This study follows the Target Trial Emulation (TTE) framework to assess the impact of unplanned resections (UEs) and planned resections (PEs) of sarcomas on local recurrence-free survival (LRFS), metastasis-free survival (MFS), cancer-specific survival (CSS), and overall survival (OS). Sarcomas, malignant tumors with mesenchymal differentiation, present a significant clinical challenge due to their rarity, complexity, and the frequent occurrence of UEs, which complicates effective management. Our analysis utilized real-world-time data from the Swiss Sarcoma Network, encompassing 429 patients, to compare the impact of UEs and PEs, adjusting for known prognostic factors through a multivariable Cox regression model and propensity score weighting. Our findings reveal a significantly higher risk of local recurrence for UEs and a short-term follow-up period that showed no marked differences in MFS, CSS, and OS between the UE and PE groups, underlining the importance of optimal initial surgical management. Furthermore, tumor grade was validated as a critical prognostic factor, influencing outcomes irrespective of surgical strategy. This study illuminates the need for improved referral systems to specialized sarcoma networks to prevent UEs and advocates for the integration of TTE in sarcoma research to enhance clinical guidelines and decision-making in sarcoma care. Future research should focus on the prospective validations of these findings and the exploration of integrated care models to reduce the incidence of UEs and improve patient outcomes.
本研究采用目标试验模拟框架，评估肉瘤非计划性切除与计划性切除对局部无复发生存期、无转移生存期、癌症特异性生存期及总生存期的影响。肉瘤作为具有间叶分化的恶性肿瘤，因其罕见性、复杂性及非计划性切除的高发率，对临床治疗构成显著挑战。我们利用瑞士肉瘤网络429例患者的真实世界数据，通过多变量Cox回归模型和倾向性评分加权法，在调整已知预后因素后对比两种手术方式的影响。研究发现非计划性切除显著增加局部复发风险，短期随访数据显示两组在无转移生存期、癌症特异性生存期及总生存期方面未见显著差异，这凸显了优化初始手术治疗的重要性。此外，研究证实肿瘤分级是关键预后因素，其影响独立于手术策略。本研究揭示了完善肉瘤专科转诊体系对预防非计划性切除的必要性，并倡导将目标试验模拟框架整合至肉瘤研究领域，以优化临床指南与诊疗决策。未来研究应聚焦于前瞻性验证这些发现，并探索综合诊疗模式以降低非计划性切除发生率，改善患者预后。
肿瘤(癌症)患者之家