Anthony Y Lin1, Svetlana Kotova2, Jane Yanagawa1, Osama Elbuluk1, Gerald Wang3, Nivedita Kar4, David Elashoff5, Tristan Grogan5, Robert B Cameron2, Arun Singh6, Bartosz Chmielowski6, Noah Federman7, Scott D Nelson8, Percy Lee9, Fritz C Eilber10, Jay M Lee11. 1. Division of Thoracic Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, Calif. 2. Division of Thoracic Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, Calif; Division of Thoracic Surgery, Department of Surgery, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, Calif. 3. Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, Calif. 4. Departments of Biostatistics and Medicine, David Geffen School of Medicine at UCLA, Los Angeles, Calif. 5. Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, Calif. 6. Division of Hematology and Medical Oncology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, Calif. 7. Division of Pediatric Hematology and Medical Oncology, Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, Calif. 8. Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, Calif. 9. Department of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, Calif. 10. Division of Surgical Oncology, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, Calif. 11. Division of Thoracic Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, Calif. Electronic address: jaymoonlee@mednet.ucla.edu.
Abstract
OBJECTIVES: Our objective was to identify risk factors associated with survival in patients who underwent pulmonary metastasectomy for soft tissue or bone sarcoma and to create a risk stratification model. METHODS: A retrospective review of the prospectively maintained University of California Los Angeles Sarcoma Database was performed. Clinical, pathologic, and treatment variables were analyzed for overall survival and disease-free survival. Univariate and multivariate analyses were performed, and variables that were identified as significant were included to create a risk model. A total of 155 patients who underwent pulmonary metastasectomy for soft tissue sarcoma (n = 108 patients) or bone sarcoma (n = 47 patients) from 1994 to 2010 were identified. RESULTS: Multivariate analysis identified 7 factors associated with poor overall survival: age more than 45 years, disease-free interval less than 1 year, thoracotomy, synchronous disease, location and type of sarcoma (soft tissue vs bone sarcoma), and performance of a lobectomy. The number of factors present was associated with poor overall survival, which varied widely from 64% in patients with 2 factors to 3% in those with 5 factors. CONCLUSIONS: We have identified prognostic variables associated with overall survival after lung metastasectomy. Our model may be used as a risk stratification model to guide treatment decisions on the basis of the number of risk factors present. Although prospective studies are warranted to determine the benefit of surgical intervention in all cohorts compared with other local therapies or medical therapy, given the attendant dismal prognosis in patients with 5 or more risk factors, the benefit of surgical resection in this group is questioned.
OBJECTIVES: Our objective was to identify risk factors associated with survival in patients who underwent pulmonary metastasectomy for soft tissue or bone sarcoma and to create a risk stratification model. METHODS: A retrospective review of the prospectively maintained University of California Los Angeles Sarcoma Database was performed. Clinical, pathologic, and treatment variables were analyzed for overall survival and disease-free survival. Univariate and multivariate analyses were performed, and variables that were identified as significant were included to create a risk model. A total of 155 patients who underwent pulmonary metastasectomy for soft tissue sarcoma (n = 108 patients) or bone sarcoma (n = 47 patients) from 1994 to 2010 were identified. RESULTS: Multivariate analysis identified 7 factors associated with poor overall survival: age more than 45 years, disease-free interval less than 1 year, thoracotomy, synchronous disease, location and type of sarcoma (soft tissue vs bone sarcoma), and performance of a lobectomy. The number of factors present was associated with poor overall survival, which varied widely from 64% in patients with 2 factors to 3% in those with 5 factors. CONCLUSIONS: We have identified prognostic variables associated with overall survival after lung metastasectomy. Our model may be used as a risk stratification model to guide treatment decisions on the basis of the number of risk factors present. Although prospective studies are warranted to determine the benefit of surgical intervention in all cohorts compared with other local therapies or medical therapy, given the attendant dismal prognosis in patients with 5 or more risk factors, the benefit of surgical resection in this group is questioned.
Authors: Neel P Chudgar; Murray F Brennan; Rodrigo R Munhoz; Peter R Bucciarelli; Kay See Tan; Sandra P D'Angelo; Manjit S Bains; Matthew Bott; James Huang; Bernard J Park; Valerie W Rusch; Prasad S Adusumilli; William D Tap; Samuel Singer; David R Jones Journal: J Thorac Cardiovasc Surg Date: 2017-03-21 Impact factor: 5.209
Authors: Jamie C Harris; Jeannine M Coburn; Andre Kajdacsy-Balla; David L Kaplan; Bill Chiu Journal: J Pediatr Surg Date: 2016-09-16 Impact factor: 2.545
Authors: Neel P Chudgar; Murray F Brennan; Kay See Tan; Rodrigo R Munhoz; Sandra P D'Angelo; Manjit S Bains; James Huang; Bernard J Park; Prasad S Adusumilli; William D Tap; David R Jones Journal: Ann Thorac Surg Date: 2017-11-02 Impact factor: 4.330