Is repeat pulmonary metastasectomy indicated for soft tissue sarcoma? Journal Article

Authors: Chudgar, N. P.; Brennan, M. F.; Tan, K. S.; Munhoz, R. R.; D'Angelo, S. P.; Bains, M. S.; Huang, J.; Park, B. J.; Adusumilli, P. S.; Tap, W. D.; Jones, D. R.
Article Title: Is repeat pulmonary metastasectomy indicated for soft tissue sarcoma?
Abstract: Background Because recurrence is high after pulmonary metastasectomy (PM) for soft tissue sarcoma (STS), repeat PM is commonly performed. Our objective was to define the selection criteria for repeat PM among patients experiencing recurrence and to identify factors associated with survival. Methods We reviewed a prospectively maintained database of 539 patients undergoing PM for STS. Characteristics of the primary tumor, metastatic disease, treatment, and recurrence were examined. Multivariable Cox models were constructed to identify factors associated with the likelihood of operative selection after recurrence. Overall survival between patients with or without repeat PM was estimated using the Kaplan-Meier method, with prognostic factors identified using Cox models. Both analyses incorporated propensity score-matching weights. Factors associated with survival after repeat PM were assessed with multivariable Cox models among patients who underwent repeat PM. Results After initial PM, 63% of patients (n = 341) experienced pulmonary recurrence; 141 (41%) underwent repeat PM. Patients who were younger (p = 0.033) underwent minimally invasive resection at first PM (p = 0.041), had a longer disease-free interval after first PM (p = 0.009), were without extrapulmonary disease (p < 0.001), and had fewer nodules on recurrence (p < 0.001) were more likely to undergo repeat PM. Comparison between the repeat and non-repeat PM groups demonstrated an increased hazard of death among patients managed nonoperatively. Factors associated with an increased hazard of death after second PM included preoperative chemotherapy (p = 0.008) and R1/R2 metastasectomy (p < 0.001). Conclusions Although operative selection occurs, when prognostic factors are controlled for, repeat PM for STS remains independently associated with prolonged overall survival. © 2017 The Society of Thoracic Surgeons
Keywords: adult; cancer survival; controlled study; primary tumor; major clinical study; cancer recurrence; conference paper; outcome assessment; recurrence risk; prospective study; treatment indication; disease association; cause of death; lung metastasis; soft tissue sarcoma; recurrent disease; intermethod comparison; disease free interval; leiomyosarcoma; synovial sarcoma; lung surgery; personal experience; managed care; health hazard; wedge resection; metastasis resection; preoperative chemotherapy; pulmonary metastasectomy; cancer prognosis; human; male; female; priority journal
Journal Title: Annals of Thoracic Surgery
Volume: 104
Issue: 6
ISSN: 0003-4975
Publisher: Elsevier Science, Inc.  
Date Published: 2017-12-01
Start Page: 1837
End Page: 1845
Language: English
DOI: 10.1016/j.athoracsur.2017.07.024
PROVIDER: scopus
PMCID: PMC5696033
PUBMED: 29074153
Notes: Conference Paper -- Export Date: 4 December 2017 -- Source: Scopus
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MSK Authors
  1. Murray F Brennan
    742 Brennan
  2. James Huang
    118 Huang
  3. Bernard J Park
    151 Park
  4. Manjit S Bains
    219 Bains
  5. William Douglas Tap
    118 Tap
  6. David Randolph Jones
    150 Jones
  7. Rodrigo Ramella Munhoz
    15 Munhoz
  8. Kay See   Tan
    68 Tan