化疗和手术时间对上肢和下肢骨髓瘤死亡率的影响
Mark D Danese1, John S Groundland2,3,4
1Outcomes Insights, Inc, Calabasas, CA, USA.
Journal of the National Cancer Institute
|September 20, 2024
概括
与标准的新辅助化疗第一方法相比,对四肢骨髓瘤的前置手术可能会改善生存率. 这项研究建议在骨髓瘤治疗方案中重新考虑手术和化疗的时间.
科学领域:
- 整形瘤学 整形瘤学
- 手术瘤学手术瘤学
- 医学瘤学 医学瘤学
背景情况:
- 目前对四肢骨质肉瘤的标准护理包括新辅助和辅助化疗.
- 有限的高质量证据支持这一标准,一些试验表明,前期手术可能会产生更好的结果.
研究的目的:
- 为了估计前期手术后的化疗与标准的新辅助化疗,然后是手术治疗四肢骨髓瘤之间的整体生存差异.
主要方法:
- 利用了2007-2019年的监测,流行病学和最终结果 (SEER) 数据.
- 包括年龄在5-29岁的患有主要四肢骨髓瘤的患者,接受手术和化疗.
- 主要终点是手术第一组和新辅助剂第一组之间的5年生存差异.
主要成果:
- 经调整后的5年生存率为手术为先的74%,而新辅助为先的67% (差异:6.9%).
- 敏感性分析始终显示,手术前组的5年生存率更高 (6.8%-13.7%).
- 死亡风险因素包括年龄较大,瘤大小较大,救援切除和晚期 (III-IV).
结论:
- 缺乏证据支持在骨髓瘤治疗中使用新辅助化疗.
- 在外科期间暂停化疗可能会影响结果.
- 结果表明,需要重新审视前性随机试验,以确定骨髓瘤治疗中手术和化疗的最佳时间.
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