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• 12495

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  P3.07 - Poster Session 3 - Surgery (ID 193)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Surgery
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/30/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 12516

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    P3.07-021 - Pulmonary Metastasis, Particularly of Sarcomas, Amenable to Aggressive Surgical Management (ID 1787)

    09:30 - 09:30  |  Author(s): A. Horvai
    • Abstract

    Background
    Background: Metastatic lesions are the most common malignancy of the lungs. In the past, pulmonary metastatectomy was reserved for cases of solitary or oligo-metastasis. Over the past decade, however, indications for surgical treatment of pulmonary metastasis have broadened for many cancers. Sarcomas have a predilection for spread to the lungs, often in the absence of metastasis to other organs. We examined our experience with an increasingly aggressive approach to pulmonary metastasis, to help define evolving parameters and expectations for clinical outcomes, exploring the perceived differences in the clinical patterns between sarcoma and other cancers.

    Methods
    Methods: We identified 262 patients who underwent a total of 361 R0 pulmonary metastatectomies, 336 of which were performed at UCSF Medical Center between 1996 and 2009. Sarcoma was the primary tumor in 118 patients undergoing 180 of these operations. Survival estimates were based on Kaplan-Meier analysis and compared using either a log-rank or Wilcoxon test. Predictors included surgical procedure; number/size of lesions; repeat resection; intervals to metastasis (DFI) and to recurrent metastasis; chemotherapy; cancer type; distribution of pulmonary and extra-pulmonary metastasis; patient age/sex. These predictors were compared using univariate and multivariate Cox proportional hazards modeling; multiple-predictor modeling started with a set of predictors based on historical/clinical significance, and stepwise forward selection determined which additional predictors were included until all p-values in the model were less than 0.1.

    Results
    Results: Despite an increasingly aggressive surgical approach, reflected in an increase in number of lesions, the percentage of patients with > 8 lesions, the number of patients with lesions < 1 cm, and in a decrease in DFI, the overall 5-year survival was 48% (median survival 4.7 years, 95%CI 3.5-5.5), and did not differ between the early and late periods of the study. Sarcoma patients, however, tended to be significantly younger (46 ± 16 yrs vs. 59 ± 14, P<0.001), and to have more lesions (4.0 ± 4.3 vs. 2.3 ± 2.3, P<0.001), a shorter DFI (2.5 ± 3.3 yrs vs. 3.6 ± 3.9, P = 0.004), more diffuse pulmonary involvement (43% bilateral disease vs. 29%, P = 0.02), and more frequent recurrence rate (80% vs. 51%, <0.001) than the non-sarcoma patients. Whereas lesion size (HR 1.2, P=0.004), age (HR 1.4, P<0.001), DFI (HR 2.1, P=0.008), and extra-pulmonary disease (HR 1.9, P=0.04) were all independent predictors of survival for non-sarcomas, only metastasis synchronous to the primary tumor (HR 2.7, P=0.007) and a need for anatomic resection (HR 2.5, P=0.006) independently predicted a higher mortality among sarcomas. Furthermore, a need for repeat resection did not impact the survival of sarcoma patients as long as complete resection remained feasible, whereas the 5-year survival of patients even with resectable recurrent non-sarcoma metastases dropped from 76% to 43% (P = 0.003).

    Conclusion
    Conclusion: Encouraging long-term survival can be achieved even with an increasingly aggressive surgical approach to pulmonary metastasis. Although sarcoma patients tend to present with rapidly progressive and extensive pulmonary disease, a tendency toward confinement of metastasis to the lungs may justify an even more aggressive surgical strategy for these patients.