Download PDF
Thorac Cardiovasc Surg 2019; 67(08): 675-682
DOI: 10.1055/s-0038-1670688
Original Thoracic
Georg Thieme Verlag KG Stuttgart · New York

Pulmonary Metastasectomy of Sarcoma: Is the Ratio of Surgical Margin to Nodule Size a Prognostic Factor?

Ali Özdil
1   Department of Thoracic Surgery, Ege University School of Medicine, Ege University, İzmir, Turkey
,
Ahmet Kayahan Tekneci
1   Department of Thoracic Surgery, Ege University School of Medicine, Ege University, İzmir, Turkey
,
Zafer Dökümcü
2   Department of Pediatric Surgery, Ege University School of Medicine, Ege University, İzmir, Turkey
,
Emre Divarcı
2   Department of Pediatric Surgery, Ege University School of Medicine, Ege University, İzmir, Turkey
,
Burçin Keçeci
3   Department of Orthopaedics and Traumatology, Ege University School of Medicine, Ege University, İzmir, Turkey
,
Murat Sezak
4   Department of Pathology, Ege University School of Medicine, Ege University, İzmir, Turkey
,
Alpaslan Çakan
1   Department of Thoracic Surgery, Ege University School of Medicine, Ege University, İzmir, Turkey
,
Ufuk Çağırıcı
1   Department of Thoracic Surgery, Ege University School of Medicine, Ege University, İzmir, Turkey
› Author Affiliations
Further Information

Publication History

10 July 2018

13 August 2018

Publication Date:
28 September 2018 (online)

   Permissions and Reprints All articles of this category

Abstract

Background Main prognostic factors of improved survival after pulmonary metastasectomy (PM) for osteogenic and soft tissue sarcomas are suggested as histological type, number and size of pulmonary nodules, and disease-free interval (DFI).

Methods Sixty-nine patients who underwent PM between January 1999 and December 2017 were evaluated retrospectively. Relations between parameters and prognostic risk factors for overall survival (OS) and disease-free survival (DFS) were evaluated.

Results Osteosarcoma was the most common histologic type (36.2%) and 21 of 25 cases were seen under the age 20 years (p < 0.001). Comparison of patient groups including osteosarcoma and nonosteosarcoma patients showed significant difference according to age (p < 0.001), nodule size (p = 0.033), ratio of surgical margin to nodule size (p = 0.007), and DFI (p = 0.039). Univariate analysis showed that the number of nodules (p = 0.008), ratio of surgical margin to nodule size (p = 0.001), and localization of nodule (p = 0.039) were significant factors associated with DFS. Also, nodule size (p = 0.042), number of nodules (p = 0.003), ratio of surgical margin to nodule size (p < 0.001), and laterality (p = 0.027) were significant prognostic factors associated with OS. Cut-off values of ratio of surgical margin to nodule size for DFS and OS were calculated as 0.94. Logistic regression analysis determined the ratio of surgical margin to nodule size as the common significant risk factor for DFS and OS.

Conclusions Our study showed that the ratio of surgical margin to nodule size ≥ 1 should be taken as a common risk factor for DFS and OS. Therefore, resection of nodules with the possible widest surgical margin is an important point of PM.

