Primary malignant chest wall tumors: surgical management and factors predicting survival

Alice Bellini, Pia Ferrigno, Giovanni Maria Comacchio, Sara Rossi, Giorgio Cannone, Ivan Lomangino, Giuseppe Bellofiore, Marco Mammana, Giulia Lorenzoni, Danila Azzolina, Dario Gregori, Andrea Zuin, Andrea Dell’Amore, Federico Rea

Abstract

Background: Primary malignant chest wall tumors (PMCWTs) are a rare heterogeneous group of neoplasms arising from bones and soft tissues of the thorax. The gold standard treatment is surgical resection. In case of wide chest wall defects, there are two possibilities of reconstruction: prosthetic or biological mesh and/or tissue flaps. The aim of this study is to analyze different factors concurring to the outcome of patients with PMCWTs surgically treated in our Institution.
Methods: Retrospective study of 52 patients treated for PMCWTs from 1982 to 2019. Survival, recurrence and postoperative morbidity were considered as outcomes. Age, sex, type of resection, neo- and adjuvant treatments, side, size, number of resected ribs, prosthetic reconstruction and histological type were analyzed as possible prognostic factors.
Results: There were 28 males (53.8%) and 24 females (46.2%), with a median age of 58 years (range, 21–85 years). Chondro-osseous subtypes were the most represented (46.2%). Tumor involved the sternum in 17 cases (32.7%). Resection with reconstruction was performed in 31 (59.6%). Prosthesis alone were utilized in 16 cases (51.6%). Eleven patients developed post-operative morbidity. Median maximum diameter of the tumor was 7 cm (range, 1.9–30 cm). The 1-, 3-, 5-, and 10-year survival rates were 83.3%, 69.9%, 51.5% and 45.6%, respectively, while the median OS was 45 months. Predictors of better OS were no prosthetic reconstruction (HR 0.25, 95% CI: 0.09–0.71, P=0.009) and chondro-osseous tumor histological type (HR 0.34, 95% CI: 0.13–0.87, P=0.02). Recurrences occurred in 13 patients and the pattern for the relapse was local in 7 patients and distant in 5.
Conclusions: A careful pre-operative selection of fit patients, especially in chondro-osseous subtype without prosthetic reconstruction leads to good survival outcomes with acceptable morbidity.