AATS 2016: Strategies for Increasing Survival In Soft-Tissue Sarcoma Patients With Lung Metastases Undergoing Resection
Up to 50% of patients with soft-tissue sarcoma develop lung metastases. Effective systemic therapies for metastatic soft-tissue sarcoma are currently limited; when possible, pulmonary metastasectomy is the preferred treatment. However, guidelines for the performance of pulmonary metastasectomy for soft-tissue sarcoma do not exist and decisions to operate are often made on an individual basis. In a presentation at the 96th American Association for Thoracic Surgery (AATS) Annual Meeting, researchers from Memorial Sloan Kettering Cancer Center (MSKCC) shared the results of their experience with more than 500 patients with pulmonary metastases from soft-tissue sarcoma and described prognostic factors associated with improved survival.
Approximately 12,000 new cases of soft-tissue sarcoma are diagnosed in the U.S. annually, resulting in nearly 5,000 deaths. Up to half of soft-tissue sarcoma patients develop one or more lung metastases. Without effective systemic therapies, doctors often rely on pulmonary metastasectomy, surgical removal of the pulmonary metastases, although current data for the practice specific to soft-tissue sarcoma are limited. In a presentation at the AATS Annual meeting, Neel P. Chudgar, MD, from the Department of Surgery at MSKCC, presented survival data and prognostic factors based on a large, single-institution database of soft-tissue sarcoma patients who have undergone pulmonary metastasectomy.
“The present study differs from previous publications in that we used a larger single-institution cohort, which increases the power to potentially identify significant differences, and we focused on soft-tissue sarcoma exclusively to enhance the homogeneity of the study population,” explained Dr. Chudgar. The database included 803 patients who underwent pulmonary metastasectomy for sarcoma between September 1991 and June 2014. After excluding patients who had primary bone sarcomas, underwent diagnostic resection, underwent pulmonary metastasectomy at another hospital, or did not undergo resection of their primary tumor, 539 patients who underwent 760 curative-intent pulmonary metastasectomies were studied.
Study Findings
The investigators found that the median overall survival after the first pulmonary metastasectomy was 33.2 months and the median disease-free survival was 6.8 months. Thirty-four percent of patients were alive after 5 years and 23% were alive after 7 years.
The researchers then analyzed the data to see if they could identify factors associated with prolonged survival. They found that leiomyosarcoma histologic subtype, primary tumor size ≤ 10 cm, increasing time from primary tumor resection to development of pulmonary metastases, and three or fewer initial lung metastases were all significantly associated with longer overall survival. Minimally invasive resections were also associated with longer overall survival (median, 44.3 months), compared with open surgery (median, 29.9 months). However, the authors attribute the reduced risk associated with minimally invasive surgery to patient selection, since 81% of these patients had only one or two pulmonary metastases.
“Our results indicate that the preoperative determination of disease characteristics can assist surgeons in selecting patients who may achieve longer survival with pulmonary metastasectomy,” commented senior author David R. Jones, MD, Professor and Chief of the Thoracic Surgery Service at MSKCC. “Until there is an improved understanding of the underlying biologic mechanisms of metastases and further identification of druggable targets, pulmonary metastasectomy remains the best available treatment for metastatic soft-tissue sarcoma.”
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