Prognostic Impact of Pulmonary Metastasectomy in Bone Sarcoma Patients: A Retrospective, Single-Centre Study

ABSTRACT:

Simple Summary

In this retrospective study, the influence of lung metastasectomy on post-metastasis survival (PMS) in bone sarcoma patients was analyzed. Inverse probability of treatment weight (IPTW) was calculated based on a propensity score whether patients underwent metastasectomy or not, in order to account for potential selection bias. We included 47 patients, 39 of whom had undergone metastasectomy. The procedure was more likely to have been performed in singular and unilateral lesions, young patients, and those with a prolonged interval from primary diagnosis to metastasis development. Both in the naive and in the IPTW-adjusted Cox-regression analysis, metastasectomy was associated with a significantly better PMS. Thus, this treatment option should be considered in bone sarcoma patients with pulmonary metastases in order to improve outcomes.

Abstract

This retrospective study aimed at analyzing the impact of metastasectomy on post-metastasis survival (PMS) in bone sarcoma patients with lung metastases. Altogether, 47 bone sarcoma patients (24 males, median age at diagnosis of lung metastases: 21.8 (IQR: 15.6–47.3) years) with primary (n = 8) or secondary (n = 39) lung metastases treated at a single university hospital were retrospectively included. Based on a propensity score, inverse probability of treatment weight (IPTW) was calculated to account for selection bias whether patients had undergone metastasectomy or not. The most common underlying histology was osteosarcoma (n = 37; 78.7%). Metastasectomy was performed in 39 patients (83.0%). Younger patients (p = 0.025) with singular (p = 0.043) and unilateral lesions (p = 0.024), as well as those with an interval ≥ 9 months from primary diagnosis to development of lung metastases (p = 0.024) were more likely to undergo metastasectomy. Weighted 1- and 3-year PMS after metastasectomy was 80.8% and 58.3%, compared to 88.5% and 9.1% for patients who did not undergo metastasectomy. Naive Cox-regression analysis demonstrated a significantly prolonged PMS for patients with metastasectomy (HR: 0.142; 95%CI: 0.045–0.450; p = 0.001), which was confirmed after IPTW-weighting (HR: 0.279; 95%CI: 0.118–0.662; p = 0.004), irrespective of age, time to metastasis, and the number of lesions. In conclusion, metastasectomy should be considered in bone sarcoma patients with lung metastases, after carefully considering the individual risks, to possibly improve PMS.

SUBMITTER: Smolle M 

PROVIDER: S-EPMC10046382 | biostudies-literature | 2023 Mar

REPOSITORIES: biostudies-literature