Survival after pulmonary metastasectomy in soft tissue sarcoma - Prognostic factors in 214 patients

This retrospective study examines prognostic factors for post-metastasectomy survival in soft tissue sarcoma patients. Between 1976 and 1992, 274 consecutive patients (median age 49 [7-96] years) with pulmonary metastatic soft tissue sarcoma of the extremity or trunk wall (31 at presentation) were managed at the Mayo Clinic. 214 underwent pulmonary metastasectomy and 163 of these also received adjuvant chemotherapy. There were 195 local excisions, 14 lobectomies, and 5 pneumonectomies. 90 patients had solitary metastases, 184 patients had 2 or more metastases. 31% of patients had MFH tumors and 88% of all tumors were high grade. Median follow-up for survivors was 8 (2-21) years. 5-year overall survival after metastasectomy was approximate to 40% (cf. 20% for non-metastasectomy). Age > 50, MFH tumors, greater than or equal to 2 metastases, metastasis size > 2 cm, metastasis-free period less than or equal to 18 months, and the use of adjuvant chemotherapy were univariately unfavorable factors. Size of metastasis > 2 cm, number of metastases greater than or equal to 2, and metastasis-free interval less than or equal to 18 months were independently unfavorable for survival. In a prognostic system, patients with 0 risk factors had a 60% 5-year survival, those with 1, 2, or 3 of these factors had 30%, 20% and 0% survival, respectively.