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

The prognosis of patients with soft-tissue sarcoma with distant metastases (M1 STS) at initial diagnosis is poor. Recently, however, with the development of new drugs, long-term survival can be expected. We retrospectively evaluated the usefulness of primary tumor resection in patients with M1 STS at initial presentation.

From January 1986 to December 2023, there were 64 cases of spindle cell (non-round cell) M1 STS at initial presentation, excluding alveolar soft part sarcoma (ASPS) and extraskeletal myxoid chondrosarcoma (EMC). The cohort included 41 males and 23 females, with a mean age of 48.6 years and a mean follow-up of 30.4 months.

Of the 64 patients, 49 (77%) underwent extensive resection of the primary tumor. Chemotherapy was administered in 58 patients (91%). The 5-year overall survival was 23%. Patients with inoperable primary tumors had a significantly worse prognosis (p<0.0001). The 5-year survival rates for the 23 patients who received preoperative chemotherapy were 53% in the partial response (PR) group, 43% in the stable disease (SD) group, and 0% in the progressive disease (PD) group. Patients who did not respond to preoperative chemotherapy had a significantly worse prognosis (p=0.0001). Furthermore, the 5-year survival rate for patients who underwent primary and metastatic surgery was 70%.

Even for M1 patients excluding slowly progressing tumors such as ASPS and EMC, those who achieve SD or better in response to preoperative chemotherapy have an approximately 50% five-year survival rate. In such cases, aggressive surgical resection of the primary tumor should be considered.