背景:多达一半的平滑肌肉瘤(LMS)患者存在远处转移,最常见的是肺部。尽管有关于管理异时寡转移疾病的指南,同步孤立性肺转移(SILMs)的证据有限。我们的组织学特异性研究描述了LMS和SILM患者在疾病部位的管理模式和结果。
方法:我们使用国家癌症数据库分析腹膜后LMS患者,四肢,躯干/胸部/腹壁,和带SILM的骨盆。排除肺外转移患者。我们确定了与原发性肿瘤切除和接受转移瘤切除相关的因素。结果包括中位数,1年,使用对数秩检验的治疗方法和5年总生存率(OS),卡普兰-迈耶曲线,和Cox比例风险模型。
结果:我们从2004年至2017年确定了629例SILM患者。与社区癌症中心相比,如果在学术中心治疗,患者更有可能切除其原发肿瘤或肺转移。同时进行原发性肿瘤切除和转移瘤切除术的患者的五年OS为20.9%,而单纯进行原发性肿瘤切除的患者为9.2%。非手术患者为2.6%。所有参与者的中位操作系统为15.5个月。社区治疗场所,合并症评分,较大的原发性肿瘤与较差的生存率相关。化疗,原发性切除,在多变量Cox回归上,根治性手术预测生存率提高。
结论:对我们人群中的部分患者采用SILM对原发性LMS进行积极的手术治疗,发现与OS改善相关。对于高容量中心的合适患者,应考虑这种方法。
BACKGROUND: Up to half of patients with
leiomyosarcoma (LMS) present with distant metastases, most commonly in the lungs. Despite guidelines around managing metachronous oligometastatic disease, limited evidence exists for synchronous isolated lung metastases (SILMs). Our histology-specific study describes management patterns and outcomes for patients with LMS and SILM across disease sites.
METHODS: We used the National Cancer Database to analyze patients with LMS of the retroperitoneum, extremity, trunk/chest/abdominal wall, and pelvis with SILM. Patients with extra-pulmonary metastases were excluded. We identified factors associated with primary tumor resection and receipt of metastasectomy. Outcomes included median, 1-year, and 5-year overall survival (OS) across treatment approaches using log-rank tests, Kaplan-Meier curves, and Cox proportional hazard models.
RESULTS: We identified 629 LMS patients with SILM from 2004 to 2017. Patients were more likely to have resection of their primary tumor or lung metastases if treated at an academic center compared to a community cancer center. Five year OS for patients undergoing both primary tumor resection and metastasectomy was 20.9% versus 9.2% for primary tumor resection alone, and 2.6% for nonsurgical patients. Median OS for all-comers was 15.5 mo. Community treatment site, comorbidity score, and larger primary tumors were associated with worse survival. Chemotherapy, primary resection, and curative intent surgery predicted improved survival on multivariate Cox regression.
CONCLUSIONS: An aggressive surgical approach to primary LMS with SILM was undertaken for select patients in our population and found to be associated with improved OS. This approach should be considered for suitable patients at high-volume centers.