PAPER 182: AN ASSESSMENT OF FACTORS AFFECTING OUTCOME IN PATIENTS PRESENTING WITH METASTATIC SOFT TISSUE SARCOMA

Abstract

Purpose: Patients presenting with metastatic soft tissue sarcoma (STS) generally have a poor prognosis. The factors that determine ultimate outcome in this setting are poorly understood. The purpose of this study is to establish factors that affect outcomes in a group of patients with metastatic STS at initial presentation who underwent surgical resection of their primary tumour.

Method: A retrospective review of our institutional database from 1986 to present was carried out. We identified all patients with STS who, at presentation, had metastatic disease. Patients who did not undergo surgical resection of their primary tumour were excluded. Factors affecting overall survival were assessed using the methods of Kaplan and Meier and ANOVA.

Results: We identified 130 patients with metastatic STS (75 male, 55 female). Of these, 81 patients presented with pulmonary metastases, 20 with lymph node metastases, 13 with both lung and lymph node metastases, and in 16 patients initial resection was of a metastatic lesion. Currently only 17 patients (13%) are free of disease. Factors associated with improved survival were lymph node metastases as opposed to pulmonary metastates (p=0.0006), size less than 5 cm (p=0.02), low grade sarcoma (p=0.05) and 3 or fewer pulmonary metastases (p=0.04). Age, gender, histological subtype, anatomic location, use of chemotherapy, depth, bilaterality of pulmonary metastases and pulmonary metastasectomy had no effect on overall survival.

Conclusion: A small percentage of patients presenting with metastatic STS can be cured with aggressive surgical management. Patients with lymph node metastases, small tumours, low grade tumours and 3 or fewer lung metastases at presentation have a better outcome and longer life expectancy.