Survival Outcome and Prognostic Factors after Pulmonary Metastasectomy in Sarcoma Patients: A 18-Year Experience at a Single High-volume Referral Center

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Abstract

Background: Metastatic sarcoma patients have a poor prognosis with 3-year survival rate of 25%. About 30% of them present isolated lung metastases. We aimed to analyze the clinical outcome of sarcoma patients undergoing pulmonary metastasectomy (PM) and prognostic factors associated with local control, disease-free, and overall survival (OS). Patients and Methods: All sarcoma patients undergoing PM at Humanitas Cancer Center were retrospectively reviewed. Analyzed variables included clinicopathologic, surgical, and survival data. Exclusion criterion comprised a follow-up period inferior to 1 year. A univariable and multivariable Cox regression analysis was performed (P<0.05). Results: In total, 154 patients underwent PM from 1997 to 2015. Total complication rate was 7.1%. The median follow-up was 24 months. The median OS was 35.4 months from initial metastasectomy. In univariable analysis, we identified as significant negative prognostic factors a disease-free interval of <18 months, male sex, grading G3, and bilateral metastases. Three histology risk groups were defined according to OS: high risk (myxofibrosarcoma, malignant peripheral nerve sheath tumor, and Ewing sarcoma), intermediate risk (leiomyosarcoma, liposarcoma, and undifferentiated pleomorphic sarcoma), and low risk (synovial and chondrosarcoma) with a 3-year OS of 21.4%, 45.7%, and 74.1%, respectively. In multivariable analysis, male sex (P=0.042), bilateral metastases (P=0.004), and histology (intermediate vs. low-risk group, P=0.021; high vs. low-risk group, P<0.001) were identified as independent predictors of survival. Conclusions: PM for sarcoma is a valid therapeutic option. High-risk histologies and bilaterality of lung metastases are independent negative prognostic factors. A prognostic score to improve patient selection is proposed.

Original languageEnglish
JournalAmerican Journal of Clinical Oncology: Cancer Clinical Trials
DOIs
Publication statusAccepted/In press - Jan 1 2018

Fingerprint

Metastasectomy
Sarcoma
Referral and Consultation
Lung
Survival
Neoplasm Metastasis
Histology
Liposarcoma
Chondrosarcoma
Ewing's Sarcoma
Leiomyosarcoma
Neurilemmoma
Patient Selection
Disease-Free Survival
Survival Rate
Regression Analysis

Keywords

  • bone sarcoma
  • lung metastasis
  • prognosis
  • pulmonary metastasectomy
  • soft tissue sarcoma

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

@article{8f1a20484a994f36a2da746fba417e1a,
title = "Survival Outcome and Prognostic Factors after Pulmonary Metastasectomy in Sarcoma Patients: A 18-Year Experience at a Single High-volume Referral Center",
abstract = "Background: Metastatic sarcoma patients have a poor prognosis with 3-year survival rate of 25{\%}. About 30{\%} of them present isolated lung metastases. We aimed to analyze the clinical outcome of sarcoma patients undergoing pulmonary metastasectomy (PM) and prognostic factors associated with local control, disease-free, and overall survival (OS). Patients and Methods: All sarcoma patients undergoing PM at Humanitas Cancer Center were retrospectively reviewed. Analyzed variables included clinicopathologic, surgical, and survival data. Exclusion criterion comprised a follow-up period inferior to 1 year. A univariable and multivariable Cox regression analysis was performed (P<0.05). Results: In total, 154 patients underwent PM from 1997 to 2015. Total complication rate was 7.1{\%}. The median follow-up was 24 months. The median OS was 35.4 months from initial metastasectomy. In univariable analysis, we identified as significant negative prognostic factors a disease-free interval of <18 months, male sex, grading G3, and bilateral metastases. Three histology risk groups were defined according to OS: high risk (myxofibrosarcoma, malignant peripheral nerve sheath tumor, and Ewing sarcoma), intermediate risk (leiomyosarcoma, liposarcoma, and undifferentiated pleomorphic sarcoma), and low risk (synovial and chondrosarcoma) with a 3-year OS of 21.4{\%}, 45.7{\%}, and 74.1{\%}, respectively. In multivariable analysis, male sex (P=0.042), bilateral metastases (P=0.004), and histology (intermediate vs. low-risk group, P=0.021; high vs. low-risk group, P<0.001) were identified as independent predictors of survival. Conclusions: PM for sarcoma is a valid therapeutic option. High-risk histologies and bilaterality of lung metastases are independent negative prognostic factors. A prognostic score to improve patient selection is proposed.",
keywords = "bone sarcoma, lung metastasis, prognosis, pulmonary metastasectomy, soft tissue sarcoma",
author = "Umberto Cariboni and {De Sanctis}, Rita and Marta Giaretta and Emanuele Voulaz and Emanuela Morenghi and Piergiuseppe Colombo and Pierluigi Novellis and Edoardo Bottoni and Valentina Errico and Alessandro Crepaldi and Andrea Marrari and Pierina Navarria and Ascolese, {Anna M.} and Alberto Testori and Marta Scorsetti and Vittorio Quagliuolo and Armando Santoro and Marco Alloisio",
year = "2018",
month = "1",
day = "1",
doi = "10.1097/COC.0000000000000476",
language = "English",
journal = "American Journal of Clinical Oncology",
issn = "0277-3732",
publisher = "Lippincott Williams and Wilkins",

