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(Chest. 2005;127:902-908.)
© 2005 American College of Chest Physicians

Soft-Tissue Sarcomas of the Chest Wall*

Prognostic Factors

Jefferson Luiz Gross, MD, PhD; Riad Naim Younes, MD, PhD; Fabio José Haddad, MD, PhD; Daniel Deheinzelin, MD, PhD; Clovis Antonio Lopes Pinto, MD, PhD and Marcelo Leite Vieira Costa, MD

* From the Departments of Thoracic Surgery (Drs. Gross, Younes, Haddad, Deheinzelin, and Vieira Costa) and Pathology (Dr. Lopes Pinto), Hospital do Cancer A. C. Camargo, Sao Paulo, Brazil.

Correspondence to: Jefferson Luiz Gross, MD, PhD, Rua Prof Antonio Prudente, 211, Liberdade, Sao Paulo, Brazil; e-mail: jefluizgross{at}yahoo.com.br

Objective: To evaluate factors that are predictive of outcome for patients with chest wall soft-tissue sarcomas.

Patients and methods: A retrospective review of 55 surgically treated patients, from March 1964 to October 1996.

Results: The median age of the patients was 47.5 years (age range, 15 to 76.3 years), and 56.4% were men. The most common presenting symptom was chest wall mass in 29 patients (52.7%). The median symptom duration was 12 months. Tumor size ranged from 1 to 26 cm (median size, 9.7 cm). The most common histologic type of tumor was fibrosarcoma (52.7%). Twenty-three sarcomas (41.8%) were high-grade, and 32 sarcomas (52.8%) were low-grade. Of the 55 patients, 27 (49.1%) had previously been treated elsewhere (surgical resection, 23 patients; radiation therapy and surgery, 3 patients; chemoradiation therapy, 1 patient). Previously treated patients presented either with residual disease (10 cases) or recurrence of disease (17 cases). All 55 patients underwent surgical resection, 15 patients (27.3%) were treated by neoadjuvant chemoradiation therapy, and 2 patients were treated by adjuvant radiotherapy. Wide surgical resection was performed in 45 patients (81.8%), and marginal resection was performed in 10 patients (18.2%). The median follow-up time was 51.9 months. Local recurrence of disease developed in 6 patients, and metastases developed in 10 patients. The overall survival rates at 5 and 10 years were 87.3% and 79.3%, respectively. Tumor size < 5 cm and low histologic grade were determinants of better survival at univariate analyses. Multivariate analyses disclosed only histologic grade as an independent predictor for the risk of death. Disease-free survival rates at 5 and 10 years were 75.3% and 64.2%, respectively. Tumor size < 5 cm, performance of wide surgical resection, and low histologic grade were determinants of a better disease-free survival rate. Independent prognostic factors for disease-free survival were histologic grade and type of surgical resection

Conclusion: The clinical behavior of chest wall soft-tissue sarcomas is similar to that of extremity sarcomas. Thoracic wall soft-tissue sarcomas are best controlled by wide surgical resection.

Key Words: prognosis • sarcoma • surgery • thoracic wall






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