Comparison of local control and survival outcomes between surgical and non-surgical local therapy on pelvic Ewing’s sarcoma patients: a meta-analysis

BACKGROUND: The efficacy of surgical therapy to nonsurgical therapy is still a controversial topic in pelvic Ewing’s sarcoma (ES) management. We perform a systemic review and meta-analysis to compare the effect of local control (LC) and survival outcomes between surgical and nonsurgical local therapy on pelvic ES patients with systemic chemotherapy. METHODS: Published retrospective studies searched from PubMed, Embase, Cochrane and Web of Science databases that investigated the effects of surgical and nonsurgical local therapy on the LC and survival outcomes of patients with pelvic ES treated with chemotherapy were included in our study. Our primary outcome was the LC rate and progression-free survival (PFS) rate. The effect of confounders of extend of disease, surgical margin and chemotherapy respond on PFS was analyzed in subgroups. RESULTS: Ten studies with 782 pelvic ES patients were included in our analysis. Surgical patients showed higher LC and PFS rate comparing to nonsurgical patients [LC: risk ratio (RR) 0.72, 95% CI: 0.52–1.00, P=0.05, I(2)=0%; PFS: RR 0.72, 95% CI: 0.61–0.86, P=0.000, I(2)=15%]. Localized patients showed higher PFS with surgical therapy than nonsurgical patients (RR 0.67, 95% CI: 0.51–0.88, P=0.003).Patients with adequate resection and good chemotherapy respond improved PFS comparing to nonsurgical patients (adequate resection vs. nonsurgical: RR 0.59, 95% CI: 0.46–0.76, P<0.001, I(2)=0%; good respond vs. nonsurgical: RR 0.56, 95% CI: 0.41–0.77, P<0.001, I(2)=21%). But patients with inadequate resection and poor chemotherapeutic respond shows no statistical different PFS comparing to nonsurgical patients (inadequate resection vs. nonsurgical: RR 1.11, 95% CI: 0.87–1.41, P=0.41, I(2)=0%; poor respond vs. nonsurgical: RR 1.17, 95% CI: 0.90–1.52, P=0.25, I(2)=0%). CONCLUSIONS: Surgical therapy is primarily recommended in localized, resectable, good chemotherapeutic respond pelvic ES. Inadequate resection and poor chemotherapeutic respond are negative prognostic factors in surgical patients and their surviving are not improved comparing with nonsurgical patients. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020149224.