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The Journal of Thoracic and Cardiovascular Surgery, Vol 97, 695-705, Copyright © 1989 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
D Jablons, SM Steinberg, J Roth, S Pittaluga, SA Rosenberg and HI Pass
Between 1982 and 1987, 74 patients (46 men and 28 women) had exploration
for presumed metastases from high-grade soft tissue sarcoma of the
head/neck, extremity, or trunk. Ages ranged from 11 to 75 years (median 38
years). Thirty (41%) had multiple procedures for recurrences (range two to
six explorations). Median postthoracotomy time for the group of patients
with histologically confirmed sarcoma (n = 63) was 20.3 months. Patients
rendered free of disease at initial thoracotomy had significantly longer
postthoracotomy survival times (26.8 months median) than those with
unresectable metastatic disease (9 months median); p2 less than 0.0001).
The prognostic significance of age, sex, location of primary tumor,
disease-free interval, number of nodules on preoperative computed tomograms
or conventional linear tomograms, number of metastases resected, and the
use of postoperative chemotherapy were analyzed. In a univariate analysis,
sex, age, and location of the primary tumor did not impact significantly on
survival, nor did the use of postoperative chemotherapy. Initial
disease-free interval of 1 year or less was associated with a significantly
shorter survival time, and patients with five nodules or fewer on
preoperative computed tomography had significantly longer survival times
than patients with six nodules or more. Patients with three nodules or
fewer on linear tomography had a longer postthoracotomy survival time than
patients with four nodules or more. In patients whose malignant disease
could be completely resected, the number of nodules resected at thoracotomy
did not impact on long-term survival. According to proportional-hazards
modeling, disease-free interval, sex, resectability, and truncal location
were found to associate with length of survival after metastasis removal.
We conclude that pulmonary metastasis resection in patients with soft
tissue sarcoma is associated with long-term survival, and consistent
indicators can define which patients may benefit from these interventions.
ARTICLES
Metastasectomy for soft tissue sarcoma. Further evidence for efficacy and prognostic indicators
Surgery Branch, National Institutes of Health, Bethesda, MD 20892.
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