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. 2017 Dec;104(6):1837-1845.
doi: 10.1016/j.athoracsur.2017.07.024. Epub 2017 Nov 2.

Is Repeat Pulmonary Metastasectomy Indicated for Soft Tissue Sarcoma?

Neel P Chudgar  1 , Murray F Brennan  1 , Kay See Tan  2 , Rodrigo R Munhoz  3 , Sandra P D'Angelo  3 , Manjit S Bains  1 , James Huang  1 , Bernard J Park  1 , Prasad S Adusumilli  1 , William D Tap  3 , David R Jones  4
Affiliations

Is Repeat Pulmonary Metastasectomy Indicated for Soft Tissue Sarcoma?

Neel P Chudgar et al. Ann Thorac Surg. 2017 Dec.

Abstract

Background: Because recurrence is high after pulmonary metastasectomy (PM) for soft tissue sarcoma (STS), repeat PM is commonly performed. Our objective was to define the selection criteria for repeat PM among patients experiencing recurrence and to identify factors associated with survival.

Methods: We reviewed a prospectively maintained database of 539 patients undergoing PM for STS. Characteristics of the primary tumor, metastatic disease, treatment, and recurrence were examined. Multivariable Cox models were constructed to identify factors associated with the likelihood of operative selection after recurrence. Overall survival between patients with or without repeat PM was estimated using the Kaplan-Meier method, with prognostic factors identified using Cox models. Both analyses incorporated propensity score-matching weights. Factors associated with survival after repeat PM were assessed with multivariable Cox models among patients who underwent repeat PM.

Results: After initial PM, 63% of patients (n = 341) experienced pulmonary recurrence; 141 (41%) underwent repeat PM. Patients who were younger (p = 0.033) underwent minimally invasive resection at first PM (p = 0.041), had a longer disease-free interval after first PM (p = 0.009), were without extrapulmonary disease (p < 0.001), and had fewer nodules on recurrence (p < 0.001) were more likely to undergo repeat PM. Comparison between the repeat and non-repeat PM groups demonstrated an increased hazard of death among patients managed nonoperatively. Factors associated with an increased hazard of death after second PM included preoperative chemotherapy (p = 0.008) and R1/R2 metastasectomy (p < 0.001).

Conclusions: Although operative selection occurs, when prognostic factors are controlled for, repeat PM for STS remains independently associated with prolonged overall survival.

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Figures

Figure 1
Figure 1
Consort diagram for inclusion into analysis. PM, pulmonary metastasectomy.
Figure 2
Figure 2
Overall survival with recurrent metastatic pulmonary soft tissue sarcoma based on treatment following weight-based propensity matching. *P value calculated from Cox proportional hazards model incorporating matching weights, and repeat PM is considered a time-dependent variable. **Considering repeat PM as a time-dependent variable, the number at risk reflects the number of patients who have undergone repeat PM by the indicated time point. The number may increase as patients are selected for repeat PM during their follow-up.
Figure 3
Figure 3
Overall survival of patients undergoing repeat pulmonary metastasectomy from second resection.
See this image and copyright information in PMC

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