Pulmonary metastases from soft tissue sarcoma - Analysis of patterns of disease and postmetastasis survival

Objective To report the patterns of disease and postmetastasis survival for patients with pulmonary metastases from soft tissue sarcoma in a large gro up of patients treated at a single institution. Clinical factors that influ ence postmetastasis survival are analyzed. Summary Background Data For patients with soft tissue sarcoma, the lungs ar e the most common site of metastatic disease. Although pulmonary me tastase s most commonly arise from primary tumors in the extremities, they may aris e from almost any primary site or histology. To date, resection of disease has been the only effective therapy for metastatic sarcoma. Methods From July 1982 to February 1997, 3149 adult patients with soft tiss ue sarcoma were admitted and treated at Memorial Sloan-Kettering Cancer Cen ter. During this interval, 719 patients either developed or presented with lung metastases. Patients were treated with resection bf metastatic disease whenever possible. Disease-specific survival was the endpoint of the study . Time to death was modeled using the method of Kaplan and Meier. The assoc iation of factors to time-to-event endpoints was analyzed using the log-ran k test for univariate analysis and the Cox proportional hazards model for m ultivariate analysis. Results The overall median survival from diagnosis of pulmonary metastasis for all patients was 15 months. The 3-year actuarial survival rate was 25%. The ability to resect all metastatic disease completely was the most impor tant prognostic factor for survival. Patients treated with complete resecti on had a median survival of 33 months and-a 3-year actuarial survival rate of 46%. For patients treated with nonoperative therapy, the median survival was 11 months, A disease-free interval of more than 12 months before the d evelopment of metastases was also a favorable prognostic factor. Unfavorabl e factors included the histologic variants of liposarcoma and malignant per ipheral nerve tumors and patient age older than 50 years at the time of tre atment of metastasis, Conclusions Resection of metastatic disease is the single most important fa ctor that determines outcome in these patients. Long-term survival is possi ble in selected patients, particularly when recurrent pulmonary disease is resected. Surgical excision should remain the treatment of choice for metas tases of soft tissue sarcoma to the lung.