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. 2017 Jul;154(1):319-330.e1.
doi: 10.1016/j.jtcvs.2017.02.061. Epub 2017 Mar 21.

Pulmonary metastasectomy with therapeutic intent for soft-tissue sarcoma

Neel P Chudgar  1 , Murray F Brennan  1 , Rodrigo R Munhoz  2 , Peter R Bucciarelli  1 , Kay See Tan  3 , Sandra P D'Angelo  2 , Manjit S Bains  1 , Matthew Bott  1 , James Huang  1 , Bernard J Park  1 , Valerie W Rusch  1 , Prasad S Adusumilli  1 , William D Tap  2 , Samuel Singer  1 , David R Jones  4
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Pulmonary metastasectomy with therapeutic intent for soft-tissue sarcoma

Neel P Chudgar et al. J Thorac Cardiovasc Surg. 2017 Jul.

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.

Keywords: lung cancer surgery; metastases; metastatic soft-tissue sarcoma; pulmonary metastasectomy; soft-tissue sarcoma.

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Conflict of interest statement

Conflict of interest statement: All authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Database Progression to Final Cohort of Patients Included for Analysis.
Figure 2
Figure 2. Minimally Invasive Surgery Utilization (1991–2014)
MIS, minimally invasive surgery.
Figure 3
Figure 3
Overall and Disease-Free Survival from First Pulmonary Metastasectomy.
See this image and copyright information in PMC

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