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Prognostic influence of the treatment approach for pulmonary metastasis in patients with soft tissue sarcoma

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Abstract

Soft tissue sarcomas (STSs) are rare heterogeneous malignancies of mesenchymal origin. Pulmonary metastases develop in approximately 50% of the patients with high-grade STS, being the major cause of mortality in patients with metastatic STS. Pulmonary metastasectomy has been reported to contribute to long-term survival; however, an appropriate treatment has not been established. We aimed to identify factors associated with post-metastasis survival in STS patients with pulmonary metastasis and determine the appropriate treatment for each patient. We retrospectively reviewed the records of metastatic STS patients treated between 2000 and 2017 and analyzed the clinico-pathologic variables to identify factors associated with the survival. The median survival after pulmonary metastasis was 20.6 months, and the 1-, 3-, and 5-year survival rates were 68.6%, 36.0%, and 25.1%, respectively. The survival was significantly greater in patients who underwent pulmonary metastasectomy than in those without surgery (38.9 months vs. 10.5 months; p < 0.0001). Among those who did not undergo surgery, the survival was significantly greater in patients who received chemotherapy than in those without chemotherapy (19.1 months vs. 6.3 months, p = 0.037). Multivariate analysis identified pulmonary metastasectomy as the most important prognostic factor for post-metastasis survival (Hazard ratio 5.623; 95% Confidence Interval 2.733–11.572; p < 0.0001). In conclusion, pulmonary metastasectomy was the most important prognostic factor for post-metastasis survival in patients with metastatic STS. In addition, chemotherapy could prolong survival in patients who were not eligible for pulmonary resection. Although we should carefully weigh the risks and benefits, appropriate treatment for pulmonary metastases could contribute to long-time survival.

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Abbreviations

STS:

Soft tissue sarcoma;

UPS:

Undifferentiated pleomorphic sarcoma

MFH:

Malignant fibrous histiocytoma

VATS:

Video-assisted thoracic surgery

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Acknowledgements

We would like to thank Editage (https://www.editage.jp) for editing and reviewing this manuscript for English language

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan

    Teruya Kawamoto, Hitomi Hara, Naomasa Fukase, Yohei Kawakami, Toshiyuki Takemori, Shuichi Fujiwara, Kazumichi Kitayama, Shunsuke Yahiro, Tomohiro Miyamoto, Kenichiro Kakutani, Tomoyuki Matsumoto, Takehiko Matsushita, Takahiro Niikura, Ryosuke Kuroda & Toshihiro Akisue

  2. Division of Orthopaedic Surgery, Kobe University Hospital International Clinical Cancer Research Center, 1-5-1 Minatojimaminami-cho, Chuo-ku, Kobe, 650-0047, Japan

    Teruya Kawamoto

  3. Department of Orthopaedic Surgery, Hyogo Cancer Center, 13-70 Kitaoji-cho, Akashi, 673-8558, Japan

    Masayuki Morishita, Takuya Fujimoto & Ikuo Fujita

  4. Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, 7-10-2 Tomogaoka, Suma-ku, Kobe, 654-0142, Japan

    Toshihiro Akisue

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  1. Teruya Kawamoto
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Contributions

TK was responsible for the study conception and design, and drafted the manuscript. HH, MM, NF, YK, TT, SF, KaK, SY, TomohiroM, TF, and IF were responsible for acquisition of data. KeK, TomoyukiM, and TakehikoM were responsible for data analyses. TN, RK, and TA helped in correction of the manuscript. All authors contributed to and approved the final version of the manuscript.

Corresponding author

Correspondence to Teruya Kawamoto.

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There are no conflicts of interest to declare.

Ethical approval

Ethics approval for the retrospective data analyses was obtained from the Institutional Review Boards of the Kobe University Hospital and the Hyogo Cancer Center (IRB Number: B190212). Informed consent was obtained in the form of opt-out. Those who rejected were excluded.

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Kawamoto, T., Hara, H., Morishita, M. et al. Prognostic influence of the treatment approach for pulmonary metastasis in patients with soft tissue sarcoma. Clin Exp Metastasis 37, 509–517 (2020). https://doi.org/10.1007/s10585-020-10038-y

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