Resection of Primary Lesion for Patients With Metastatic Soft Tissue Sarcoma at Initial Presentation

Area of Science:

• Oncology
• Surgical Oncology
• Medical Oncology

Background:

• Prognosis for soft-tissue sarcoma with distant metastases (M1 STS) at diagnosis is historically poor.
• Recent advancements in chemotherapy offer potential for long-term survival in M1 STS patients.
• The role of primary tumor resection in M1 STS requires further evaluation.

Purpose of the Study:

• To retrospectively evaluate the impact of primary tumor resection on survival outcomes in patients with M1 STS at initial presentation.
• To assess the effectiveness of preoperative chemotherapy and subsequent surgical intervention in M1 STS.
• To identify prognostic factors influencing survival in M1 STS patients.

Main Methods:

• Retrospective analysis of 64 patients with spindle cell M1 STS (excluding ASPS and EMC) diagnosed between 1986 and 2023.
• Evaluation of primary tumor resection, chemotherapy administration, and surgical outcomes.
• Survival analysis based on treatment response and surgical intervention.

Main Results:

• The 5-year overall survival for M1 STS patients was 23%.
• Patients with inoperable primary tumors had a significantly worse prognosis (p<0.0001).
• Patients responding to preoperative chemotherapy (SD or better) had a 5-year survival rate of approximately 50%, with 70% survival for those undergoing primary and metastatic surgery.

Conclusions:

• Primary tumor resection is a valuable treatment modality for M1 STS patients.
• M1 STS patients achieving stable disease or better with preoperative chemotherapy benefit significantly from aggressive surgical resection.
• Aggressive surgical management, including primary tumor resection, should be considered for select M1 STS patients to improve survival outcomes.