}

TY - JOUR

T1 - Survival Outcome and Prognostic Factors after Pulmonary Metastasectomy in Sarcoma Patients

T2 - A 18-Year Experience at a Single High-volume Referral Center

AU - Cariboni, Umberto

AU - De Sanctis, Rita

AU - Giaretta, Marta

AU - Voulaz, Emanuele

AU - Morenghi, Emanuela

AU - Colombo, Piergiuseppe

AU - Novellis, Pierluigi

AU - Bottoni, Edoardo

AU - Errico, Valentina

AU - Crepaldi, Alessandro

AU - Marrari, Andrea

AU - Navarria, Pierina

AU - Ascolese, Anna M.

AU - Testori, Alberto

AU - Scorsetti, Marta

AU - Quagliuolo, Vittorio

AU - Santoro, Armando

AU - Alloisio, Marco

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Metastatic sarcoma patients have a poor prognosis with 3-year survival rate of 25%. About 30% of them present isolated lung metastases. We aimed to analyze the clinical outcome of sarcoma patients undergoing pulmonary metastasectomy (PM) and prognostic factors associated with local control, disease-free, and overall survival (OS). Patients and Methods: All sarcoma patients undergoing PM at Humanitas Cancer Center were retrospectively reviewed. Analyzed variables included clinicopathologic, surgical, and survival data. Exclusion criterion comprised a follow-up period inferior to 1 year. A univariable and multivariable Cox regression analysis was performed (P<0.05). Results: In total, 154 patients underwent PM from 1997 to 2015. Total complication rate was 7.1%. The median follow-up was 24 months. The median OS was 35.4 months from initial metastasectomy. In univariable analysis, we identified as significant negative prognostic factors a disease-free interval of <18 months, male sex, grading G3, and bilateral metastases. Three histology risk groups were defined according to OS: high risk (myxofibrosarcoma, malignant peripheral nerve sheath tumor, and Ewing sarcoma), intermediate risk (leiomyosarcoma, liposarcoma, and undifferentiated pleomorphic sarcoma), and low risk (synovial and chondrosarcoma) with a 3-year OS of 21.4%, 45.7%, and 74.1%, respectively. In multivariable analysis, male sex (P=0.042), bilateral metastases (P=0.004), and histology (intermediate vs. low-risk group, P=0.021; high vs. low-risk group, P<0.001) were identified as independent predictors of survival. Conclusions: PM for sarcoma is a valid therapeutic option. High-risk histologies and bilaterality of lung metastases are independent negative prognostic factors. A prognostic score to improve patient selection is proposed.

AB - Background: Metastatic sarcoma patients have a poor prognosis with 3-year survival rate of 25%. About 30% of them present isolated lung metastases. We aimed to analyze the clinical outcome of sarcoma patients undergoing pulmonary metastasectomy (PM) and prognostic factors associated with local control, disease-free, and overall survival (OS). Patients and Methods: All sarcoma patients undergoing PM at Humanitas Cancer Center were retrospectively reviewed. Analyzed variables included clinicopathologic, surgical, and survival data. Exclusion criterion comprised a follow-up period inferior to 1 year. A univariable and multivariable Cox regression analysis was performed (P<0.05). Results: In total, 154 patients underwent PM from 1997 to 2015. Total complication rate was 7.1%. The median follow-up was 24 months. The median OS was 35.4 months from initial metastasectomy. In univariable analysis, we identified as significant negative prognostic factors a disease-free interval of <18 months, male sex, grading G3, and bilateral metastases. Three histology risk groups were defined according to OS: high risk (myxofibrosarcoma, malignant peripheral nerve sheath tumor, and Ewing sarcoma), intermediate risk (leiomyosarcoma, liposarcoma, and undifferentiated pleomorphic sarcoma), and low risk (synovial and chondrosarcoma) with a 3-year OS of 21.4%, 45.7%, and 74.1%, respectively. In multivariable analysis, male sex (P=0.042), bilateral metastases (P=0.004), and histology (intermediate vs. low-risk group, P=0.021; high vs. low-risk group, P<0.001) were identified as independent predictors of survival. Conclusions: PM for sarcoma is a valid therapeutic option. High-risk histologies and bilaterality of lung metastases are independent negative prognostic factors. A prognostic score to improve patient selection is proposed.

KW - bone sarcoma

KW - lung metastasis

KW - prognosis

KW - pulmonary metastasectomy

KW - soft tissue sarcoma

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U2 - 10.1097/COC.0000000000000476

DO - 10.1097/COC.0000000000000476

M3 - Article

C2 - 30048248

AN - SCOPUS:85052717536

JO - American Journal of Clinical Oncology

JF - American Journal of Clinical Oncology

SN - 0277-3732

ER -