Prognostic influence of the treatment approach for pulmonary metastasis in patients with soft tissue sarcoma
Prognostic influence of the treatment approach for pulmonary metastasis in patients with soft tissue sarcoma
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DOI：
10.1007/s10585-020-10038-y
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发表时间：
2020-05-20
影响因子：
4
通讯作者：
Akisue, Toshihiro
中科院分区：
文献类型：
--
作者：
Kawamoto, Teruya;Hara, Hitomi;Akisue, Toshihiro
摘要软组织肉瘤（STSs）是一种罕见的间质异质性恶性肿瘤。约50%的高级别STS患者发生肺转移，这是转移性STS患者死亡的主要原因。据报道，肺转移切除术有助于长期生存；然而，适当的治疗方法尚未确立。我们的目的是确定与肺转移的STS患者转移后生存相关的因素，并确定每位患者的适当治疗方法。我们回顾性回顾了2000年至2017年间治疗的转移性STS患者的记录，并分析了临床病理变量，以确定与生存相关的因素。肺转移后中位生存期为20.6个月，1、3、5年生存率分别为68.6%、36.0%、25.1%。肺转移切除术患者的生存期明显高于未手术患者（38.9个月vs 10.5个月；p < 0.0001）。在未接受手术的患者中，接受化疗的患者的生存期明显高于未接受化疗的患者（19.1个月比6.3个月，p = 0.037）。多因素分析发现肺转移切除术是影响转移后生存最重要的预后因素（危险比5.623；95%可信区间2.733-11.572;p < 0.0001）。总之，肺转移切除术是转移性STS患者转移后生存的最重要预后因素。此外，化疗可以延长不适合肺切除术的患者的生存期。尽管我们应该仔细权衡风险和收益，但对肺转移瘤进行适当的治疗可能有助于延长生存期。
Soft tissue sarcomas (STSs) are rare heterogeneous malignancies of mesenchymal origin. Pulmonary metastases develop in approximately 50% of the patients with high-grade STS, being the major cause of mortality in patients with metastatic STS. Pulmonary metastasectomy has been reported to contribute to long-term survival; however, an appropriate treatment has not been established. We aimed to identify factors associated with post-metastasis survival in STS patients with pulmonary metastasis and determine the appropriate treatment for each patient. We retrospectively reviewed the records of metastatic STS patients treated between 2000 and 2017 and analyzed the clinico-pathologic variables to identify factors associated with the survival. The median survival after pulmonary metastasis was 20.6 months, and the 1-, 3-, and 5-year survival rates were 68.6%, 36.0%, and 25.1%, respectively. The survival was significantly greater in patients who underwent pulmonary metastasectomy than in those without surgery (38.9 months vs. 10.5 months; p < 0.0001). Among those who did not undergo surgery, the survival was significantly greater in patients who received chemotherapy than in those without chemotherapy (19.1 months vs. 6.3 months, p = 0.037). Multivariate analysis identified pulmonary metastasectomy as the most important prognostic factor for post-metastasis survival (Hazard ratio 5.623; 95% Confidence Interval 2.733-11.572; p < 0.0001). In conclusion, pulmonary metastasectomy was the most important prognostic factor for post-metastasis survival in patients with metastatic STS. In addition, chemotherapy could prolong survival in patients who were not eligible for pulmonary resection. Although we should carefully weigh the risks and benefits, appropriate treatment for pulmonary metastases could contribute to long-time survival.