Surgery for metachronous metastasis of soft tissue sarcoma – A magnitude of benefit analysis using propensity score methods

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 patien...

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Published in:European journal of surgical oncology 2019-02, Vol.45 (2), p.242-248
Main Authors: 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
Format: Article
Language:English
Subjects:
Aged
Austria
Female
Humans
Male
Metastasectomy
Metastasectomy - methods
Metastasis
Neoplasm Grading
Neoplasms, Second Primary - pathology
Neoplasms, Second Primary - surgery
Netherlands
Overall-survival
Prognosis
Propensity Score
Retrospective Studies
Sarcoma - pathology
Sarcoma - surgery
Soft tissue sarcoma
Survival Rate
Treatment Outcome
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Summary: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). 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. 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 
ISSN:0748-7983
1532-2157
DOI:10.1016/j.ejso.2018.06.019