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A novel preoperative risk score to guide patient selection for resection of soft tissue sarcoma lung metastases: An analysis from the United States Sarcoma Collaborative. J Surg Oncol 2021 Dec;124(8):1477-1484

Date

08/11/2021

Pubmed ID

34374088

Pubmed Central ID

PMC8595861

DOI

10.1002/jso.26635

Scopus ID

2-s2.0-85112074442   3 Citations

Abstract

BACKGROUND: Surgical resection for sarcoma lung metastases has been associated with improved overall survival (OS).

METHODS: Patients who underwent curative-intent resection of sarcoma lung metastases (2000-2016) were identified from the US Sarcoma Collaborative. Patients with extrapulmonary metastatic disease or R2 resections of primary tumor or metastases were excluded. Primary endpoint was OS.

RESULTS: Three hundred and fifty-two patients met inclusion criteria. Location of primary tumor was truncal/extremity in 85% (n = 270) and retroperitoneal in 15% (n = 49). Forty-nine percent (n = 171) of patients had solitary and 51% (n = 180) had multiple lung metastasis. Median OS was 49 months; 5-year OS 42%. Age ≥55 (HR 1.77), retroperitoneal primary (HR 1.67), R1 resection of primary (HR 1.72), and multiple (≥2) lung metastases (HR 1.77) were associated with decreased OS(all p < 0.05). Assigning one point for each factor, we developed a risk score from 0 to 4. Patients were then divided into two risk groups: low (0-1 factor) and high (2-4 factors). The low-risk group (n = 159) had significantly better 5-year OS compared to the high-risk group (n = 108) (51% vs. 16%, p < 0.001).

CONCLUSION: We identified four characteristics that in aggregate portend a worse OS and created a novel prognostic risk score for patients with sarcoma lung metastases. Given that patients in the high-risk group have a projected OS of <20% at 5 years, this risk score, after external validation, will be an important tool to aid in preoperative counseling and consideration for multimodal therapy.

Author List

Lee RM, Ethun CG, Gamboa AC, Turgeon MK, Tran T, Poultsides G, Grignol V, Bedi M, Mogal H, Clarke CN, Tseng J, Roggin KK, Chouliaras K, Votanopoulos K, Krasnick BA, Fields RC, Oskouei SV, Monson DK, Reimer NB, Maithel SK, Pickens A, Cardona K

Authors

Manpreet Bedi MD, MS Associate Professor in the Radiation Oncology department at Medical College of Wisconsin
Callisia N. Clarke MD Associate Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Female
Follow-Up Studies
Humans
Lung Neoplasms
Male
Metastasectomy
Middle Aged
Patient Selection
Preoperative Care
Prognosis
Retrospective Studies
Risk Factors
Sarcoma
Survival Rate
United States