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

Publication date: Available online 3 July 2018

Source: European Journal of Surgical Oncology

Author(s): Maria A. Smolle, Veroniek M. van Praag, Florian Posch, Marko Bergovec, Lukas Leitner, Jörg Friesenbichler, Ronald Heregger, Jakob M. Riedl, Martin Pichler, Armin Gerger, Joanna Szkandera, Herbert Stöger, Freyja-Maria Smolle-Jüttner, Bernadette Liegl-Atzwanger, Marta Fiocco, Michiel AJ. van de Sande, Andreas Leithner

Abstract

Introduction

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).

Materials and Methods

From a population of 1578 STS patients, 135 patients who underwent surgery for localised STS at two European centres between 1998 and 2015, developing metachronous STS metastases, were retrospectively 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.

Results

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<0.0001). This association prevailed after IPTW-weighting of the data to control for the higher prevalence of favourable prognostic factors in the surgery group (adjusted 10-year OS: 17% vs. 3%, log-rank p<0.0001; HR=0.33, 95%CI: 0.20-0.52, p<0.0001). Five-year OS estimates were 27.8% in patients who had and 14.5% in patients who had not undergone metastasectomy within the first 3 months after metastasis diagnosis (p<0.0001).

Conclusion

In this observational bi-centre study, metastasectomy was associated with prolonged survival in patients with metachronous STS metastases. In the absence of randomized studies, our results indicate that metastasectomy should be clearly considered as an important treatment option for metachronous STS metastases.

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