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Takeshi Kurosaki
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P1.14 - Thymoma/Other Thoracic Malignancies (Not CME Accredited Session) (ID 946)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 2
- Moderators:
- Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
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P1.14-29 - Surgical Treatment for Metastatic Lung Tumors from Various Sarcomas (ID 12551)
16:45 - 18:00 | Author(s): Takeshi Kurosaki
- Abstract
Background
Sarcomas are known to be one of the aggressive malignant tumors. They often develop multiple pulmonary metastasis, and thus systemic therapy is a treatment of choice for metastatic lung tumors. However, effective chemotherapeutic treatments have not yet been established. Surgical resection for metastatic lung tumors is a therapeutic option to control the disease, although it is not a curative therapy.
a9ded1e5ce5d75814730bb4caaf49419 Method
Between January 2006 and April 2018, 396 pulmonary resections were performed for 219 sarcoma patients with metastatic lung tumors in Okayama University Hospital. Among them, 129 sarcoma patients who underwent pulmonary metastasectomy between January 2006 and December 2014 were retrospectively reviewed. In total, 229 pulmonary resections were performed. We analyzed the following factors: age, sex, site of primary lesion, histology, operative procedures, size of the largest lesions resected, maximum number of the resected tumors, postoperative complications, and survival rate.
4c3880bb027f159e801041b1021e88e8 Result
In total, 939 metastatic nodules were resected. Average number of tumors per intervention was 4.1 (range 1-19). These sarcoma patients consisted of 31 males and 98 females, and their average age was 53.6 years (range 14-80 years). Leiomyosarcoma was the most common histological subtype (n = 72, 55.8%) and uterus was the most common location of the primary disease (n = 55, 42.6%). Operative procedures were composed of 173 partial resections, 31 segmentectomies with or without partial resections, 24 lobectomies with or without partial resections, and 1 basal segmental auto-transplantation after pneumonectomy. The postoperative complications were limited, showing that pulmonary metastasectomies for sarcomas are acceptable. Overall 3-year survival after the first pulmonary metastasectomy was 49.5%, and multivariate analysis revealed that the survival was significantly better for the group with disease-free interval of more than 2 years or the size of the largest resected lesion less than 30 mm.
8eea62084ca7e541d918e823422bd82e Conclusion
Surgical resections for metastatic lung tumors from various sarcomas were performed without major complications, indicating the acceptable feasibility. If disease-free interval is more than 2 years and the size of the largest resected lesion is less than 30 mm, patients may maximally benefit from surgical resection.
6f8b794f3246b0c1e1780bb4d4d5dc53 -
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P1.14-30 - Prognostic Factors for Sarcoma Patients with Lung Metastasis Who Underwent Extended Pulmonary Resection (ID 12710)
16:45 - 18:00 | Author(s): Takeshi Kurosaki
- Abstract
Background
Since the effects of chemotherapy and molecular targeting agents for sarcoma with lung metastasis are limited, pulmonary metastasectomy can become one of the treatment options for the control of disease. Partial resection is the first choice of surgical procedure for lung metastasis to preserve pulmonary function. As for the tumors which occur at hilum or are too large for partial resection, the extended resection such as segmentectomy or lobectomy is occasionally required while the clinical impact of these procedures is unknown. In this study, we examined preoperative prognostic factors of sarcoma patients who underwent segmentectomy or lobectomy for lung metastasis.
a9ded1e5ce5d75814730bb4caaf49419 Method
During January 2006 to December 2014, a total of 129 patients underwent pulmonary resection for lung metastasis of sarcoma at Okayama University Hospital. Among them, 40 patients (31%) underwent segmentectomy or lobectomy. The 3-year survival rate was evaluated by univariate (Kaplan‑Meier method) and multivariate (Cox proportional hazard model) analyses with log-rank test.
4c3880bb027f159e801041b1021e88e8 Result
Among 40 patients, the median age was 55 years old (range, 17 to 76). Thirty-five patients (88%) were female. Thirty patients (75%) harbored two or more distant metastatic lesions at initial diagnosis and 21 patients (52.5%) suffered from bilateral lung metastasis at the first lung metastasectomy. Median maximum diameter of the maximum lung tumor and median number of the lung metastasis was 30 mm (range, 8 to 110) and 3 (range, 1 to 19), respectively. Eight patients (20%) had two years or more disease-free interval at the first lung resection. The 3-year survival rate was 36.8% in the entire cohort. The univariate analyses revealed that the 3-year survival rate was significantly better in the patients with smaller size of lung metastasis (50.5% in the tumors with maximum diameter ≤ 30mm vs 20.7% in those > 30mm, P < 0.01), unilateral lung metastasis (45.6% vs 29.5% for bilateral, P < 0.05), and the absence of metastatic lesion at initial diagnosis (50.9% vs 28.1% for the presence, P < 0.05). Smaller numbers of lung metastasis and longer disease-free interval showed favorable prognosis with marginal significance (P < 0.1). The multivariate analysis with the above five factors revealed that unilateral lung metastasis at the first pulmonary metasetasectomy was an independent favorable prognostic factor (HR 2.41, 95%CI 1.09 to 5.32, P < 0.05).
8eea62084ca7e541d918e823422bd82e Conclusion
Extended pulmonary resection such as segmentectomy or lobectomy may be considered for the patients with sarcoma lung metastasis especially when the tumors are unilateral.
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