European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology · 2024
Pulmonary metastasectomy for sarcoma: Insights from a referral-center cohort.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
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Charrier Thomas, Robin Edouard-Frédéric, De Pauw Vincent, Boudou-Rouquette Pascaline, Tlemsani Camille, Beinse Guillaume, De Percin Sixtine, Lupo Audrey, Canny Emelyne, Bobbio Antonio, Alifano Marco, Fournel Ludovic
Аннотация
INTRODUCTION: The low incidence and heterogeneity of sarcomas limit understanding of their progression in metastatic cases. The use of metastasectomy is debated due to lack of consensus and evidence-based data. This study aimed to identify simple prognostic factors that could contribute to the therapeutic strategy.
METHODS: We retrospectively reviewed all patients undergoing pulmonary metastasectomy from sarcoma in our referral center between 2011 and 2022. Demographic, radiologic, pathologic, and operative data were collected. Oncological follow-up, survival, and risk factor analyses were performed.
RESULTS: 192 patients were identified (mean age 49.3 years). Primary sarcoma arose from the trunk (24.6 %) or limbs (75.4 %), and metastases were metachronous in 85.4 % of cases. The median number of operated lesions was 2, and anatomic resection were performed in 24.1 %. The postoperative course was uneventful in 91.3 % of cases. Post-operative chemotherapy followed lung resection in 68.7 %. 1-, 3-, and 5-year Overall Survival (OS) were 89.6 %, 69.8 %, 57.6 %, respectively, with a plateau phase beyond 5 years. Higher grade or trunk location of the primary sarcoma, incomplete or anatomic pulmonary resection, and post-operative systemic treatment were significantly associated with shorter OS. No histological subtype significantly impacted OS. Location of the primary, resection type, and post-operative systemic treatment independently influenced OS. Non-anatomic and repeated pulmonary resections, were independently associated with "long surviving".
CONCLUSION: In metastatic sarcoma, pulmonary resections offer prolonged survival in selected patients, supporting its essential role in the whole therapeutic strategy. Anatomic and sequential metastasectomy should be cautiously discussed.
METHODS: We retrospectively reviewed all patients undergoing pulmonary metastasectomy from sarcoma in our referral center between 2011 and 2022. Demographic, radiologic, pathologic, and operative data were collected. Oncological follow-up, survival, and risk factor analyses were performed.
RESULTS: 192 patients were identified (mean age 49.3 years). Primary sarcoma arose from the trunk (24.6 %) or limbs (75.4 %), and metastases were metachronous in 85.4 % of cases. The median number of operated lesions was 2, and anatomic resection were performed in 24.1 %. The postoperative course was uneventful in 91.3 % of cases. Post-operative chemotherapy followed lung resection in 68.7 %. 1-, 3-, and 5-year Overall Survival (OS) were 89.6 %, 69.8 %, 57.6 %, respectively, with a plateau phase beyond 5 years. Higher grade or trunk location of the primary sarcoma, incomplete or anatomic pulmonary resection, and post-operative systemic treatment were significantly associated with shorter OS. No histological subtype significantly impacted OS. Location of the primary, resection type, and post-operative systemic treatment independently influenced OS. Non-anatomic and repeated pulmonary resections, were independently associated with "long surviving".
CONCLUSION: In metastatic sarcoma, pulmonary resections offer prolonged survival in selected patients, supporting its essential role in the whole therapeutic strategy. Anatomic and sequential metastasectomy should be cautiously discussed.