Strategies of the management of pulmonary metastases in children with Ewing sarcoma- single institution experience of 137 patients

IF 2.1 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford Pub Date : 2026-02-01 Epub Date: 2025-11-19 DOI:10.1016/j.suronc.2025.102334

Krzysztof Bronowicki, Justyna Antoniuk-Majchrzak, Iwona Malesza, Tomasz Walenta, Agnieszka Szymborska, Anna Raciborska

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引用次数: 0

Abstract

Background

The role of pulmonary metastasectomy in pediatric Ewing sarcoma remains controversial, with significant treatment selection bias complicating the interpretation of retrospective series.

Objective

To evaluate treatment outcomes in isolated pulmonary metastases (PM) using propensity score analysis to control for selection bias.

Methods

Retrospective analysis of 137 patients with pulmonary metastases (85 isolated PM, 52 PM with extrapulmonary metastases) treated between 1998 and 2024. Primary comparison focused on thoracotomy alone versus radiotherapy alone in isolated PM patients with primary tumor surgery (n = 30). Propensity score matching was performed to address selection bias.

Results

Patients with isolated PM had superior overall survival compared to those with extrapulmonary disease (median OS: 111 vs 66 months, p < 0.001). In isolated PM patients with primary tumor surgery, direct comparison between thoracotomy alone and radiotherapy alone revealed superior survival with surgical resection (median OS: 125 vs 38 months, p = 0.009).

Stratified analysis by chemotherapy response demonstrated that thoracotomy benefit was primarily evident in patients with poor histologic response (≤10 % viable cells, median OS: 56 vs 27 months, p = 0.017), while patients with good response showed similar outcomes regardless of local treatment approach (p = 0.104).

After propensity score matching and multivariable adjustment for age and gender, the apparent benefit of thoracotomy was maintained in direct treatment comparisons, though overall comparison against all non-surgical treatments showed no significant difference (HR 0.75, p = 0.343), highlighting the importance of appropriate treatment comparisons and patient selection.

Conclusions

Thoracotomy may benefit carefully selected isolated PM patients, particularly those with poor response to chemotherapy. However, significant selection bias complicates the interpretation of retrospective surgical series. The benefit appears limited to specific clinical scenarios rather than representing a general therapeutic advantage. Future studies should focus on developing standardized selection criteria and prospective validation of treatment algorithms.

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儿童尤文氏肉瘤肺转移的治疗策略- 137例患者的单院经验

背景肺转移切除术在儿童尤文氏肉瘤中的作用仍然存在争议，明显的治疗选择偏倚使回顾性研究的解释复杂化。目的评价孤立性肺转移瘤（PM）的治疗效果，采用倾向评分分析控制选择偏倚。方法回顾性分析1998 ~ 2024年收治的137例肺转移患者的临床资料，其中分离性PM 85例，合并肺外转移的PM 52例。最初的比较集中在孤立性PM患者原发肿瘤手术单独开胸与单独放疗（n = 30）。进行倾向评分匹配以解决选择偏差。结果孤立性PM患者的总生存期优于肺外疾病患者（中位生存期：111个月vs 66个月，p < 0.001）。在原发肿瘤手术的孤立性PM患者中，直接比较单独开胸和单独放疗显示手术切除的生存率更高（中位生存期：125个月vs 38个月，p = 0.009）。化疗反应的分层分析表明，开胸手术的益处主要体现在组织学反应差的患者（活细胞≤10%，中位生存期：56 vs 27个月，p = 0.017），而反应良好的患者无论采用何种局部治疗方法，其结果都相似（p = 0.104）。经过倾向评分匹配和年龄和性别的多变量调整后，尽管与所有非手术治疗的总体比较没有显着差异（HR 0.75, p = 0.343），但在直接治疗比较中，开胸手术仍然有明显的优势，这突出了适当的治疗比较和患者选择的重要性。结论谨慎选择孤立的PM患者，特别是对化疗反应较差的患者，开胸手术可能会受益。然而，明显的选择偏倚使回顾性手术系列的解释复杂化。这种益处似乎仅限于特定的临床情况，而不是代表一般的治疗优势。未来的研究应侧重于制定标准化的选择标准和治疗算法的前瞻性验证。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Surgical Oncology-Oxford 医学-外科

CiteScore

4.50

自引率

0.00%

发文量

169

审稿时长

38 days

期刊介绍： Surgical Oncology is a peer reviewed journal publishing review articles that contribute to the advancement of knowledge in surgical oncology and related fields of interest. Articles represent a spectrum of current technology in oncology research as well as those concerning clinical trials, surgical technique, methods of investigation and patient evaluation. Surgical Oncology publishes comprehensive Reviews that examine individual topics in considerable detail, in addition to editorials and commentaries which focus on selected papers. The journal also publishes special issues which explore topics of interest to surgical oncologists in great detail - outlining recent advancements and providing readers with the most up to date information.