Maria A Smolle1, Veroniek M van Praag2, Florian Posch3, Marko Bergovec4, Lukas Leitner5, Jörg Friesenbichler6, Ronald Heregger7, Jakob M Riedl8, Martin Pichler9, Armin Gerger10, Joanna Szkandera11, Herbert Stöger12, Freyja-Maria Smolle-Jüttner13, Bernadette Liegl-Atzwanger14, Marta Fiocco15, Michiel Aj van de Sande16, Andreas Leithner17. 1. Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria; Comprehensive Cancer Centre Graz, Graz, Austria. Electronic address: maria.smolle@medunigraz.at. 2. Department of Orthopaedic Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands. Electronic address: v.m.van_praag@lumc.nl. 3. Comprehensive Cancer Centre Graz, Graz, Austria; Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria. Electronic address: florian.posch@medunigraz.at. 4. Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria; Comprehensive Cancer Centre Graz, Graz, Austria. Electronic address: marko.bergovec@medunigraz.at. 5. Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria; Comprehensive Cancer Centre Graz, Graz, Austria. Electronic address: lukas.leitner@medunigraz.at. 6. Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria; Comprehensive Cancer Centre Graz, Graz, Austria. Electronic address: joerg.friesenbichler@medunigraz.at. 7. Comprehensive Cancer Centre Graz, Graz, Austria; Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria. Electronic address: Ronald.heregger@stud.medunigraz.at. 8. Comprehensive Cancer Centre Graz, Graz, Austria; Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria. Electronic address: j.riedl@stud.medunigraz.at. 9. Comprehensive Cancer Centre Graz, Graz, Austria; Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria; Department of Experimental Therapeutics, The UT MD Anderson Cancer Center, Sout Campus Research Building 4, 1901 East Road, Houston, TX, USA. Electronic address: martin.pichler@medunigraz.at. 10. Comprehensive Cancer Centre Graz, Graz, Austria; Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria. Electronic address: armin.gerger@medunigraz.at. 11. Comprehensive Cancer Centre Graz, Graz, Austria; Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria. Electronic address: Joanna.szkandera@medunigraz.at. 12. Comprehensive Cancer Centre Graz, Graz, Austria; Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria. Electronic address: Herbert.stoeger@medunigraz.at. 13. Comprehensive Cancer Centre Graz, Graz, Austria; Division of Thoracic and Hyperbaric Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036, Austria. Electronic address: freyja.smolle@medunigraz.at. 14. Comprehensive Cancer Centre Graz, Graz, Austria; Institute of Pathology, Medical University of Graz, Auenbruggerplatz 25, 8036, Graz, Austria. Electronic address: Bernadette.liegl-atzwanger@medunigraz.at. 15. Department of Orthopaedic Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands; Department of Medical Statistics and Bioinformatics, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands; Mathematical Institute Leiden University, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands. Electronic address: m.fiocco@lumc.nl. 16. Department of Orthopaedic Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands. Electronic address: m.a.j.van_de_Sande@lumc.nl. 17. Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria; Comprehensive Cancer Centre Graz, Graz, Austria. Electronic address: andreas.leithner@medunigraz.at.
Abstract
INTRODUCTION: Metastasectomy is hypothesised to improve OS in metastatic STS, but evidence in favour of this approach derives from non-controlled single-arm cohorts affected by selection bias. The objective was to quantify the effect of metastasectomy vs. non-surgical management on overall survival (OS) in patients with metachronous metastases from extremity- and trunk soft tissue sarcoma (STS). MATERIALS AND METHODS: From a population of 1578 STS patients, 135 patients who underwent surgery for localised STS at two European centres between 1998 and 2015 and developed metachronous STS metastases were included. Propensity score analyses with inverse-probability-of-treatment-weights (IPTW) and landmark analyses were performed to control for selection and immortal time bias, respectively. RESULTS: OS was significantly longer in the 68 patients undergoing metastasectomy than in the 67 patients who were treated non-invasively for their metastasis (10-year OS: 23% vs. 4%; hazard ratio (HR) = 0.34, 95% CI: 0.22-0.53, p < 0.0001). This association prevailed after IPTW-weighting of the data to control for the higher prevalence of favourable prognostic factors in the surgery group (adjusted 10-year OS: 17% vs. 3%, log-rank p < 0.0001; HR = 0.33, 95% CI: 0.20-0.52, p < 0.0001). Five-year OS estimates were 27.8% in patients who had and 14.5% in patients who had not undergone metastasectomy within the first 3 months after diagnosis of a metastasis (p < 0.0001). CONCLUSION: In this observational bi-centre study, metastasectomy was associated with prolonged survival in patients with metachronous STS metastases. In the absence of randomized studies, our results indicate that metastasectomy should be considered as an important treatment option for metachronous STS metastases.
