Improved Survival after Pulmonary Metastasectomy for Soft Tissue Sarcoma

Introduction Survival after pulmonary metastasectomy for soft tissue sarcoma (STS) has been lower than in osteosarcoma (14–40% versus 40–50%). With improved patient selection criteria and advanced chemotherapy agents, we hypothesized that survival after metastasectomy for STS has improved in recent years. Methods Retrospective study of 48 patients undergoing pulmonary metastasectomy for STS between 1995 and 2007. Potential predictors of overall survival and disease-free survival (DFS) were examined using the log-rank test or Cox regression. Multivariate analysis was conducted using Cox regression. Results Overall survival after initial metastasectomy was 67% and 52% at 3 and 5 years, respectively; DFS was 17% and 10% at 3 and 5 years. Univariate analysis indicated that ≤2 pulmonary metastases ( p = 0.03), diameter of largest metastasis ≤2 cm ( p = 0.09), and the absence of extrapulmonary metastases ( p = 0.10) were associated with longer overall survival. Absence of extrapulmonary metastases ( p = 0.07) and smaller size of the largest pulmonary metastasis ( p = 0.06) were associated with longer DFS. Before 2001, 46.7% of patients received adjuvant chemotherapy versus 72.7% after ( p = 0.10). Neither use of chemotherapy nor chemotherapy type was related to overall survival or DFS. Conclusion Five-year overall survival is substantially higher after pulmonary metastasectomy for STS in our study relative to previously published results (52% versus 14–40%). This improvement does not seem to be the result of greater use of, or newer, chemotherapeutic regimens. Among potential explanations, improved patient selection is the most likely factor.