Factors associated with actual long-term survival following soft tissue sarcoma pulmonary metastasectomy

Eur J Surg Oncol. 2009 Apr;35(4):356-61. doi: 10.1016/j.ejso.2008.01.004. Epub 2008 Feb 21.


Aims: To identify clinicopathologic and treatment variables associated with long-term overall survival (OS) in soft tissue sarcoma (STS) patients with lung metastases undergoing pulmonary metastasectomy (PM).

Methods: Retrospective review of 94 STS PM patients with an actual follow-up > or = 5 years. Data were collected on demographics, tumor features, treatment, and outcome.

Results: Most primary tumors were intermediate/high grade and the common histopathologies were evenly distributed. Half of the primary tumors were located on the extremities. The mean disease-free interval (DFI) from time of original diagnosis until metastases was 25 months (median 15 months). Eighteen patients had synchronous metastatic disease. Bilateral pulmonary metastases and >1 metastasis were common. The median number of metastases resected was 2.5. Thirty-four patients had extrapulmonary tumor at the time of PM; all extrapulmonary disease was resected. Negative margin resection (R0) PM was performed in 74 patients. Actual 5-year disease-free survival (DFS) and OS for all patients were 5% and 15%, respectively. For the R0 group, actual 5-year DFS and OS were 7% and 18%, respectively. R0 resection and a prolonged DFI were associated with improved OS. Patient characteristics, tumor features, local recurrence, and adjuvant therapy did not affect OS.

Conclusions: Less than 20% of STS PM patients will survive 5 years. Complete resection and DFI are the most predictive factors for prolonged survival.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Child
  • Disease-Free Survival
  • Extremities / surgery
  • Female
  • Humans
  • Lung Neoplasms / secondary*
  • Lung Neoplasms / surgery
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Neoplasm Recurrence, Local / surgery
  • Radiotherapy, Adjuvant
  • Retroperitoneal Neoplasms / mortality*
  • Retroperitoneal Neoplasms / radiotherapy
  • Retroperitoneal Neoplasms / surgery
  • Retrospective Studies
  • Sarcoma / mortality*
  • Sarcoma / radiotherapy
  • Sarcoma / secondary*
  • Sarcoma / surgery
  • Survival Rate
  • Treatment Outcome
  • Uterine Neoplasms / mortality*
  • Uterine Neoplasms / radiotherapy
  • Uterine Neoplasms / surgery
  • Young Adult