Survival Following Lung Metastasectomy in Soft Tissue Sarcomas.
BACKGROUND
The most common site of metastasis for soft tissue sarcomas (STSs) is the lung. In patients who are candidates for resection, metastasectomy improves survival. Debate remains, however, on approach and patient selection for surgery.


METHODS
We retrospectively analyzed demographics, tumor characteristics, peri- and postoperative factors for 53 patients who underwent lung metastasectomy for STS from 1989 to 2013. Disease-free intervals (DFIs) and survival were determined. Kaplan-Meier estimates and log-rank test were used for comparison and survival analyses.


RESULTS
Median overall survival (diagnosis to death or last visit) was 59.9 months (IQR: 118.5), with mean follow-up of 85.3 months (SD: 69.5). Post-lung metastasectomy survival was 82.9%, 52.2%, 28.3%, and 13.3% at 1, 3, 5, and 10 years, respectively. Age at diagnosis of less than 50 years (p = 0.037), a low pathologic grade (p = 0.040), and a DFI until metastasis of greater than 13.5 months (p = 0.007) were significant predictors of improved survival.


CONCLUSIONS
Patients diagnosed at a younger age with low-grade tumors and those with a longer DFI prior to metastasis diagnosis gain the greatest survival advantage with surgery.
School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States.
Katherine
K
Giuliano
Department of Surgery, Boston University, Boston, Massachusetts, United States.
Teviah
T
Sachs
Department of Pathology, Johns Hopkins University, Baltimore, Maryland, United States.
Elizabeth
E
Montgomery
Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, United States.
Angela
A
Guzzetta
Department of Surgery, Johns Hopkins University, Baltimore, Maryland, United States.
Malcolm
M
Brock
Department of Surgery, Johns Hopkins University, Baltimore, Maryland, United States.
Timothy M
TM
Pawlik
Department of Surgery, Johns Hopkins University, Baltimore, Maryland, United States.
Stephen C
SC
Yang
Department of Surgery, Johns Hopkins University, Baltimore, Maryland, United States.
Nita
N
Ahuja
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008297:Male; D059146:Metastasectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D008875:Middle Aged; D060787:Neoplasm Grading; D011013:Pneumonectomy / Q000009:adverse effects / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D012509:Sarcoma / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D012983:Soft Tissue Neoplasms / Q000401:mortality / Q000473:pathology*; D013906:Thoracoscopy / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult