Abstract：
Local treatment is a crucial element in the standard of care for Ewing sarcoma (EWS). While systemic treatment is improved in randomised clinical trials, local treatment modalities are discussed controversially. We analysed the association between local therapy and event-free survival (EFS), overall survival (OS), and local recurrence (LR) in prospectively collected data of patients with localised EWS.
We analysed data from the international Ewing 2008 study registered between 2009 and 2019 in 117 centres. After induction chemotherapy, patients received surgery, radiotherapy, or a combination thereof. We performed Cox regression, conducted propensity score-weighted sensitivity analysis, and performed subgroup analyses. Hazard ratios (HRs) and 95% confidence intervals are reported.
We included 863 patients with localised EWS (surgery alone: 331, combination therapy: 358, definitive radiotherapy: 174). In patients treated with combination therapy compared to surgery alone, EFS HR was 0.84 (0.57-1.24; p = 0.38), OS HR was 0.84 (0.57-1.23; p = 0.41), and LR HR was 0.58 (0.26-1.31; p = 0.19). Hazards of any event were increased in patients treated with definitive radiotherapy compared to surgery only, HR 1.53 (1.02-2.31; p = 0.04). Patients with poor responses to chemotherapy benefitted from combination therapy over definitive surgery with an EFS HR 0.49 (0.27-0.89; p = 0.02). Patients with pelvic tumours benefitted from combination therapy over surgery only regarding LR, HR 0.12 (0.02-0.72; p = 0.02).
Patients with poor responses to chemotherapy benefitted from radiotherapy added to surgery. In the whole group, radiotherapy alone as opposed to surgery alone increased the hazards of any event.
We analysed data from the international Ewing 2008 study registered between 2009 and 2019 in 117 centres. After induction chemotherapy, patients received surgery, radiotherapy, or a combination thereof. We performed Cox regression, conducted propensity score-weighted sensitivity analysis, and performed subgroup analyses. Hazard ratios (HRs) and 95% confidence intervals are reported.
We included 863 patients with localised EWS (surgery alone: 331, combination therapy: 358, definitive radiotherapy: 174). In patients treated with combination therapy compared to surgery alone, EFS HR was 0.84 (0.57-1.24; p = 0.38), OS HR was 0.84 (0.57-1.23; p = 0.41), and LR HR was 0.58 (0.26-1.31; p = 0.19). Hazards of any event were increased in patients treated with definitive radiotherapy compared to surgery only, HR 1.53 (1.02-2.31; p = 0.04). Patients with poor responses to chemotherapy benefitted from combination therapy over definitive surgery with an EFS HR 0.49 (0.27-0.89; p = 0.02). Patients with pelvic tumours benefitted from combination therapy over surgery only regarding LR, HR 0.12 (0.02-0.72; p = 0.02).
Patients with poor responses to chemotherapy benefitted from radiotherapy added to surgery. In the whole group, radiotherapy alone as opposed to surgery alone increased the hazards of any event.
摘要：
背景：局部治疗是尤文肉瘤（EWS）标准治疗中的关键因素。虽然系统治疗在随机临床试验中得到改善，当地的治疗方式有争议的讨论。我们分析了局部治疗与无事件生存率(EFS)之间的关系，总生存期（OS），前瞻性收集的局部EWS患者数据中的局部复发（LR）。
方法：我们分析了2009年至2019年在117个中心注册的国际Ewing2008研究数据。诱导化疗后，患者接受手术,放射治疗,或其组合。我们做了Cox回归,进行了倾向得分加权敏感性分析，并进行了亚组分析。报告了危险比(HR)和95%置信区间。
结果：我们纳入了863例局部EWS患者（单纯手术：331例，联合治疗：358例，明确放疗：174例）。与单独手术相比，联合治疗的患者，EFSHR为0.84（0.57-1.24；p=0.38），OSHR为0.84（0.57-1.23；p=0.41），LRHR为0.58（0.26-1.31；p=0.19）。与仅接受手术治疗相比，接受确定性放疗的患者发生任何事件的风险均增加，HR1.53（1.02-2.31；p=0.04）。对化疗反应较差的患者受益于联合治疗，而不是EFSHR为0.49（0.27-0.89；p=0.02）的确定性手术。骨盆肿瘤患者受益于联合治疗，而不是仅在LR方面的手术，HR0.12（0.02-0.72；p=0.02）。
结论：化疗反应差的患者可从手术后的放疗中获益。在整个群体中,与单纯手术相比,单纯放疗增加了任何事件的危害.
方法：我们分析了2009年至2019年在117个中心注册的国际Ewing2008研究数据。诱导化疗后，患者接受手术,放射治疗,或其组合。我们做了Cox回归,进行了倾向得分加权敏感性分析，并进行了亚组分析。报告了危险比(HR)和95%置信区间。
结果：我们纳入了863例局部EWS患者（单纯手术：331例，联合治疗：358例，明确放疗：174例）。与单独手术相比，联合治疗的患者，EFSHR为0.84（0.57-1.24；p=0.38），OSHR为0.84（0.57-1.23；p=0.41），LRHR为0.58（0.26-1.31；p=0.19）。与仅接受手术治疗相比，接受确定性放疗的患者发生任何事件的风险均增加，HR1.53（1.02-2.31；p=0.04）。对化疗反应较差的患者受益于联合治疗，而不是EFSHR为0.49（0.27-0.89；p=0.02）的确定性手术。骨盆肿瘤患者受益于联合治疗，而不是仅在LR方面的手术，HR0.12（0.02-0.72；p=0.02）。
结论：化疗反应差的患者可从手术后的放疗中获益。在整个群体中,与单纯手术相比,单纯放疗增加了任何事件的危害.
