本文收集了局部治疗对幽门肉瘤（EWS）的标准护理的重要性的数据。尽管系统性治疗在随机临床试验中有所改善，但对于局部治疗方法却存在争议。我们分析了患有局限性EWS的患者的前瞻性数据，以了解局部治疗与事件无进展生存（EFS）、总生存（OS）和局部复发（LR）之间的关联。我们收集了2009年至2019年间117个中心登记的国际Ewing 2008研究的数据。在进行诱导化疗后，患者接受了手术、放射治疗或两者的组合治疗。我们进行了Cox回归分析、进行了倾向性评分加权敏感性分析，并进行了亚组分析。报告了危险比（HR）和95%的置信区间。我们纳入了863例患有局限性EWS的患者（仅手术组：331例，组合治疗组：358例，明确放射治疗组：174例）。与仅手术组相比，接受组合治疗的患者的EFS HR为0.84（0.57-1.24；p=0.38），OS HR为0.84（0.57-1.23；p=0.41），LR HR为0.58（0.26-1.31；p=0.19）。与仅手术组相比，接受明确放射治疗的患者任何事件的危险性增加，HR为1.53（1.02-2.31；p=0.04）。对于对化疗反应不佳的患者，组合治疗比明确手术更有益，EFS HR为0.49（0.27-0.89；p=0.02）。对于盆腔肿瘤的患者，组合治疗比仅手术在LR方面更有效，HR为0.12（0.02-0.72；p=0.02）。对于化疗反应不佳的患者，放射治疗与手术相结合更为有益。在整个研究组中，单独的放射治疗相对于仅手术会增加任何事件的风险。版权所有©2023 Elsevier Ltd.保留所有权利。

Local treatment is a crucial element in the standard of care for Ewing sarcoma (EWS). While systemic treatment is improved in randomised clinical trials, local treatment modalities are discussed controversially. We analysed the association between local therapy and event-free survival (EFS), overall survival (OS), and local recurrence (LR) in prospectively collected data of patients with localised EWS.We analysed data from the international Ewing 2008 study registered between 2009 and 2019 in 117 centres. After induction chemotherapy, patients received surgery, radiotherapy, or a combination thereof. We performed Cox regression, conducted propensity score-weighted sensitivity analysis, and performed subgroup analyses. Hazard ratios (HRs) and 95% confidence intervals are reported.We included 863 patients with localised EWS (surgery alone: 331, combination therapy: 358, definitive radiotherapy: 174). In patients treated with combination therapy compared to surgery alone, EFS HR was 0.84 (0.57-1.24; p = 0.38), OS HR was 0.84 (0.57-1.23; p = 0.41), and LR HR was 0.58 (0.26-1.31; p = 0.19). Hazards of any event were increased in patients treated with definitive radiotherapy compared to surgery only, HR 1.53 (1.02-2.31; p = 0.04). Patients with poor responses to chemotherapy benefitted from combination therapy over definitive surgery with an EFS HR 0.49 (0.27-0.89; p = 0.02). Patients with pelvic tumours benefitted from combination therapy over surgery only regarding LR, HR 0.12 (0.02-0.72; p = 0.02).Patients with poor responses to chemotherapy benefitted from radiotherapy added to surgery. In the whole group, radiotherapy alone as opposed to surgery alone increased the hazards of any event.Copyright © 2023 Elsevier Ltd. All rights reserved.