Primary Tumor Resection in Leiomyosarcoma Patients With Synchronous Isolated Lung Metastases: A National Cancer Database Study.

Autor: Istl AC; Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin., Nudotor R; Department of Surgery, Anne Arundel Medical Center, Annapolis, Maryland., Greer JB; Division of Surgical Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland., Gross JM; Division of Surgical Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland., Meyer CF; Division of Medical Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland., Johnston FM; Division of Surgical Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: fjohnst4@jhmi.edu.
Jazyk: angličtina
Zdroj: The Journal of surgical research [J Surg Res] 2024 Aug; Vol. 300, pp. 559-566. Date of Electronic Publication: 2024 Jun 25.
DOI: 10.1016/j.jss.2024.03.020
Abstrakt: Introduction: 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.
(Copyright © 2024. Published by Elsevier Inc.)
Databáze: MEDLINE
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