title: Resection of Primary and Secondary Tumors of the Sternum: An Analysis of Prognostic Variables.
abstract: BACKGROUND
  We sought to determine the prognostic variables associated with overall survival (OS) and recurrence-free probability (RFP) in patients with primary and secondary sternal tumors treated with surgical resection.
  
  
  METHODS
  A retrospective analysis of patients who underwent resection of primary or secondary sternal tumors at 2 cancer institutes between 1995 and 2013 was performed. OS and RFP were estimated using the Kaplan-Meier method, and predictors of OS and RFP were analyzed using the Cox proportional hazards model.
  
  
  RESULTS
  Sternal resection was performed in 78 patients with curative (67 [86%]) or palliative (6 [8%]) intent. Seventy-three patients (94%) had malignant tumors, of which 28 (36%) were primary and 45 (57%) were secondary malignancies. Sternal resections were complete in 13 patients (17%) and partial in 65 (83%). There were no perioperative deaths, and grade III/IV complications were noted in 17 patients (22%). The 5-year OS was 80% for patients with primary malignant tumors, 73% for patients with nonbreast secondary malignant tumors, and 58% for patients with breast tumors (p = 0.85). In the overall cohort, R0 resection was associated with prolonged 5-year OS (84% vs 20%) on univariate (p = 0.004) and multivariate (adjusted hazard ratio, 3.37; p = 0.029) analysis. On subgroup analysis, R0 resection was associated with improved OS and RFP only for patients with primary malignant tumors.
  
  
  CONCLUSIONS
  Sternal resection can achieve favorable OS for patients with primary and secondary sternal tumors. R0 resection is associated with improved 5-year OS and RFP in patients with primary malignant tumors. We did not detect a similar effect in patients with breast or nonbreast secondary tumors.
authors.affiliation: Thoracic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Usman
authors.initials: U
authors.lastname: Ahmad
authors.affiliation: Thoracic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Thoracic Surgery, Sun Yat-Sen University Cancer Center, Guangzhou City, Guangdong Province, China.
authors.forename: Haoxian
authors.initials: H
authors.lastname: Yang
authors.affiliation: Thoracic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Camelia
authors.initials: C
authors.lastname: Sima
authors.affiliation: Thoracic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Buitrago
authors.affiliation: Thoracic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: R Taylor
authors.initials: RT
authors.lastname: Ripley
authors.affiliation: Thoracic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Kei
authors.initials: K
authors.lastname: Suzuki
authors.affiliation: Thoracic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Manjit S
authors.initials: MS
authors.lastname: Bains
authors.affiliation: Thoracic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Nabil P
authors.initials: NP
authors.lastname: Rizk
authors.affiliation: Thoracic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Valerie W
authors.initials: VW
authors.lastname: Rusch
authors.affiliation: Thoracic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: James
authors.initials: J
authors.lastname: Huang
authors.affiliation: Thoracic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Prasad S
authors.initials: PS
authors.lastname: Adusumilli
authors.affiliation: Division of Thoracic Surgery, Istituto Nazionale dei Tumori, Istituto di Ricovero e Cura a Carattere Scientifico, Fondazione Pascale, Naples, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Rocco
authors.affiliation: Thoracic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York. Electronic address: jonesd2@mskcc.org.
authors.forename: David R
authors.initials: DR
authors.lastname: Jones
mesh_terms: D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000401:mortality* / Q000556:secondary / Q000601:surgery*; D001943:Breast Neoplasms / Q000556:secondary / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013249:Sternum; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult