Curative-intent surgery for solitary bone metastasis from extremity and trunk wall sarcoma: what are the outcomes and complications?
Menée à l'aide de données portant sur 47 patients atteints d'un sarcome osseux ou des tissus mous localisé aux extrémités, cette étude analyse la survie spécifique après un traitement chirurgical des métastases osseuses solitaires
Résumé en anglais
Introduction: Approximately 40–50% of sarcoma patients will develop lung metastasis, but only 10% will develop bone metastasis. The survival benefit of surgery for solitary bone metastasis remains unclear.
Methods: From 1987 to 2019, 47 patients who underwent curative-intent treatment for localized bone or soft tissue sarcoma in the extremities or trunk wall developed solitary bone metastases as the first distant recurrence. Of them, 51% (24/47) received curative-intent metastasectomy. We compared the clinicopathologic characteristics of the metastasectomy versus non-metastasectomy patients and evaluated the prognostic impact of solitary bone metastasectomy. The primary outcome measure was disease-specific survival (DSS) after developing solitary bone metastasis.
Results: The post-metastasis DSS was worse with larger primary tumour size (HR 1.09; 95% CI 1.02–1.16; p=0.01) and bone metastasis in the pelvis or spine versus other bones (HR 3.79, 95% CI 1.46–9.87; p=0.01), and better with curative-intent surgery for the solitary bone metastasis (HR 0.14; 95% CI 0.06–0.34; p<0.001). The median DSS was 43 (95% CI, 24–69) months for the metastasectomy group vs. 13 (95% CI, 7–19) months for the non-metastasectomy group (p<0.001). The metastasectomy group had fewer patients with metastasis in the spine or pelvis and longer metastasis-free interval. In the multivariate analysis, curative-intent surgery for solitary bone metastasis was associated with better survival (HR 0.21; 95% CI 0.08–0.53; p=0.001).
Conclusions: Curative-intent surgery for solitary bone metastasis from sarcoma is associated with a better prognosis and is a reasonable treatment strategy whenever feasible.
