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

Background/Aim: 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. Patients and Methods: 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. Results: 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%. Conclusion: 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.