Prognostic Value of Computed Tomography for Monitoring Pulmonary Metastases in Soft Tissue Sarcoma Patients After Surgical Management: a Retrospective Cohort Study

Background: The lung is the most common site of metastases in patients with a soft tissue sarcoma. However, surveillance protocol for pulmonary metastasis after surgical management has not been proved. The goal of this retrospective study was to evaluate the prognostic value of computed tomography of the chest in soft tissue sarcoma patients after surgery.

Methods: A retrospective study was performed on 176 patients who were followed up with chest computed tomographic (CT) scan or plain chest radiographs for pulmonary metastasis monitoring after surgery. Ninety-six patients were followed up with plain chest radiographs and 80 patients with chest CT scan. Mean duration of follow-up was 55.8 months. The Kaplan-Meier method and the log-rank test were used to calculate overall survival rates and survival rate difference between chest CT and plain radiograph cohorts.

Results: The overall 5- and 10-year survival rates of 176 patients were 75.6% and 70.3%, respectively. The 5-year survival estimates of 96 patients who were included in the plain radiograph cohort and 80 patients in the chest CT cohort were 74.2% and 76.6%, respectively (P=0.70). Fifty-four patients (30.7%) had pulmonary metastasis. Of the 54 patients, 26 belonged to the plain radiograph cohort and 28 patients belonged to the chest CT cohort. Pulmonary metastasis of chest CT cohort had the tendencies of unilaterality, a smaller number of patients, and management with metastasectomy other than palliative management. The 2- and 4-year survival ratess after detection of pulmonary metastasis were 20.1% and 0% in the plain radiograph cohort and 47.4% and 31.6% in the chest CT cohort (P<0.05).

Conclusion: Serial monitoring with chest CT could give rise to early detection of pulmonary metastases, chance for metastasectomy, and eventually survival advantage.