INTRODUCTION: Metastasectomy is hypothesised to improve OS in metastatic STS, but evidence in favour of this approach derives from non-controlled single-arm cohorts affected by selection bias. The objective was to quantify the effect of metastasectomy vs. non-surgical management on overall survival (OS) in patients with metachronous metastases from extremity- and trunk soft tissue sarcoma (STS). MATERIALS AND METHODS: From a population of 1578 STS patients, 135 patients who underwent surgery for localised STS at two European centres between 1998 and 2015 and developed metachronous STS metastases were included. Propensity score analyses with inverse-probability-of-treatment-weights (IPTW) and landmark analyses were performed to control for selection and immortal time bias, respectively. RESULTS:OS was significantly longer in the 68 patients undergoing metastasectomy than in the 67 patients who were treated non-invasively for their metastasis (10-year OS: 23% vs. 4%; hazard ratio (HR) = 0.34, 95% CI: 0.22-0.53, p < 0.0001). This association prevailed after IPTW-weighting of the data to control for the higher prevalence of favourable prognostic factors in the surgery group (adjusted 10-year OS: 17% vs. 3%, log-rank p < 0.0001; HR = 0.33, 95% CI: 0.20-0.52, p < 0.0001). Five-year OS estimates were 27.8% in patients who had and 14.5% in patients who had not undergone metastasectomy within the first 3 months after diagnosis of a metastasis (p < 0.0001). CONCLUSION: In this observational bi-centre study, metastasectomy was associated with prolonged survival in patients with metachronous STS metastases. In the absence of randomized studies, our results indicate that metastasectomy should be considered as an important treatment option for metachronous STS metastases.
Authors: Maria A Smolle; Angelika Schaffler; Andreas Leithner; Veroniek M Van Praag; Marko Bergovec; Joanna Szkandera; Bernadette Liegl-Atzwanger; Maya Niethard; Per-Ulf Tunn; Michiel Van De Sande; Dimosthenis Andreou Journal: J Surg Oncol Date: 2020-01-31 Impact factor: 3.454
Authors: Cecilia Tetta; Antonio Giugliano; Laura Tonetti; Michele Rocca; Alessandra Longhi; Francesco Londero; Gianmarco Parise; Orlando Parise; Linda Renata Micali; Mark La Meir; Jos G Maessen; Sandro Gelsomino Journal: J Clin Med Date: 2020-04-23 Impact factor: 4.241
Authors: Maria Anna Smolle; Michiel van de Sande; Dario Callegaro; Jay Wunder; Andrew Hayes; Lukas Leitner; Marko Bergovec; Per-Ulf Tunn; Veroniek van Praag; Marta Fiocco; Joannis Panotopoulos; Madeleine Willegger; Reinhard Windhager; Sander P D Dijkstra; Winan J van Houdt; Jakob M Riedl; Michael Stotz; Armin Gerger; Martin Pichler; Herbert Stöger; Bernadette Liegl-Atzwanger; Josef Smolle; Dimosthenis Andreou; Andreas Leithner; Alessandro Gronchi; Rick L Haas; Joanna Szkandera Journal: Cancers (Basel) Date: 2019-12-21 Impact factor: 6.639
Authors: Moritz Müller; Florian Posch; Dominik Kiem; Dominik Barth; Lena Horvath; Michael Stotz; Renate Schaberl-Moser; Martin Pichler; Richard Greil; Philipp J Jost; Andreas Seeber; Arno Amann; Konstantin Schlick; Armin Gerger; Jakob M Riedl Journal: Ther Adv Med Oncol Date: 2021-09-30 Impact factor: 8.168