title: An analysis of patient characteristics and clinical outcomes in primary pulmonary sarcoma.
abstract: BACKGROUND
  Literature concerning primary pulmonary sarcomas (PPS) is limited to small case series. This study examines, in a large cohort, the clinical characteristics and therapeutic strategies of PPS and their impact on overall survival (OS).
  
  
  METHODS
  This was a retrospective analysis from the Surveillance, Epidemiology, and End Results database (1988-2008). Eligible patients had primary PPS and underwent local therapy. Survival estimates were obtained using the Kaplan-Meier method and the Cox regression model. OS of PPS patients were compared with a cohort of 10,909 patients with extremity soft-tissue sarcomas.
  
  
  RESULTS
  The cohort included 365 PPS patients with a median follow-up of 21 months. Fifty-five percent of the patients had large tumors (>5 cm), 76% were high-grade, and 16% had node-positive disease. Seventy-five percent of the cohort underwent surgery alone, 14% underwent surgery and radiation therapy, and 11% underwent radiation therapy alone. Multivariate analysis showed reduced OS for patients with tumors more than 5 cm (hazard ratio [HR] 1.6, 95% confidence interval [CI] 1.25-2.19), high tumor grade (HR 3.1, 95% CI 1.26-3.62), and unresectable disease (HR 2.6, 95% CI 1.76-3.88. The 5-year OS for the cohort of pulmonary sarcomas versus sarcomas of the extremities was 35% versus 71% (p < 0.0001).
  
  
  CONCLUSIONS
  This large study examining PPS patients reveals a high rate of nodal involvement and a markedly worse OS than patients with extremity soft-tissue sarcomas. Thus, given the poor overall prognosis, it is recommended that PPS patients undergo a thorough mediastinal nodal evaluation to rule out locoregional metastasis and proceed with aggressive treatment.
authors.affiliation: Department of Radiation Oncology, University of Illinois at Chicago, Chicago, Illinois, USA.
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Spraker
authors.forename: Eric
authors.initials: E
authors.lastname: Bair
authors.forename: Ryan
authors.initials: R
authors.lastname: Bair
authors.forename: Philip P
authors.initials: PP
authors.lastname: Connell
authors.forename: Usama
authors.initials: U
authors.lastname: Mahmood
authors.forename: Matthew
authors.initials: M
authors.lastname: Koshy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D005121:Extremities / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D011379:Prognosis; D012189:Retrospective Studies; D018426:SEER Program; D012509:Sarcoma / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D015996:Survival Rate; D055815:Young Adult