Clinical Outcome in Soft Tissue Sarcoma Patients with Lung Metastasis Who Received Metastasectomy and/or Radiofrequency Ablation: Tokai Musculoskeletal Oncology Consortium Study

Tomoki Nakamura; Kunihiro Asanuma; Motoshi Takao; Takashi Yamanaka; Hiroshi Koike; Toyofumi F Chen-Yoshikawa; Satoshi Tsukushi; Hiroaki Kuroda; Eiji Kozawa; Masaaki Sano; Hisaki Aiba; Ryoichi Nakanishi; Akihito Nagano; Kenji Yamada; Yoji Shido; Katsuhisa Kawanami; Yuya Izubuchi; Akihiro Sudo; Yoshihiro Nishida

doi:10.2147/CMAR.S333721

Clinical Outcome in Soft Tissue Sarcoma Patients with Lung Metastasis Who Received Metastasectomy and/or Radiofrequency Ablation: Tokai Musculoskeletal Oncology Consortium Study

Cancer Manag Res. 2021 Nov 10:13:8473-8480. doi: 10.2147/CMAR.S333721. eCollection 2021.

Authors

Tomoki Nakamura¹, Kunihiro Asanuma¹, Motoshi Takao², Takashi Yamanaka³, Hiroshi Koike⁴, Toyofumi F Chen-Yoshikawa⁵, Satoshi Tsukushi⁶, Hiroaki Kuroda⁷, Eiji Kozawa⁸, Masaaki Sano⁹, Hisaki Aiba¹⁰, Ryoichi Nakanishi¹¹, Akihito Nagano¹², Kenji Yamada¹³, Yoji Shido¹⁴, Katsuhisa Kawanami¹⁵, Yuya Izubuchi¹⁶, Akihiro Sudo¹, Yoshihiro Nishida^{4

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Affiliations

¹ Department of Orthopedic Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan.
² Department of Thoracic Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan.
³ Department of Radiology, Mie University Graduate School of Medicine, Tsu, Mie, Japan.
⁴ Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
⁵ Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
⁶ Department of Orthopedic Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan.
⁷ Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan.
⁸ Department of Orthopedic Surgery, Nagoya Memorial Hospital, Nagoya, Aichi, Japan.
⁹ Department of Thoracic Surgery, Nagoya Memorial Hospital, Nagoya, Aichi, Japan.
¹⁰ Department of Orthopedic Surgery, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Aichi, Japan.
¹¹ Department of Oncology, Immunology and Surgery, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Aichi, Japan.
¹² Department of Orthopedic Surgery, Gifu University Graduate School of Medicine, Gifu, Gifu, Japan.
¹³ Department of Musculoskeletal Oncology, Okazaki City Hospital, Okazaki, Aichi, Japan.
¹⁴ Department of Orthopedic Surgery, Hamamatsu Medical University, Hamamatsu, Sizuoka, Japan.
¹⁵ Department of Orthopedic Surgery, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan.
¹⁶ Department of Orthopedics and Rehabilitation Medicine, University of Fukui Faculty of Medical Sciences, Eiheiji, Fukui, Japan.
¹⁷ Department of Rehabilitation, Nagoya University Hospital, Nagoya, Aichi, Japan.

Abstract

Purpose: Here, we investigated the oncological outcomes of lung metastasectomy and/or radiofrequency ablation (RFA) of 92 patients with soft tissue sarcoma (STS) at nine institutions.

Methods: The study cohort included 65 men and 27 women with a mean age of 59 years at the time of metastasis. The mean follow-up duration was 51 months. All patients underwent metastasectomy and/or RFA for lung metastasis.

Results: The mean maximum size of the initial lung metastasis was 14.6 mm. At the initial evaluation, 41 patients had a single metastasis, whereas 51 patients had multiple metastases. The mean number of metastasectomies and/or RFA was 2 per patient. A total of 70 patients underwent lung metastasectomy, whereas the other 13 underwent lung RFA. The remaining nine patients underwent both RFA and metastasectomy. The 5-year post-metastatic survival rate was 52%. The patients who underwent complete treatment for the initial metastasis had better post-metastatic survival rates than those who underwent incomplete treatment. A univariate analysis of all possible prognostic factors for complete treatment confirmed the predictive value of disease-free interval, metastasis at initial presentation, distribution, tumor size, and number of lung metastases. Of the 92 patients, 74 underwent complete treatment for initial metastasis; in these patients, univariate and multivariate analyses showed that a smaller tumor size and single-lung metastasis were prognostic factors for superior post-metastatic survival. The patients with a smaller (<11.5 mm) single metastasis had better post-metastasis survival. The 5-year post-metastatic survival rates were 89.9% for patients with a smaller (<11.5 mm) single metastasis versus 22.7% for patients with larger (>11.5 mm) and multiple metastases.

Discussion: We propose that complete treatment for lung metastasis in patients with STS may improve post-metastatic survival rates. Furthermore, tumor number and size are important variables for clinical decision-making.

Keywords: lung metastasis; metastasectomy; radiofrequency ablation; soft tissue sarcoma.

Grants and funding

This study received no financial support.