Keywords

pulmonary metastasectomy - sarcoma - survival - prognostic factor
 

  • References

  • 1 Blackmon SH, Shah N, Roth JA. , et al. Resection of pulmonary and extrapulmonary sarcomatous metastases is associated with long-term survival. Ann Thorac Surg 2009; 88 (03) 877-884 , discussion 884–885
    CrossrefPubMedGoogle Scholar
  • 2 Mizuno T, Taniguchi T, Ishikawa Y. , et al. Pulmonary metastasectomy for osteogenic and soft tissue sarcoma: who really benefits from surgical treatment?. Eur J Cardiothorac Surg 2013; 43 (04) 795-799
    CrossrefPubMedGoogle Scholar
  • 3 Kim S, Ott HC, Wright CD. , et al. Pulmonary resection of metastatic sarcoma: prognostic factors associated with improved outcomes. Ann Thorac Surg 2011; 92 (05) 1780-1786 , discussion 1786–1787
    CrossrefPubMedGoogle Scholar
  • 4 García Franco CE, Torre W, Tamura A. , et al. Long-term results after resection for bone sarcoma pulmonary metastases. Eur J Cardiothorac Surg 2010; 37 (05) 1205-1208
    CrossrefPubMedGoogle Scholar
  • 5 Pastorino U, Buyse M, Friedel G. , et al; International Registry of Lung Metastases. Long-term results of lung metastasectomy: prognostic analyses based on 5206 cases. J Thorac Cardiovasc Surg 1997; 113 (01) 37-49
    CrossrefPubMedGoogle Scholar
  • 6 Predina JD, Puc MM, Bergey MR. , et al. Improved survival after pulmonary metastasectomy for soft tissue sarcoma. J Thorac Oncol 2011; 6 (05) 913-919
    CrossrefPubMedGoogle Scholar
  • 7 Smith R, Pak Y, Kraybill W, Kane III JM. Factors associated with actual long-term survival following soft tissue sarcoma pulmonary metastasectomy. Eur J Surg Oncol 2009; 35 (04) 356-361
    CrossrefPubMedGoogle Scholar
  • 8 Grimer R, Judson I, Peake D, Seddon B. Guidelines for the management of soft tissue sarcomas. Sarcoma 2010; 2010: 506182
    PubMedGoogle Scholar
  • 9 ESMO / European Sarcoma Network Working Group. Soft tissue and visceral sarcomas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2012; 23 (Suppl. 07) vii92-vii99
    CrossrefPubMedGoogle Scholar
  • 10 Kang S, Kim HS, Kim S, Kim W, Han I. Post-metastasis survival in extremity soft tissue sarcoma: a recursive partitioning analysis of prognostic factors. Eur J Cancer 2014; 50 (09) 1649-1656
    CrossrefPubMedGoogle Scholar
  • 11 Casson AG, Putnam JB, Natarajan G. , et al. Five-year survival after pulmonary metastasectomy for adult soft tissue sarcoma. Cancer 1992; 69 (03) 662-668
    CrossrefPubMedGoogle Scholar
  • 12 Dossett LA, Toloza EM, Fontaine J. , et al. Outcomes and clinical predictors of improved survival in a patients undergoing pulmonary metastasectomy for sarcoma. J Surg Oncol 2015; 112 (01) 103-106
    CrossrefPubMedGoogle Scholar
  • 13 Chudgar NP, Brennan MF, Munhoz RR. , et al. Pulmonary metastasectomy with therapeutic intent for soft-tissue sarcoma. J Thorac Cardiovasc Surg 2017; 154 (01) 319-330.e1
    CrossrefPubMedGoogle Scholar
  • 14 Okiror L, Peleki A, Moffat D. , et al. Survival following pulmonary metastasectomy for sarcoma. Thorac Cardiovasc Surg 2016; 64 (02) 146-149
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Pfannschmidt J, Klode J, Muley T, Dienemann H, Hoffmann H. Pulmonary metastasectomy in patients with soft tissue sarcomas: experiences in 50 patients. Thorac Cardiovasc Surg 2006; 54 (07) 489-492
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Allen MS, Putnam JB. Secondary tumors of the lung. In: Shields TW, LoCicero III J, Reed CE, Feins RH. , eds. General Thoracic Surgery. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2009: 1619-1646
    Google Scholar
  • 17 Seebacher G, Decker S, Fischer JR, Held M, Schäfers HJ, Graeter TP. Unexpected lymph node disease in resections for pulmonary metastases. Ann Thorac Surg 2015; 99 (01) 231-236
    CrossrefPubMedGoogle Scholar
  • 18 Internullo E, Cassivi SD, Van Raemdonck D, Friedel G, Treasure T. ; ESTS Pulmonary Metastasectomy Working Group. Pulmonary metastasectomy: a survey of current practice amongst members of the European Society of Thoracic Surgeons. J Thorac Oncol 2008; 3 (11) 1257-1266
    CrossrefPubMedGoogle Scholar
  • 19 Gossot D, Radu C, Girard P. , et al. Resection of pulmonary metastases from sarcoma: can some patients benefit from a less invasive approach?. Ann Thorac Surg 2009; 87 (01) 238-243
    CrossrefPubMedGoogle Scholar
  • 20 Nakajima J, Murakawa T, Fukami T, Takamoto S. Is thoracoscopic surgery justified to treat pulmonary metastasis from colorectal cancer?. Interact Cardiovasc Thorac Surg 2008; 7 (02) 212-216 , discussion 216–217
    PubMedGoogle Scholar