Pulmonary metastasectomy from bone and soft tissue sarcomas: defining surgical indications at the time of second...

Pulmonary metastasectomy (PM) is a treatment for lung metastases of bone and soft tissue sarcomas. However, the criteria for repeat PM after a second pulmonary recurrence remain unclear. We evaluated prognostic significance of the second disease-free interval (DFI-2; from initial PM to second pulmonary recurrence) and defined the criteria for repeat PM.

We retrospectively reviewed 60 patients who underwent PM for bone or soft tissue sarcomas (2000-2024), among whom 31 experienced a second pulmonary recurrence. Overall survival (OS) was analyzed using the Kaplan-Meier method and log-rank test. Cox proportional hazards models were used to identify independent prognostic factors. OS was compared between patients with DFI-2 < 6 and ≥ 6 months. The DFI-2 cut-off was determined to maximize Harrell's concordance index for OS.

The median patient age, metastasis number, and metastasis size were 55 years, two, and 1.4 cm. The 5-year OS rate was 41.3%. Multivariable analysis identified DFI-1 < 12 months, ≥ 3 metastases, and incomplete resection as independent adverse factors. Among the 31 patients who developed second pulmonary recurrence, 16 underwent repeat PM, achieving the 5-year OS of 39.5%. Patients with DFI-2 ≥ 6 months had significantly better OS (median, 56.6 vs. 14.4 months, p < 0.001) and were more likely to undergo repeat PM (73.3% vs. 31.3%). All patients with DFI-2 < 6 months who underwent repeat PM experienced recurrence within 6 months.

DFI-2 ≥ 6 months predicts a favorable prognosis and may be a practical criterion for selecting candidates for repeat PM in bone and soft tissue sarcomas.