Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Heregger, R.
Metastasectomy in patients with advanced soft tissue sarcoma: Quantifying the benefit
Humanmedizin; [ Diplomarbeit/Master Thesis (UNI) ] Graz Medical University; 2019. pp.77.
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Szkandera Joanna
- Altmetrics:
- Abstract:
- Introduction: Metastasectomy is an approved therapy option in patients with soft tissue sarcoma (STS). However, the results refer only to a handful of non-controlled observational studies, which are not without limitation (e.g. selection bias). This diploma thesis aimed to quantify the benefit of metastasectomy on overall survival (OS). Patients and Methods: This study included 87 STS patients treated at our institution in the time from 1998 to 2017. Baseline characteristics such as patient-, tumour-, and treatment-parameters were compared between surgically intervened (i.e. metastasectomy) and conservatively treated patients. The primary endpoint of the study was OS, estimated with the Kaplan-Meier method. We used a propensity score approach to consider differences in patient characteristics between the two comparing groups. Factors with impact on OS were identified via the use of uni- and multivariate Cox proportional hazard models. Results: Forty-seven patients underwent metastasectomy. Of the remaining 40 patients, 27 received best supportive care (BSC) and 13 chemotherapy (CTX) ± radiotherapy (RTX). According to univariate (p<0.004) and multivariate (p=0.050) Cox regression-analysis, patients who underwent metastasectomy had a prolonged OS. In the univariate setting, favourable prognostic factors for OS turned out to be higher albumin- (p=0.031, Hazard Ratio (HR) 0.484, 95% confidence interval (95% CI) 0.250–0.937) and haemoglobin-level (p=0.047, HR 0.554, 95% CI 0.309–0.992). Multivariate analysis identified that primary tumours situated in the extremities (p=0.011, HR 0.259, 95% CI 0.091–0.737) and a low score in the Eastern Co-operative of Oncology Group Scale of Performance Status (ECOG-PS) (p=0.046, HR 3.848, 95%CI 1.022–14.487) were associated with a better OS. After weighting all patients for the inverse propensity of treatment weighting (IPTW) score and recalculating the data, metastasectomy still remained a positive prognostic factor. Conclusion: Our data indicate that in STS patients metastasectomy is associated with a significant benefit on OS. Despite the lack of prospective randomised trials, metastasectomy may offer a valuable treatment strategy for selected patients.