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Poster display session: Breast cancer - early stage, locally advanced & metastatic, CNS tumours, Developmental therapeutics, Genitourinary tumours - prostate & non-prostate, Palliative care, Psycho-oncology, Public health policy, Sarcoma, Supportive care

628 - Efficacy of metastasectomy on survival in patients with metachronous soft tissue sarcoma-metastasis. Results of a bi-centre study including 135 patients.

Date

22 Oct 2018

Session

Poster display session: Breast cancer - early stage, locally advanced & metastatic, CNS tumours, Developmental therapeutics, Genitourinary tumours - prostate & non-prostate, Palliative care, Psycho-oncology, Public health policy, Sarcoma, Supportive care

Topics

Surgical Oncology

Tumour Site

Soft Tissue Sarcomas

Presenters

Andreas Leithner

Citation

Annals of Oncology (2018) 29 (suppl_8): viii576-viii595. 10.1093/annonc/mdy299

Authors

A. Leithner1, V. van Praag2, F. Posch3, M. Bergovec1, L. Leitner1, J. Friesenbichler1, R. Heregger3, F. Smolle-Jüttner4, M. Fiocco2, M. van de Sande2, J. Riedl3, M. Pichler3, A. Gerger3, J. Szkandera3, H. Stöger3, B. Liegl-Atzwanger5, M.A. Smolle1

Author affiliations

  • 1 Department Of Orthopaedics And Trauma, Medical University of Graz, 8036 - Graz/AT
  • 2 Department Of Orthopaedic Surgery, Leiden University Medical Centre, 2333 - Leiden/NL
  • 3 Division Of Clinical Oncology, Medical University of Graz, Graz/AT
  • 4 Division Of Thoracic And Hyperbaric Surgery, Medical University of Graz, Graz/AT
  • 5 Institute Of Pathology, Medical University of Graz, Graz/AT
More

Resources

Abstract 628

Background

Metastasectomy is hypothesised to improve overall survival (OS) in patients with metachronous metastasis of STS. Evidence in favour of this approach comes from non-controlled single-arm studies subjected to selection bias. In the present study, advanced comparative effectiveness methods were used to assess the efficacy of metastasectomy vs. “non-invasive” treatments (i.e. chemotherapy, radiotherapy, best supportive care) in patients with metachronous STS-metastasis.

Methods

135 patients with metachronous STS metastasis, selected out of a population of over 1000 STS patients, who had primarily undergone surgery for localised STS between 1998 and 2015 at two tertiary tumour centres were retrospectively included. In order to evaluate the efficacy of metastasectomy on OS, a propensity score (PS) was estimated, including variables at time of treatment decision for metastatic disease (“baseline”). Based on the PS, an inverse-probability-of-treatment-weight (IPTW) model was calculated to allow analyses with adjustment for favourable prognostic factors prevailing in patients undergoing metastasectomy (for metastasectomy: IPTW=1/PS; for “non-invasive” treatment: IPTW=1/(1-PS)).

Results

OS was significantly better in those 68 patients (44.4%) who had undergone metastasectomy (10-year OS: 23% vs. 4%; log-rank test: p < 0.0001; hazard ratio (HR): 0.34, 95% confidence interval (CI): 0.22-0.53, p < 0.0001). This positive association prevailed after recalculation of time-to-event-analyses with IPTW-weighted data ((adjusted 10-year OS: 17% vs. 3%, log-rank-test: p < 0.0001; HR: 0.33, 95%CI: 0.20-0.52, p < 0.0001), compensating for positive prognostic factors prevailing in patients with metastasectomy (i.e. smaller number of metastases, better ECOG performance status, better haemoglobin- and albumin-levels).

Conclusions

In the present bi-centre study, metastasectomy was associated with a significant benefit on OS, persisting even after adjustment for favourable prognostic factors prevailing in patients undergoing metastasectomy. Our data indicate that metastasectomy should be considered as first choice in patients with metachronous metastasis of STS.

Clinical trial identification

Legal entity responsible for the study

Medical University of Graz.

Funding

Has not received any funding.

Editorial Acknowledgement

Disclosure

All authors have declared no conflicts of interest.

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