Fatores prognósticos no tratamento cirúrgico de pacientes com metástases pulmonares de sarcoma de partes moles

Metastases pulmonares isoladas de sarcomas de partes moles ocorrem em 20%-50% dos pacientes, e 70% destes pacientes apresentarao doenca limitada aos pulmoes. A resseccao cirurgica e bem aceita como tratamento padrao nas metastases de sarcomas de partes moles confinadas aos pulmoes, com muitos estudos relatando sobrevida em cinco anos de 305-40%, ssndo que o fator preditor de sobrevida e a resseccao completa. O objetivo deste estudo e determinar as variaveis clinicas e demograficas relacionadas ao tratamento e associadas com a sobrevida global a longo prazo (90 meses) nos pacientes submetidos a metastasectomia pulmonar de sarcomas de partes moles. Uma revisao retrospectiva foi realizada nos pacientes com metastases pulmonares que foram submetidos a toracotomia para resseccao das metastases, apos o tratamento do tumor primario. Os dados foram coletados de acordo com as caracteristicas do tumor primario, dados demograficos, tipo de tratamento e evolucao. Pacientes (n=77) com sarcomas de partes moles previamente tratados foram submetidos a um total of 122 toracotomias e 273 nodulos ressecados. O seguimento mediando de todos os pacientes foi de 36.7 meses (variacao: 10-138 meses). O indice de complicacoes pos-peratorias foi 9.1%, e a mortalidade em 30 dias de 0%. A sobrevida global em 90 meses para todos os pacientes foi de 34.7%. A analise multivariada identificou o numero de metastases, o intervalo livre de doenca, e resseccao completa, como fatores prognosticos independentes para a sobrevida global. Estes resultados confirmam que a metastasectomia pulmonar e um procedimento seguro e com potencial curativo para pacientes com tumors primarios tratados. Um grupo seleto de pacientes pode apresentar uma sobrevida a longo prazo interessante apos a resseccao pulmonar. Isolated pulmonary metastases from soft tissue sarcomas occur in 20%-50% of these patients, and 70% of these patients will have disease limited only to the lungs. Surgical resection is well accepted as a standard approach to treat metastases from soft tissue sarcomas isolated to the lungs, with many studies reporting overall 5-year survival ranging from 30% to 40%, and the most consistent predictor of survival in these patients is complete resection. The aim of this study is to determine demographics and clinical treatment-related variables associated with long-term (90-month) overall survival in patients with lung metastases undergoing pulmonary metastasectomy from soft tissue sarcomas. A retrospective review was performed of patients who were admitted with lung metastases and underwent thoracotomy for resection, after treatment of the primary tumor. Data were collected regarding primary tumor features, demographics, treatment, and outcome. Patients (n=77) with preview soft tissue sarcomas treated, were submitted to a total of 122 thoracotomies and 273 nodules resected. Median follow-up time of all patients was 36.7 months (range: 10-138 months). The postoperative complication rate was 9.1%, and the 30-day mortality rate was 0%. The 90-month overall survival rate for all patients was 34.7%. Multivariate analysis identified the number of metastases resected, disease-free interval, and complete resection as the independent prognostic factors for overall survival. These results confirm that lung metastasectomy is a safe and potentially curative procedure for patients with treated primary tumors. A select group of patients can achieve long-term survival after lung resection.