Patient selection: adult with metastatic sarcoma to the lung, with a history of neoadjuvant chemotherapy
All lung resections were performed within 3 months of chemotherapy.
Risk factors for a poor outcome if pulmonary metastasectomy performed:
(1) progression of lung nodules after chemotherapy (increase in number and/or size of lung nodules between 2 thoracic CT scans prior to lung resection)
(2) disease-free interval (DFI) < 2 years
where:
• The timeframe for disease-free interval is a little unclear. Based on usage in the text on page 822 it appears that DFI refers to the patient's course prior to selection (and not after pulmonary metastasectomy. A longer DFI suggests a more indolent tumor.
Additional risk factor:
(1) 3 or more lung metastases resected (p value 0.10 in multivariate analysis)
The median survival for a patent without disease progression after chemotherapy was 35.5 months (+/- 16 months) vs 17 months for a patient with progression after chemotherapy.
The authors noted that selected patients with risk factors for a poor outcome might still be cleared for surgery if the the risk of surgery was low and if the palliative benefits were high.