PDF(Pubmed)
Abstract：
OBJECTIVE: With the development of osteosarcoma treatment, limb salvage surgery is gradually replacing amputation as the primary surgical option. Most pediatric osteosarcomas of the limbs undergo limb-salvage surgery. We aimed to use propensity score matching (PSM) analysis test the difference in cancer-specific mortality (CSM) between amputation and limb-salvage surgery in pediatric patients with Osteosarcoma of the limbs. PSM is a statistical method used to deal with data from an Observational Study. The PSM method is designed to reduce the influence of biases and confounding variables to make a more reasonable comparison between experimental and control groups.
METHODS: Patient information was downloaded from the SEER (surveillance, epidemiology, and End Results) database from 2004 to 2018. We included all primary pediatric osteosarcoma patients who underwent limb salvage or amputation. Multivariate logistic regression models were used to explore the factors influencing patient choice of amputation. Differences in CSM and other causes of mortality (OSM) between limb salvage and amputation were analyzed using cumulative incidence plots and competitive risk regression tests after 1:1 proportional propensity score matching.
RESULTS: A total of 1,058 pediatric patients with limbs Osteosarcoma were included. Patients who underwent amputations were more likely to be male (OR 1.4, P = 0.024) and more likely to have distant metastasis (OR 2.1, P < 0.001). Before propensity matching, CSM was 1.4 times higher in patients undergoing amputation than in patients undergoing limb salvage (P = 0.017) and 3.4 times higher in OSM (P = 0.007). After adjustment for propensity matching, CSM was 1.5 times higher in patients undergoing amputation than in patients undergoing limb salvage (P = 0.028), but there was no significant difference in OSM (HR 3.2, P = 0.078).
CONCLUSIONS: Our results suggested that amputation is associated with a 1.5-fold increase in CSM in pediatric patients with limbs Osteosarcoma. Therefore, in the surgical selection of pediatric patients with Osteosarcoma, limb salvage surgery should be the first choice in the absence of other contraindications.
METHODS: Patient information was downloaded from the SEER (surveillance, epidemiology, and End Results) database from 2004 to 2018. We included all primary pediatric osteosarcoma patients who underwent limb salvage or amputation. Multivariate logistic regression models were used to explore the factors influencing patient choice of amputation. Differences in CSM and other causes of mortality (OSM) between limb salvage and amputation were analyzed using cumulative incidence plots and competitive risk regression tests after 1:1 proportional propensity score matching.
RESULTS: A total of 1,058 pediatric patients with limbs Osteosarcoma were included. Patients who underwent amputations were more likely to be male (OR 1.4, P = 0.024) and more likely to have distant metastasis (OR 2.1, P < 0.001). Before propensity matching, CSM was 1.4 times higher in patients undergoing amputation than in patients undergoing limb salvage (P = 0.017) and 3.4 times higher in OSM (P = 0.007). After adjustment for propensity matching, CSM was 1.5 times higher in patients undergoing amputation than in patients undergoing limb salvage (P = 0.028), but there was no significant difference in OSM (HR 3.2, P = 0.078).
CONCLUSIONS: Our results suggested that amputation is associated with a 1.5-fold increase in CSM in pediatric patients with limbs Osteosarcoma. Therefore, in the surgical selection of pediatric patients with Osteosarcoma, limb salvage surgery should be the first choice in the absence of other contraindications.
摘要：
目的：随着骨肉瘤治疗的发展，保肢手术正在逐渐取代截肢手术成为主要的手术选择。大多数小儿四肢骨肉瘤都接受保肢手术。我们旨在使用倾向评分匹配（PSM）分析测试截肢和保肢手术之间的癌症特异性死亡率（CSM）在小儿四肢骨肉瘤患者中的差异。PSM是用于处理来自观察性研究的数据的统计方法。PSM方法旨在减少偏差和混杂变量的影响，以在实验组和对照组之间进行更合理的比较。
方法：从SEER下载患者信息（监测，流行病学,和最终结果）2004年至2018年的数据库。我们纳入了所有接受保肢或截肢的原发性小儿骨肉瘤患者。采用多因素logistic回归模型探讨患者选择截肢的影响因素。在1：1比例倾向评分匹配后，使用累积发生率图和竞争性风险回归测试分析了保肢和截肢之间CSM和其他死亡原因（OSM）的差异。
结果：共纳入1,058例四肢骨肉瘤患儿。接受截肢的患者更可能是男性（OR1.4，P=0.024），更可能发生远处转移（OR2.1，P<0.001）。在倾向匹配之前，截肢患者的CSM比保肢患者高1.4倍（P=0.017），OSM患者的CSM高3.4倍（P=0.007）。在调整倾向匹配后，截肢患者的CSM是截肢患者的1.5倍（P=0.028），OSM差异无统计学意义(HR3.2,P=0.078)。
结论：我们的结果表明截肢与儿童四肢骨肉瘤患者的CSM增加1.5倍相关。因此,在小儿骨肉瘤患者的手术选择中，在没有其他禁忌症的情况下，保肢手术应该是首选。
方法：从SEER下载患者信息（监测，流行病学,和最终结果）2004年至2018年的数据库。我们纳入了所有接受保肢或截肢的原发性小儿骨肉瘤患者。采用多因素logistic回归模型探讨患者选择截肢的影响因素。在1：1比例倾向评分匹配后，使用累积发生率图和竞争性风险回归测试分析了保肢和截肢之间CSM和其他死亡原因（OSM）的差异。
结果：共纳入1,058例四肢骨肉瘤患儿。接受截肢的患者更可能是男性（OR1.4，P=0.024），更可能发生远处转移（OR2.1，P<0.001）。在倾向匹配之前，截肢患者的CSM比保肢患者高1.4倍（P=0.017），OSM患者的CSM高3.4倍（P=0.007）。在调整倾向匹配后，截肢患者的CSM是截肢患者的1.5倍（P=0.028），OSM差异无统计学意义(HR3.2,P=0.078)。
结论：我们的结果表明截肢与儿童四肢骨肉瘤患者的CSM增加1.5倍相关。因此,在小儿骨肉瘤患者的手术选择中，在没有其他禁忌症的情况下，保肢手术应该是首选。
