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Background <p>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.</p> Methods <p>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 &lt; 6 and ≥ 6&#xa0;months. The DFI-2 cut-off was determined to maximize Harrell's concordance index for OS.</p> Results <p>The median patient age, metastasis number, and metastasis size were 55&#xa0;years, two, and 1.4&#xa0;cm. The 5-year OS rate was 41.3%. Multivariable analysis identified DFI-1 &lt; 12&#xa0;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&#xa0;months had significantly better OS (median, 56.6 vs. 14.4&#xa0;months, p &lt; 0.001) and were more likely to undergo repeat PM (73.3% vs. 31.3%). All patients with DFI-2 &lt; 6&#xa0;months who underwent repeat PM experienced recurrence within 6&#xa0;months.</p> Conclusions <p>DFI-2 ≥ 6&#xa0;months predicts a favorable prognosis and may be a practical criterion for selecting candidates for repeat PM in bone and soft tissue sarcomas.</p>

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

  • 期刊论文

  • 发表日期：

    2026年1月23日

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  • Daichi Kakibuchi,
  • Satoru Okada,
  • Tatsuo Furuya,
  • Masanori Shimomura,
  • Chiaki Nakazono,
  • Satoshi Teramukai,
  • Ryu Terauchi,
  • Toshiharu Shirai,
  • Kenji Takahashi,
  • Masayoshi Inoue

摘要

Background

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.

Methods

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.

Results

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.

Conclusions

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.