A New Scoring System for Predicting the Survival of Sarcoma Patients with Pulmonary Metastases: Sarcoma Lung Metastasis
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ASO AUTHOR REFLECTIONS
A New Scoring System for Predicting the Survival of Sarcoma Patients with Pulmonary Metastases: Sarcoma Lung Metastasis Score Haruchika Yamamoto, MD, PhD, Hiromasa Yamamoto, MD, PhD
, and Shinichi Toyooka, MD, PhD
Department of Thoracic Surgery, Okayama University Hospital, Okayama-City, Okayama, Japan
PAST Sarcoma, in general, is a disease that responds poorly to treatment, and often metastasizes to the lung.1,2 Because only limited effects of chemotherapy and treatment with molecular-targeted agents can be expected for sarcoma patients with pulmonary metastases, pulmonary metastasectomy could be considered one of the treatment options for control of the disease.3,4 However, to date, no clear evidence exists to support the possibility of preoperatively predicting the prognostic impact of surgical treatment for sarcoma patients with pulmonary metastases. This report proposes a simple beneficial scoring system for sarcoma patients with pulmonary metastases using factors identified by multivariate regression analyses in previous studies. PRESENT In the current study,5 uni- and multivariate analyses were performed to identify differences in prognostic factors between a 3-year survivor group (n = 66) and a nonsurvivor group (n = 69) using various preoperative factors. The uni- and multivariate analyses both identified diseasefree interval (DFI: \ 2 years), maximum tumor diameter (C 15 mm), and number of pulmonary metastases (C 6) as significant factors influencing the 3-year survival rate. Based on this result, the Sarcoma Lung Metastasis Score was calculated as a total of these three factors, with a score
Ó Society of Surgical Oncology 2020 First Received: 16 October 2020 Accepted: 16 October 2020 H. Yamamoto, MD, PhD e-mail: [email protected]
of 1 each assigned to DFI, maximum tumor diameter, and number of pulmonary metastases. The Sarcoma Lung Metastasis Score was found to be moderately discriminatory, with a c-index of 0.75 reliably predicting the 3-year survival rate (Sarcoma Lung Metastasis Score: 0 [89.5%], 1 [63.2%], 2 [39.0%], 3 [10.5%]; P = 0.000000019). FUTURE The authors propose the simple but useful Sarcoma Lung Metastasis Score, which can be calculated from only three following factors measured preoperatively: DFI, tumor size, and number of pulmonary metastases. This score not only enables the treating doctors to predict the prognosis at the time of diagnosis for sarcoma patients with pulmonary metastases, but also allows them to offer the appropriate treatment for metastatic sarcoma patients from the perspective of both the patients and the physicians. Future studies investigating the external validation of the Sarcoma Lung Metastasis Score using a different cohort would be desirable to determine its accuracy. DISCLOSURE
The authors have no conflicts of interest.
REFERENCES 1. Potter DA, Glenn J, Kinsella T, et al. Patterns of recurrence in patients with high-grade soft tissue sarcomas. J Clin Oncol. 1985;3:353–66. https://doi.org/10.1200/jco.1985.3.3.353. 2. Bi
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