Objective: To evaluate outcome and prognostic factors of patients with primary pulmonary sarcoma (PPS) who underwent curative-intent surgery within multimodality treatment.
Methods: An international, multicenter, retrospective study including patients with PPS was performed through a network of sarcoma experts. Data on demographics, staging, treatment, and outcomes were retrieved. Overall survival was calculated from the date of diagnosis. Prognostic factors were assessed using uni- and multivariate analysis.
Results: Eighteen centers from 9 countries contributed, for a total of 173 patients. One hundred fifteen patients (66%) underwent curative-intent surgery within multimodality treatment. There were 58 male patients (50%). Twenty-two patients (20%) had metastases, mainly to lung (n = 7, 30%) and pleura (n = 9, 39%). Thirty-three patients (30%) underwent preoperative chemotherapy. Extent of lung resection was sublobar (n = 11, 10%), lobar (n = 58, 54%), or bilobar/pneumonectomy (n = 39, 36%). Median tumor size was 85 mm. Sixty-nine patients had grade 3 tumors (71%). Resection was complete in 85 patients (75%). Lymphadenectomy was performed in 70 patients (63%), with nodal involvement in 10 (14%). Thirty-seven (37%) patients received adjuvant chemotherapy, and 27 (27%) patients received adjuvant radiotherapy. Overall survival was 49% and 31% at 5 and 10 years, respectively. Median follow-up was 33 months. Male gender (P = .003), age older than 60 years (P = .021), presence of metastasis (P = . 002), tumor size >40 mm (P = . 046), and incomplete resections (P = . 008) were independent prognostic factors for poor survival.
Conclusions: In patients with curative-intent multimodal treatment for PPS, an encouraging 5-year survival rate of 49% can be achieved in expert centers. Independent prognostic factors may aid in selecting patients for curative treatment.
Keywords: EURACAN; chemotherapy; outcome; primary pulmonary sarcoma; radiotherapy; soft-tissue sarcoma; surgery.
© 2025 The Author(s).