Metachronous Pulmonary Metastases in Soft Tissue Sarcoma: Prognostic Factors and Survival Outcomes Following...

Pulmonary metastasectomy (PM) remains a key component in the management of soft tissue sarcoma (STS) patients with isolated lung metastases. However, data on long-term outcomes and prognostic factors in Indian cohorts remain limited. We retrospectively analyzed 21 patients with previously treated soft tissue sarcoma (STS) who developed metachronous pulmonary metastases and underwent pulmonary metastasectomy (PM) at a tertiary care centre between January 2014 and March 2025. Demographic, clinical, radiological, and pathological variables were assessed. Survival outcomes were analysed using Kaplan-Meier estimates, and prognostic factors were evaluated using both univariate and multivariate Cox regression analyses. The median overall survival (OS) following PM was 66 months (95% CI: 32-85 months), with an estimated 5-year OS of 38% (95% CI: 20%-56%). On univariate analysis, a significantly better disease-free interval post-PM was observed in patients undergoing a single video-assisted thoracoscopic surgery (VATS) (p = 0.006), with ≤ 5 pulmonary nodules (p = 0.037), and with nodules ≤ 2 cm in size (p = 0.009). Other variables, including age, primary tumour site, laterality of nodules, and chemotherapy, showed no significant association with survival. Multivariate analysis did not identify any independent predictors, likely due to the small sample size. Six patients (28.5%) underwent repeat metastasectomy for recurrence. A disease-free interval (DFI) ≥ 12 months was associated with improved OS, although the difference was not statistically significant (p = 0.166). PM offers favourable long-term survival in carefully selected STS patients with metachronous lung metastases. Prognostic indicators such as limited metastatic burden and smaller nodule size are associated with improved outcomes. Further multicentre prospective studies are warranted to validate these findings and refine patient selection criteria.

The online version contains supplementary material available at 10.1007/s13193-025-02425-2.