title: Improved survival after pulmonary metastasectomy for soft tissue sarcoma.
abstract: BACKGROUND
  Survival after pulmonary metastasectomy for soft tissue sarcoma (STS) has been lower than in osteosarcoma (14-40% versus 40-50%). With improved patient selection criteria and advanced chemotherapy agents, we hypothesized that survival after metastasectomy for STS has improved in recent years.
  
  
  METHODS
  Retrospective study of 48 patients undergoing pulmonary metastasectomy for STS between 1995 and 2007. Potential predictors of overall survival and disease-free survival (DFS) were examined using the log-rank test or Cox regression. Multivariate analysis was conducted using Cox regression.
  
  
  RESULTS
  Overall survival after initial metastasectomy was 67% and 52% at 3 and 5 years, respectively; DFS was 17% and 10% at 3 and 5 years. Univariate analysis indicated that ≤2 pulmonary metastases (p = 0.03), diameter of largest metastasis ≤2 cm (p = 0.09), and the absence of extrapulmonary metastases (p = 0.10) were associated with longer overall survival. Absence of extrapulmonary metastases (p = 0.07) and smaller size of the largest pulmonary metastasis (p = 0.06) were associated with longer DFS. Before 2001, 46.7% of patients received adjuvant chemotherapy versus 72.7% after (p = 0.10). Neither use of chemotherapy nor chemotherapy type was related to overall survival or DFS.
  
  
  CONCLUSIONS
  Five-year overall survival is substantially higher after pulmonary metastasectomy for STS in our study relative to previously published results (52% versus 14-40%). This improvement does not seem to be the result of greater use of, or newer, chemotherapeutic regimens. Among potential explanations, improved patient selection is the most likely factor.
authors.affiliation: Division of Thoracic Surgery, Joan Karnell Cancer Center, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
authors.forename: Jarrod D
authors.initials: JD
authors.lastname: Predina
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Puc
authors.forename: Meredith R
authors.initials: MR
authors.lastname: Bergey
authors.forename: Seema S
authors.initials: SS
authors.lastname: Sonnad
authors.forename: John C
authors.initials: JC
authors.lastname: Kucharczuk
authors.forename: Arthur
authors.initials: A
authors.lastname: Staddon
authors.forename: Larry R
authors.initials: LR
authors.lastname: Kaiser
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Shrager
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality* / Q000556:secondary / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality*; D011013:Pneumonectomy / Q000401:mortality*; D012189:Retrospective Studies; D012509:Sarcoma / Q000401:mortality* / Q000556:secondary / Q000601:surgery; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult