title: Pulmonary metastasectomy with therapeutic intent for soft-tissue sarcoma.
abstract: Soft-tissue sarcoma is a heterogeneous disease that frequently includes the development of pulmonary metastases. The purpose of this study is to determine factors associated with improved survival among patients with soft-tissue sarcoma to help guide selection for pulmonary metastasectomy.
  
  
  
  We reviewed a prospectively maintained database and identified 803 patients who underwent pulmonary metastasectomy for metastatic soft-tissue sarcoma between September 1991 and June 2014; of these, 539 patients undergoing 760 therapeutic-intent pulmonary metastasectomies were included. Clinicopathologic variables and characteristics of treatment were examined. The outcomes of interest were overall survival and disease-free survival. Survival was estimated with the Kaplan-Meier method and compared between variables with the log-rank test. Factors associated with hazard of death and recurrence were identified via the use of univariable and multivariable Cox proportional hazards models.
  
  
  
  Median overall survival was 33.2 months (95% confidence interval, 29.9-37.1), and median disease-free survival was 6.8 months (95% confidence interval, 6.0-8.0). In multivariable analyses, leiomyosarcoma histologic subtype (P = .007), primary tumor size ≤10 cm (P = .006), increasing time from primary tumor resection to development of metastases (P < .001), solitary lung metastasis (P = .001), and minimally invasive resection (P = .023) were associated with lower hazard of death. Disease-free interval ≥1 year (P = .002), and 1 pulmonary metastasis (P < .001) were associated with lower hazard of disease recurrence.
  
  
  
  In a large single-institution study, primary tumor histologic subtype and size, numbers of pulmonary metastases, disease-free interval, and selection for minimally invasive resection are associated with increased survival in patients undergoing pulmonary metastasectomy for soft-tissue sarcoma.
authors.affiliation: Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Neel P
authors.initials: NP
authors.lastname: Chudgar
authors.affiliation: Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Murray F
authors.initials: MF
authors.lastname: Brennan
authors.affiliation: Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Rodrigo R
authors.initials: RR
authors.lastname: Munhoz
authors.affiliation: Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Bucciarelli
authors.affiliation: Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Kay See
authors.initials: KS
authors.lastname: Tan
authors.affiliation: Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Sandra P
authors.initials: SP
authors.lastname: D'Angelo
authors.affiliation: Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Manjit S
authors.initials: MS
authors.lastname: Bains
authors.affiliation: Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Matthew
authors.initials: M
authors.lastname: Bott
authors.affiliation: Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: James
authors.initials: J
authors.lastname: Huang
authors.affiliation: Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: Park
authors.affiliation: Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Valerie W
authors.initials: VW
authors.lastname: Rusch
authors.affiliation: Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Prasad S
authors.initials: PS
authors.lastname: Adusumilli
authors.affiliation: Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: William D
authors.initials: WD
authors.lastname: Tap
authors.affiliation: Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Samuel
authors.initials: S
authors.lastname: Singer
authors.affiliation: Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY. Electronic address: jonesd2@mskcc.org.
authors.forename: David R
authors.initials: DR
authors.lastname: Jones
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008297:Male; D059146:Metastasectomy; D008875:Middle Aged; D012189:Retrospective Studies; D012509:Sarcoma / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D015996:Survival Rate; D055815:Young Adult
keywords: lung cancer surgery; metastases; metastatic soft-tissue sarcoma; pulmonary metastasectomy; soft-tissue sarcoma