Progression after chemotherapy is a novel predictor of poor outcomes after pulmonary metastasectomy in sarcoma patients

Background: Sarcoma patients with pulmonary metastases frequently receive chemotherapy before resection. We hypothesized that measurable progression after chemotherapy is a novel predictor of poor outcomes in sarcoma patients undergoing pulmonary metastasectomy. Study Design: We conducted a retrospective review of patients between 1998 and 2006 identifying those with sarcoma in whom lung metastases developed as their first site of recurrence, received chemotherapy for their metastases, and then underwent pulmonary metastasectomy. Multivariable analysis of preoperative factors was performed to identify predictors of poor survival. Progression after chemotherapy was defined as either an increase in the size of the nodules or the number of nodules on 2 CT scans before resection. All operations were performed within 3 months of completion of chemotherapy. Results: Eighty-one sarcoma patients underwent pulmonary metastasectomy after chemotherapy (45 men, mean age 43 years). Multivariable analysis suggested disease-free interval <2 years versus <2 years (hazard ratio = 0.375; 95% CI, 0.206-0.682; p = 0.001) and progression after chemotherapy (hazard ratio = 4.025; 95% CI, 1.089-14.881; p = 0.04) were significant predictors of survival. Five-year survival after metastasectomy in patients whose disease progressed after neoadjuvant chemotherapy was substantially worse compared with patients without measurable progression (0% versus 32%). Median survival for those with no progression was 35.5 ± 15.7 months, compared with 17.2 ± 4.8 months for those with progression. Conclusions: Progression of pulmonary metastases after chemotherapy is a novel prognostic factor for survival in patients with sarcoma undergoing metastasectomy, even when controlled for known factors such as disease-free interval and number of metastases.