prognostic factors in the surgery group (adjusted 10-year OS: 17% vs. 3%, log-rank p < 0.0001; HR = 0.33, 95% CI: 0.20-0.52, p < 0.0001). Five-year OS estimates were 27.8% in patients who had and 14.5% in patients who had not undergone metastasectomy within the first 3 months after diagnosis of a metastasis (p < 0.0001). CONCLUSION: In this observational bi-centre study, metastasectomy was associated with prolonged survival in patients with metachronous STS metastases. In the absence of randomized studies, our results indicate that metastasectomy should be considered as an important treatment option for metachronous STS metastases.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Sarcoma / Segunda Neoplasia Primária / Metastasectomia Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male País/Região como assunto: Europa Idioma: En Revista: Eur J Surg Oncol Assunto da revista: NEOPLASIAS Ano de publicação: 2019 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Sarcoma / Segunda Neoplasia Primária / Metastasectomia Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male País/Região como assunto: Europa Idioma: En Revista: Eur J Surg Oncol Assunto da revista: NEOPLASIAS Ano de publicação: 2019 Tipo de documento: Article