Abstract
BackgroundMetastasectomy is performed on a select cohort of patients with advanced and/or recurrent bone and soft tissue sarcomas because of the potential for long term relapse free and overall survival associated with the procedure. However, the evidence supporting metastasectomy is difficult to summarize without a systematic examination of existing literature. The objective of this systematic review will be to examine survival among both adults and children with advanced and recurrent bone and STS who undergo metastasectomy.MethodsWe designed and registered a study protocol for a systematic review and meta-analysis. We will include data from survival studies (e.g., randomized trials, cohort studies, routine case registries, and case control) conducted in children and adults with advanced and recurrent bone and soft tissue sarcoma who undergo metastasectomy. The primary outcome will be overall survival. Secondary outcomes will be 30-day post-operative mortality, recurrence-free survival, time off systemic therapy, and patient-reported outcomes including quality of life end points where available. Literature searches will be performed in multiple electronic databases including Ovid MEDLINE ® (1946 to present), Ovid EMBASE (1974 to present), Web of Science, and Cochrane Library. Grey literature will be identified through searching references, conference abstracts, Papers First, and Google Scholar. Two investigators will independently screen all citations, full-text articles, and abstract data. Full-text articles selected for analysis will be assessed for quality and risk of bias. If feasible, we will conduct a random effects meta-analysis. Estimates will be stratified according to histology comparing survival based on organ of metastasectomy. Additional analysis will be conducted to explore the potential sources of heterogeneity according to various patient, disease, and treatment characteristics (e.g., metastasis status, age, disease burden, and concomitant interventions).DiscussionThis systematic review and meta-analysis will identify, evaluate, and integrate data on survival of metastasectomy of bone and soft tissue sarcoma by organ of metastasis. Our findings may have implications for clinicians, patients, and their families when considering selection for resection of oligometastatic disease in de novo, or recurrent bone and soft tissue sarcoma. Implications for future research will be identified to improve the outcomes of these complex patients.Systematic review registrationPROSPERO CRD42019126906
Highlights
Metastasectomy is performed on a select cohort of patients with advanced and/or recurrent bone and soft tissue sarcomas because of the potential for long term relapse free and overall survival associated with the procedure
Soft tissue sarcomas are distinct from osteosarcomas, with a wide variety of histologies further differing in biologic behavior within soft tissue sarcomas
– Outcomes: Journal articles reporting on the survival outcome of the above-described patients, including reports of either median overall survival or survival follow-up of at least 1 year, whichever is the longer period to ensure an adequate amount of time has passed from time of metastasectomy
Summary
Protocol and registration This present protocol has been registered within the international prospective register of systematic reviews (PROSPERO) database (registration ID: CRD42019126906). Journal information (name of journal, year of publication, authors, study design, country of origin), baseline patient characteristics (median age at diagnosis, median age at metastasectomy, gender, size of intervention, and control populations where applicable), disease characteristics (histology, site of primary sarcoma, stage and grade of disease at initial diagnosis, sites of metastasis, and disease-free interval), treatment characteristics (receipt of chemotherapy and/or radiation therapy for primary or metastatic disease, resection of primary disease, organ of metastasectomy, type of resection, number of metastasis resected, size of largest metastasis, operative approach, completeness of resection, additional metastasectomies, and other organ directed treatment(s) for recurrent disease), and outcome(s) post metastasectomy. – Year of publication (older vs newer): the initial search is inclusive of all articles regardless of timing of publication, we plan on conducting stratified analysis on articles published from 1980 onwards to reflect survival in the more modern era of sarcoma therapies This period was chosen to capture all relevant articles relating to the treatment of metastasis in bone and soft tissue sarcoma. We would like to compare outcomes based on if patients received additional systemic or local therapies to surgery at the time of metastasectomy
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