Abstract

OBJECTIVES
Pulmonary metastasectomy is firmly established in the multidisciplinary management of patients with advanced sarcomas. While the number of metastases, completeness of resection, disease-free interval and grading of the primary sarcoma are well established prognostic factors in metastatic surgery, histological parameters are not widely evaluated. The objective of the present study was to evaluate the prognostic impact of intrapulmonary growth patterns of sarcoma metastases.
METHODS
We retrospectively analysed the clinicopathological characteristics of 52 sarcoma patients who underwent surgical resection of lung metastases at our centre from January 2006 to January 2009. The histological growth characteristics of all 261 metastases have been categorized and published previously. 'Interstitial growth' was defined as a diffuse spread of the sarcoma cells into the alveolar septae at the transition of the metastasis to the normal lung tissue and was found to be prognostic. 'Pleural penetration' was defined as the infiltration and destruction of all visceral pleural layers by the tumour and was found to be a risk factor for local recurrence.
RESULTS
The median post-metastasectomy overall survival was 50.3 months, and the corresponding 5-year survival rate was 44.7%. Age >55 years at metastasectomy (P = 0.02), the presence of interstitial growth (P = 0.008), size of the largest metastasis >35 mm (P = 0.023) and the presence of tumour recurrence at any site after metastasectomy (P < 0.001) were identified as risk factors for death. Pleural penetration (P = 0.007) and size of the metastasis >5 mm were found to be risk factors for local intrapulmonary recurrence.
CONCLUSIONS
Interstitial tumour growth, which is easily detected by light microscopy, can serve as a strong predictor of survival following pulmonary metastasectomy in sarcoma patients. Obvious pleural infiltration indicates the need for larger margins.

Links

Publisher Full Text

Authors

Welter S, Grabellus F, Bauer S, Schuler M, Eberhardt W, Tötsch M, Stamatis G

Institution

Division of Thoracic Surgery, Ruhrlandklinik, Essen, Germany. stefan.welter@ruhrlandklinik.uk-essen.de

Source

Interactive cardiovascular and thoracic surgery 15:4 2012 Oct pg 612-7

MeSH

Adult
Aged
Aged, 80 and over
Cell Proliferation
Chi-Square Distribution
Disease-Free Survival
Female
Humans
Kaplan-Meier Estimate
Lung Neoplasms
Lymphatic Metastasis
Male
Metastasectomy
Middle Aged
Neoplasm Invasiveness
Neoplasm Recurrence, Local
Pneumonectomy
Retrospective Studies
Risk Assessment
Risk Factors
Sarcoma
Time Factors
Treatment Outcome
Tumor Burden
Young Adult

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22761121