Metastasectomy in Leiomyosarcoma: A Systematic Review and Pooled Survival Analysis

被引:6
作者
Delisle, Megan [1 ]
Alshamsan, Bader [2 ,3 ]
Nagaratnam, Kalki [4 ]
Smith, Denise [5 ]
Wang, Ying [6 ,7 ]
Srikanthan, Amirrtha [3 ,8 ,9 ]
机构
[1] Univ Ottawa, Ottawa Hosp, Div Gen Surg, Ottawa, ON K1N 6N5, Canada
[2] Qassim Univ, Coll Med, Dept Med, Buraydah 52571, Saudi Arabia
[3] Univ Ottawa, Dept Med, Fac Med, Ottawa, ON K1N 6N5, Canada
[4] Univ Ottawa, Fac Hlth Sci, Interdisciplinary Sch Hlth Sci, Ottawa, ON K1N 6N5, Canada
[5] McMaster Univ, Hlth Sci Lib, Hamilton, ON L8S 4L8, Canada
[6] BC Canc Vancouver Canc Ctr, Div Med Oncol, Vancouver, BC V5Z 4E6, Canada
[7] Univ British Columbia, Dept Med, Vancouver, BC V6T 1Z4, Canada
[8] Ottawa Hosp, Div Med Oncol, Ottawa, ON K1H 8L6, Canada
[9] Ottawa Hosp, Res Inst, Ottawa, ON K1H 8L6, Canada
关键词
sarcoma; metastasis; leiomyosarcoma; metastasectomy; surgery; survival; systematic review; SOFT-TISSUE SARCOMA; GEMCITABINE PLUS DOCETAXEL; RANDOMIZED PHASE-II; LONG-TERM SURVIVAL; PULMONARY METASTASECTOMY; OPEN-LABEL; EUROPEAN ORGANIZATION; 1ST-LINE TREATMENT; PROGNOSTIC-FACTORS; LIVER RESECTION;
D O I
10.3390/cancers14133055
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Simple Summary Leiomyosarcoma (LMS) is an aggressive soft tissue sarcoma with a poor prognosis. Approximately 40% of patients will develop metastatic disease. The optimal treatment for patients with metastatic LMS is not well established, and there are no randomized controlled trials regarding metastasectomy. This systematic review and pooled survival analysis aims to assess the survival in patients undergoing a metastasectomy for LMS and compare the outcomes based on the site of metastasectomy. We identified that patients with LMS metastases in the lungs, liver, spine, and brain can undergo metastasectomy with acceptable survival. Two studies have compared survival outcomes between patients treated and not treated with metastasectomy; despite their low quality, these studies support a survival benefit associated with metastasectomy. This study assesses the survival in patients undergoing metastasectomy for leiomyosarcoma (LMS) and compares the outcomes by the site of metastasectomy. We conducted a systematic review and pooled survival analysis of patients undergoing metastasectomy for LMS. Survival was compared between sites of metastasectomy. We identified 23 studies including 573 patients undergoing metastasectomy for LMS. The pooled median survival was 59.6 months (95% CI 33.3 to 66.0). The pooled median survival was longest for lung metastasectomy (72.8 months 95% CI 63.0 to 82.5), followed by liver (34.8 months 95% CI 22.3 to 47.2), spine (14.1 months 95% CI 8.6 to 19.7), and brain (14 months 95% CI 6.7 to 21.3). Two studies compared the survival outcomes between patients who did, versus who did not undergo metastasectomy; both demonstrated a significantly improved survival with metastasectomy. We conclude that surgery is currently being utilized for LMS metastases to the lung, liver, spine, and brain with acceptable survival. Although low quality, comparative studies support a survival benefit with metastasectomy. In the absence of randomized studies, it is impossible to determine whether the survival benefit associated with metastasectomy is due to careful patient selection rather than a surgical advantage; limited data were included about patient selection.
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页数:22
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