Pulmonary metastasectomy with therapeutic intent for soft-tissue sarcoma.

Abstract

OBJECTIVE:

Soft-tissue sarcoma is a heterogeneous disease that frequently includes the development of pulmonary metastases. The purpose of this study is to determine factors associated with improved survival among patients with soft-tissue sarcoma to help guide selection for pulmonary metastasectomy.

METHODS:

We reviewed a prospectively maintained database and identified 803 patients who underwent pulmonary metastasectomy for metastatic soft-tissue sarcoma between September 1991 and June 2014; of these, 539 patients undergoing 760 therapeutic-intent pulmonary metastasectomies were included. Clinicopathologic variables and characteristics of treatment were examined. The outcomes of interest were overall survival and disease-free survival. Survival was estimated with the Kaplan-Meier method and compared between variables with the log-rank test. Factors associated with hazard of death and recurrence were identified via the use of univariable and multivariable Cox proportional hazards models.

RESULTS:

Median overall survival was 33.2 months (95% confidence interval, 29.9-37.1), and median disease-free survival was 6.8 months (95% confidence interval, 6.0-8.0). In multivariable analyses, leiomyosarcoma histologic subtype (P = .007), primary tumor size ≤10 cm (P = .006), increasing time from primary tumor resection to development of metastases (P < .001), solitary lung metastasis (P = .001), and minimally invasive resection (P = .023) were associated with lower hazard of death. Disease-free interval ≥1 year (P = .002), and 1 pulmonary metastasis (P < .001) were associated with lower hazard of disease recurrence.

CONCLUSIONS:

In a large single-institution study, primary tumor histologic subtype and size, numbers of pulmonary metastases, disease-free interval, and selection for minimally invasive resection are associated with increased survival in patients undergoing pulmonary metastasectomy for soft-tissue sarcoma.

• Authors: Neel P Chudgar, Murray F Brennan, Rodrigo R Munhoz, Peter R Bucciarelli, Kay See Tan, Sandra P D'Angelo, Manjit S Bains, Matthew Bott, James Huang, Bernard J Park, Valerie W Rusch, Prasad S Adusumilli, William D Tap, Samuel Singer, David R Jones
• Journal: The Journal of thoracic and cardiovascular surgery (J Thorac Cardiovasc Surg) Vol. 154 Issue 1 Pg. 319-330.e1 (07 2017) ISSN: 1097-685X [Electronic] United States
• PMID: 28395901 (Publication Type: Journal Article)
• Copyright: Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Child
• Female
• Humans
• Lung Neoplasms (mortality, secondary, surgery)
• Male
• Metastasectomy
• Middle Aged
• Retrospective Studies
• Sarcoma (mortality, secondary, surgery)
• Survival Rate
• Young Adult