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

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

doi:10.1007/s10147-026-02965-9

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

Int J Clin Oncol. 2026 Jan 23. doi: 10.1007/s10147-026-02965-9. Online ahead of print.

Authors

Affiliations

¹ Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan.
² Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan. s-okada@koto.kpu-m.ac.jp.
³ Department of Biostatistics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
⁴ Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.

PMID: 41575705
DOI: 10.1007/s10147-026-02965-9

Abstract

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.

Keywords: Bone and soft tissue sarcoma; Disease-free interval; Pulmonary metastasectomy; Repeat pulmonary metastasectomy; Surgical indication.