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. 2022 Jun 6:12:873323.
doi: 10.3389/fonc.2022.873323. eCollection 2022.

Impact of Limb Salvage on Prognosis of Patients Diagnosed With Extremity Bone and Soft Tissue Sarcomas

Kaixu Yu  1 , Ying Chen  2 , Kehan Song  1 , Fanxiu Xiong  3 , Yahao Tian  1 , Hanfeng Guan  1 , Feng Li  1
Affiliations

Impact of Limb Salvage on Prognosis of Patients Diagnosed With Extremity Bone and Soft Tissue Sarcomas

Kaixu Yu et al. Front Oncol. .

Abstract

Background: Although clinicians and patients with extremity bone and soft tissue (EBST) are increasingly interested in limb salvage surgery (LSS), because of the minimal damage to physical appearance and function, however, there is still a lack of large-scale population studies on whether LSS improves the prognosis of patients.

Purpose: The aim of this study was to compare the survival of patients with EBST sarcomas after receiving LSS and amputation.

Methods: To conduct the population-based study, we identified 6,717 patients with a histologically diagnosed bone sarcoma and 24,378 patients with a histologically diagnosed soft tissue sarcoma from the Surveillance, Epidemiology, and End Results database. We analyzed overall survival (OS), cancer-specific survival (CSS), and non-sarcoma survival (NSS) using the Kaplan-Meier method, log-rank test or Gray test, Cox regression model, propensity score-matched analysis, and landmark analysis.

Results: LSS could improve the prognosis in patients with most EBST subtypes, except for Ewing sarcomas and MPNST. However, in the subgroup without distant metastases, limb salvage increased CSS only for patients with osteosarcoma, Ewing sarcoma, and leiomyosarcoma, as well as NSS for patients with chondrosarcoma and synovial sarcoma. Landmark analysis further demonstrated that sarcoma survivors surviving <10 years could benefit from LSS but not for long-term survivors ≥10 years. Moreover, for patients with distant metastases, LSS could improve survival of osteosarcoma patients but worsen CSS among patients with MPNST. Landmark analysis further demonstrated that LSS improved survival among osteosarcomas patients with distant metastases only within 1 year after surgery. Moreover, patients receiving LSS and those receiving amputation had a high risk of dying from different non-sarcoma diseases during the postoperative follow-up.

Conclusions: The impact of limb salvage on the prognosis of patients depends on the pathological subtype and stage of EBST sarcomas.

Keywords: amputation; limb salvage; metastasis; sarcomas; survival.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart describing initial dataset and exclusions leading to final study cohorts.
Figure 2
Figure 2
Incidence of limb salvage and amputation with calendar year among all patients with EBST sarcomas.
Figure 3
Figure 3
As a whole, overall survival, cancer-specific survival, and non-sarcoma survival for patients receiving limb salvage or amputation after EBST sarcomas using the initial cohort and cohort after PSM, respectively. PSM, propensity score-matched patients; OS, overall survival; CSS, cancer-specific survival; NSS, non-sarcomas survival.
Figure 4
Figure 4
Based on Cox regression model, forest plots of the association between limb salvage after sarcomas and survival in different sarcoma subgroups. HR, hazard ratio; CI, confidence interval.
Figure 5
Figure 5
Subgroup analysis: Landmark analyses of overall survival, cancer-specific survival, and non-sarcoma survival for long-term survivors with localized and regional sarcomas in the cohort after PSM. PSM, propensity score-matched patients; OS, overall survival; CSS, cancer-specific survival; NSS, non-sarcoma survival.
Figure 6
Figure 6
Subgroup analysis: Landmark analyses of overall survival, cancer-specific survival, and non-sarcoma survival for long-term survivors with advanced sarcomas in the cohort after PSM. PSM, propensity score-matched patients; OS, overall survival; CSS, cancer-specific survival; NSS, non-sarcoma survival.
See this image and copyright information in PMC

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