| Autor: |
Obergfell TTAF; Faculty of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002 Luzern, Switzerland.; Sarcoma Center, LUKS University Teaching Hospital, Luzerner Kantonsspital, 6000 Lucerne, Switzerland., Nydegger KN; Faculty of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002 Luzern, Switzerland.; Sarcoma Center, LUKS University Teaching Hospital, Luzerner Kantonsspital, 6000 Lucerne, Switzerland., Heesen P; Medizinische Fakultät, Universität Zürich, 8032 Zurich, Switzerland., Schelling G; Sarcoma Center, LUKS University Teaching Hospital, Luzerner Kantonsspital, 6000 Lucerne, Switzerland., Bode-Lesniewska B; Sarcoma Center, LUKS University Teaching Hospital, Luzerner Kantonsspital, 6000 Lucerne, Switzerland., Studer G; Faculty of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002 Luzern, Switzerland.; Sarcoma Center, LUKS University Teaching Hospital, Luzerner Kantonsspital, 6000 Lucerne, Switzerland., Fuchs B; Faculty of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002 Luzern, Switzerland.; Sarcoma Center, LUKS University Teaching Hospital, Luzerner Kantonsspital, 6000 Lucerne, Switzerland.; Sarkomzentrum KSW, Klinik für Orthopädie und Traumatologie, Kantonsspital Winterthur, 8400 Winterthur, Switzerland. |
| Abstrakt: |
This study follows the Target Trial Emulation (TTE) framework to assess the impact of unplanned resections (UEs) and planned resections (PEs) of sarcomas on local recurrence-free survival (LRFS), metastasis-free survival (MFS), cancer-specific survival (CSS), and overall survival (OS). Sarcomas, malignant tumors with mesenchymal differentiation, present a significant clinical challenge due to their rarity, complexity, and the frequent occurrence of UEs, which complicates effective management. Our analysis utilized real-world-time data from the Swiss Sarcoma Network, encompassing 429 patients, to compare the impact of UEs and PEs, adjusting for known prognostic factors through a multivariable Cox regression model and propensity score weighting. Our findings reveal a significantly higher risk of local recurrence for UEs and a short-term follow-up period that showed no marked differences in MFS, CSS, and OS between the UE and PE groups, underlining the importance of optimal initial surgical management. Furthermore, tumor grade was validated as a critical prognostic factor, influencing outcomes irrespective of surgical strategy. This study illuminates the need for improved referral systems to specialized sarcoma networks to prevent UEs and advocates for the integration of TTE in sarcoma research to enhance clinical guidelines and decision-making in sarcoma care. Future research should focus on the prospective validations of these findings and the exploration of integrated care models to reduce the incidence of UEs and improve patient outcomes. |
