Impact of Primary Tumor Resection on Metastasis to the Lung in Patients With Bone and Soft-tissue Sarcoma

Abstract

Background: Few reports have investigated the effect of primary tumor resection on lung metastasis and prognosis in patients with bone and soft-tissue sarcoma, and we evaluated its effect on lung metastasis and prognosis. Patients and Methods: We retrospectively identified patients with lung metastasis from bone and soft-tissue sarcoma. We examined the factors affecting prognosis and the rate of lung metastasis increase. Results: A total of 48 patients were included. The multivariate analysis revealed that poor prognosis was significantly associated with a large maximum diameter of lung metastasis at the first visit and a rapid rate of increase (p=0.0400 and p=0.0003, respectively). The multivariate logistic regression analysis revealed that the rate of increase of size of lung metastases was only significantly associated with a large maximum diameter at the first visit (p=0.0245). Conclusion: Primary tumor resection of bone and soft-tissue sarcoma in patients with lung metastasis was not shown to affect their prognosis.Bone and soft-tissue sarcomas, although relatively rare diseases, have various histological subtypes, including liposarcoma, synovial sarcoma, osteosarcoma, and Ewing sarcoma. Treatment is based on radical resection with adequate margins, regardless of the histological subtype, in order to prevent local recurrence. However, there is a consensus that the presence of distant metastases, particularly in the lungs, strongly influences prognosis (1-3). Chemotherapy is commonly used in patients with bone and soft-tissue sarcomas with lung metastases, especially those with numerous ones. The primary tumor is not aggressively resected in these patients. However, if the primary tumor interferes significantly with the patient's quality of life in terms of pain, neuropathy, and breaking of the skin, resection or even amputation may be required. Therefore, it is possible to remove only the primary tumor in these patients.In recent years, prognosis has been shown to improve in certain malignancies, such as gastric and colorectal cancer with multiple metastases, when the primary tumor is removed (4-6). However, very few reports have investigated the effect of primary tumor resection on the prognosis of patients with bone and soft-tissue sarcomas with distant metastases (7,8). Furthermore, to our knowledge, no reports have examined how excision of the primary tumor affects metastasis to the lungs, which is the most common type. This study aimed to examine the impact of primary tumor resection on lung metastasis and prognosis in patients with bone and soft-tissue sarcoma. Patients and MethodsPatients. We retrospectively identified patients with bone and softtissue sarcoma involving the extremities or trunk with lung metastasis at the first visit treated at our two hospitals between 1994 and 2020. Patients with lung metastasis confirmed at the same time as local primary tumor recurrence were also included. Since we aimed to assess the impact of primary tumor treatment, those who did not receive radiotherapy or sur...

Clinical characteristic–assisted surgical benefit stratification for resection of primary tumor in patients with advanced primary malignant bone neoplasms: a population-based propensity score–matched analysis

“…Of these variables, the status of DM exhibited the strongest correlation with the probability of surgical benefit. Previous studies have demonstrated improved survival in in patients with PMBNs with metastatic disease who underwent PTR ( 31 , 32 ). This could be attributed to the reduction of the overall tumor load and the eradication of the primary source of cells capable of metastasizing ( 33 ).…”