title: Risk stratification of patients undergoing pulmonary metastasectomy for soft tissue and bone sarcomas.
abstract: OBJECTIVE
  Our objective was to identify risk factors associated with survival in patients who underwent pulmonary metastasectomy for soft tissue or bone sarcoma and to create a risk stratification model.
  
  
  METHODS
  A retrospective review of the prospectively maintained University of California Los Angeles Sarcoma Database was performed. Clinical, pathologic, and treatment variables were analyzed for overall survival and disease-free survival. Univariate and multivariate analyses were performed, and variables that were identified as significant were included to create a risk model. A total of 155 patients who underwent pulmonary metastasectomy for soft tissue sarcoma (n = 108 patients) or bone sarcoma (n = 47 patients) from 1994 to 2010 were identified.
  
  
  RESULTS
  Multivariate analysis identified 7 factors associated with poor overall survival: age more than 45 years, disease-free interval less than 1 year, thoracotomy, synchronous disease, location and type of sarcoma (soft tissue vs bone sarcoma), and performance of a lobectomy. The number of factors present was associated with poor overall survival, which varied widely from 64% in patients with 2 factors to 3% in those with 5 factors.
  
  
  CONCLUSIONS
  We have identified prognostic variables associated with overall survival after lung metastasectomy. Our model may be used as a risk stratification model to guide treatment decisions on the basis of the number of risk factors present. Although prospective studies are warranted to determine the benefit of surgical intervention in all cohorts compared with other local therapies or medical therapy, given the attendant dismal prognosis in patients with 5 or more risk factors, the benefit of surgical resection in this group is questioned.
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, Calif.
authors.forename: Anthony Y
authors.initials: AY
authors.lastname: Lin
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, Calif; Division of Thoracic Surgery, Department of Surgery, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, Calif.
authors.forename: Svetlana
authors.initials: S
authors.lastname: Kotova
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, Calif.
authors.forename: Jane
authors.initials: J
authors.lastname: Yanagawa
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, Calif.
authors.forename: Osama
authors.initials: O
authors.lastname: Elbuluk
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, Calif.
authors.forename: Gerald
authors.initials: G
authors.lastname: Wang
authors.affiliation: Departments of Biostatistics and Medicine, David Geffen School of Medicine at UCLA, Los Angeles, Calif.
authors.forename: Nivedita
authors.initials: N
authors.lastname: Kar
authors.affiliation: Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, Calif.
authors.forename: David
authors.initials: D
authors.lastname: Elashoff
authors.affiliation: Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, Calif.
authors.forename: Tristan
authors.initials: T
authors.lastname: Grogan
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, Calif; Division of Thoracic Surgery, Department of Surgery, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, Calif.
authors.forename: Robert B
authors.initials: RB
authors.lastname: Cameron
authors.affiliation: Division of Hematology and Medical Oncology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, Calif.
authors.forename: Arun
authors.initials: A
authors.lastname: Singh
authors.affiliation: Division of Hematology and Medical Oncology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, Calif.
authors.forename: Bartosz
authors.initials: B
authors.lastname: Chmielowski
authors.affiliation: Division of Pediatric Hematology and Medical Oncology, Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, Calif.
authors.forename: Noah
authors.initials: N
authors.lastname: Federman
authors.affiliation: Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, Calif.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Nelson
authors.affiliation: Department of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, Calif.
authors.forename: Percy
authors.initials: P
authors.lastname: Lee
authors.affiliation: Division of Surgical Oncology, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, Calif.
authors.forename: Fritz C
authors.initials: FC
authors.lastname: Eilber
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, Calif. Electronic address: jaymoonlee@mednet.ucla.edu.
authors.forename: Jay M
authors.initials: JM
authors.lastname: Lee
mesh_terms: D000328:Adult; D001859:Bone Neoplasms / Q000401:mortality / Q000473:pathology*; D016208:Databases, Factual; D003661:Decision Support Techniques; D006801:Humans; D053208:Kaplan-Meier Estimate; D015141:Los Angeles; D008175:Lung Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D059146:Metastasectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D008875:Middle Aged; D015999:Multivariate Analysis; D012516:Osteosarcoma / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D018579:Patient Selection; D011013:Pneumonectomy / Q000009:adverse effects / Q000401:mortality; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012983:Soft Tissue Neoplasms / Q000401:mortality / Q000473:pathology*; D013997:Time Factors; D016896:Treatment Outcome