Pulmonary metastasectomy for sarcoma-survival and prognostic analysis.
Sarcoma
lung metastases
pulmonary metastasectomy (PM)
survival
Journal
Journal of thoracic disease
ISSN: 2072-1439
Titre abrégé: J Thorac Dis
Pays: China
ID NLM: 101533916
Informations de publication
Date de publication:
Aug 2019
Aug 2019
Historique:
entrez:
28
9
2019
pubmed:
29
9
2019
medline:
29
9
2019
Statut:
ppublish
Résumé
Pulmonary metastasectomy (PM) has commonly been performed in patients with controlled metastatic sarcoma. We reviewed our single-institution experience with pulmonary resections for sarcoma to analyse clinical outcome and to identify prognostic factors associated with patient survival. All sarcoma patients undergoing curative intent PM between 2008 and 2014 were retrospectively analysed. Factors related to primary tumour, metastases, applied therapy, systematic inflammation and preoperative nutritional condition, associated with survival after PM were evaluated using the univariable Cox proportional hazard model. Cut-off values of continuous variables were determined by a receiver operating characteristic (ROC) analysis. In total, 33 patients (19 male and 14 female, median age 55 years) underwent PM for metastatic sarcoma. There were no perioperative deaths; major complications occurred in 5 (15.2%) patients. The median interval between the treatment of primary tumour and PM was 16 months (range, 0-171 months). The median size of the largest pulmonary lesion was 1.3 cm. Mean follow-up was 37 months (range, 1-100 months) and the 5-year overall survival (OS) rate after first PM was 40.4%. Resection was complete (R0) in 31 (93.9%) patients. In univariable analysis, a shorter interoperative interval [<30 months, hazard ratio (HR) 5.05, 95% confidence interval (CI): 1.15-22.19] and grade 3 (G3) sarcoma (HR 3.52, 95% CI: 1.01-12.25) were significant negative prognosticators. Despite the lack of randomized controlled trials PM for sarcomatous disease is a reasonable therapeutic option with acceptable survival in a selected patient population. In sarcoma patients with a shorter interoperative interval and G3 tumour, shorter survival after PM can be expected.
Sections du résumé
BACKGROUND
BACKGROUND
Pulmonary metastasectomy (PM) has commonly been performed in patients with controlled metastatic sarcoma. We reviewed our single-institution experience with pulmonary resections for sarcoma to analyse clinical outcome and to identify prognostic factors associated with patient survival.
METHODS
METHODS
All sarcoma patients undergoing curative intent PM between 2008 and 2014 were retrospectively analysed. Factors related to primary tumour, metastases, applied therapy, systematic inflammation and preoperative nutritional condition, associated with survival after PM were evaluated using the univariable Cox proportional hazard model. Cut-off values of continuous variables were determined by a receiver operating characteristic (ROC) analysis.
RESULTS
RESULTS
In total, 33 patients (19 male and 14 female, median age 55 years) underwent PM for metastatic sarcoma. There were no perioperative deaths; major complications occurred in 5 (15.2%) patients. The median interval between the treatment of primary tumour and PM was 16 months (range, 0-171 months). The median size of the largest pulmonary lesion was 1.3 cm. Mean follow-up was 37 months (range, 1-100 months) and the 5-year overall survival (OS) rate after first PM was 40.4%. Resection was complete (R0) in 31 (93.9%) patients. In univariable analysis, a shorter interoperative interval [<30 months, hazard ratio (HR) 5.05, 95% confidence interval (CI): 1.15-22.19] and grade 3 (G3) sarcoma (HR 3.52, 95% CI: 1.01-12.25) were significant negative prognosticators.
CONCLUSIONS
CONCLUSIONS
Despite the lack of randomized controlled trials PM for sarcomatous disease is a reasonable therapeutic option with acceptable survival in a selected patient population. In sarcoma patients with a shorter interoperative interval and G3 tumour, shorter survival after PM can be expected.
Identifiants
pubmed: 31559040
doi: 10.21037/jtd.2019.08.10
pii: jtd-11-08-3369
pmc: PMC6753416
doi:
Types de publication
Journal Article
Langues
eng
Pagination
3369-3376Déclaration de conflit d'intérêts
Conflicts of Interest: The authors have no conflicts of interest to declare.
Références
J Am Coll Surg. 2000 Aug;191(2):184-90; discussion 190-1
pubmed: 10945362
Arch Surg. 2007 Jan;142(1):70-5; discission 76
pubmed: 17224503
Eur J Surg Oncol. 2009 Apr;35(4):356-61
pubmed: 18294807
Pediatr Blood Cancer. 2010 Feb;54(2):216-21
pubmed: 19890902
Clinics (Sao Paulo). 2010;65(9):871-6
pubmed: 21049215
Ann Thorac Surg. 2011 Nov;92(5):1780-6; discussion 1786-7
pubmed: 22051274
Interact Cardiovasc Thorac Surg. 2012 Oct;15(4):612-7
pubmed: 22761121
Eur J Cardiothorac Surg. 2013 Apr;43(4):795-9
pubmed: 22833540
BMJ Open. 2012 Oct 08;2(5):null
pubmed: 23048062
BMJ Open. 2013 May 28;3(5):null
pubmed: 23793698
Ann Surg Oncol. 2014 Mar;21(3):778-85
pubmed: 24306668
Pathology. 2014 Feb;46(2):95-104
pubmed: 24378391
J Thorac Cardiovasc Surg. 2014 Apr;147(4):1193-200; discussion 1200-1
pubmed: 24507991
J Thorac Cardiovasc Surg. 2015 Jan;149(1):85-92
pubmed: 25312228
Interact Cardiovasc Thorac Surg. 2015 Nov;21(5):616-23
pubmed: 26242317
Thorac Cardiovasc Surg. 2016 Mar;64(2):150-8
pubmed: 26339728
J Thorac Cardiovasc Surg. 2017 Jul;154(1):319-330.e1
pubmed: 28395901
Eur J Cardiothorac Surg. 2017 Jul 1;52(1):39-46
pubmed: 28402510
Ann Thorac Surg. 2017 Jul;104(1):296-302
pubmed: 28433217
J Thorac Dis. 2017 Oct;9(Suppl 12):S1305-S1315
pubmed: 29119019
Asian Cardiovasc Thorac Ann. 2018 May;26(4):296-301
pubmed: 29587522
Am J Clin Oncol. 2019 Jan;42(1):6-11
pubmed: 30048248
Ann Surg Oncol. 2019 Mar;26(3):869-875
pubmed: 30607764
J Cancer. 2019 Jun 2;10(12):2679-2686
pubmed: 31258776