Perioperative chemotherapy in patients undergoing pulmonary resection for metastatic soft-tissue sarcoma of the extremity : a retrospective analysis

BACKGROUND: The benefit of chemotherapy in the treatment of primary soft-tissue sarcoma (STS) is controversial. To the authors' knowledge, few studies to date have examined the effect of chemotherapy in patients undergoing pulmonary resection for metastatic STS of the extremity. METHODS: Between 1990 and 2005, 1897 patients with extremity STS were treated and prospectively followed at a single institution. In all, 508 patients (27%) developed lung metastases as the first site of distant recurrence, and 138 (7%) were treated with pulmonary resection. RESULTS: Perioperative chemotherapy was administered to 53 patients (38%). Age at diagnosis and disease-free interval were significantly different between patients who received perioperative chemotherapy and those who did not, whereas sex, grade, size of the primary tumor, depth, histology, number and size of lung metastases, and rate of complete resection were not. The median postmetastasis disease-specific survival was 24 months in patients who were treated with surgery and chemotherapy compared with 33 months in patients who were treated with surgery alone (P = .19). The median postmetastasis pulmonary progression-free survival in the 2 groups was 10 months and 11 months, respectively (P = .63). Multivariate Cox proportional hazards modeling and propensity score analysis revealed no association between perioperative chemotherapy and disease-specific, overall, or pulmonary progression-free survival. CONCLUSIONS: Although it is difficult to completely control for the effects of selection bias on outcome in this highly selected cohort of patients, data from the current study suggest that systemic chemotherapy has minimal, if any, long-term impact on the outcome of patients undergoing pulmonary resection for metastatic STS of the extremity.