Burkhard-Meier Anton, Grube Matthias, Jurinovic Vindi, Agaimy Abbas, Albertsmeier Markus, Berclaz Luc M, Di Gioia Dorit, Dürr Hans Roland, von Eisenhart-Rothe Rüdiger, Eze Chukwuka, Fechner Katja, Fey Emma, Güler Sinan E, Hecker Judith S, Hendricks Anne, Keil Felix, Klein Alexander, Knebel Carolin, Kovács Julia R, Kunz Wolfgang G, Lenze Ulrich, Lörsch Alisa M, Lutz Mathias, Meidenbauer Norbert, Mogler Carolin, Schmid Sebastian, Schmidt-Hegemann Nina-Sophie, Schneider Christian, Semrau Sabine, Sienel Wulf, Trepel Martin, Waldschmidt Johannes, Wiegering Armin, Lindner Lars H
Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.
Bavarian Cancer Research Center (BZKF), Erlangen, Germany.
Ann Surg Oncol. 2025 May 14. doi: 10.1245/s10434-025-17450-2.
Pulmonary metastasectomy (PM) is the most frequently performed local ablative therapy for leiomyosarcoma (LMS), synovial sarcoma (SyS), and undifferentiated pleomorphic sarcoma (UPS). This study aimed to assess surgical feasibility, outcome, and clinical prognostic factors, as well as the value of a peri-interventional systemic therapy.
This multicenter retrospective study enrolled 77 patients with LMS, SyS, or UPS who underwent first-time complete resection of isolated lung metastases between 2009 and 2021. Disease-free survival (DFS), overall survival (OS), and clinical prognostic factors were analyzed.
After the first PM, the median DFS was 7.4 months, and the median OS was 58.7 months. A maximal lesion diameter greater than 2 cm was associated with reduced DFS in both the univariable (hazard ratio [HR], 2.29; p = 0.006) and multivariable (HR, 2.60; p = 0.005) analyses. The univariable analysis identified a maximal lesion diameter greater than 2 cm as an adverse prognostic factor for OS (HR, 5.6; p < 0.001), whereas a treatment-free interval longer than 12 months was associated with improved OS (HR, 0.42; p = 0.032). The addition of systemic therapy was associated with a trend toward improved DFS for patients with lesions larger than 2 cm (HR, 0.29; p = 0.063). Severe postoperative complications (grade ≥IIIa) occurred in 2 % of the patients.
The size of resected lung metastases might be a more relevant prognostic factor than their number for patients with LMS, SyS, or UPS. For patients with lung metastases larger than 2 cm in maximal diameter, additional systemic therapy may be warranted.
肺转移瘤切除术（PM）是平滑肌肉瘤（LMS）、滑膜肉瘤（SyS）和未分化多形性肉瘤（UPS）最常施行的局部消融治疗。本研究旨在评估手术可行性、结局和临床预后因素，以及介入性全身治疗的价值。
这项多中心回顾性研究纳入了77例LMS、SyS或UPS患者，他们在2009年至2021年间首次接受了孤立性肺转移瘤的完整切除。分析无病生存期（DFS）、总生存期（OS）和临床预后因素。
首次PM后，中位DFS为7.4个月，中位OS为58.7个月。在单变量（风险比[HR]，2.29；p = 0.006）和多变量（HR，2.60；p = 0.005）分析中，最大病灶直径大于2 cm均与DFS降低相关。单变量分析确定最大病灶直径大于2 cm是OS的不良预后因素（HR，5.6；p < 0.001），而无治疗间隔超过12个月与OS改善相关（HR，0.42；p = 0.032）。对于病灶大于2 cm的患者，添加全身治疗与DFS改善趋势相关（HR，0.29；p = 0.063）。2%的患者发生了严重术后并发症（≥IIIa级）。
对于LMS、SyS或UPS患者，切除的肺转移瘤大小可能比其数量更能作为相关的预后因素。对于最大直径大于2 cm的肺转移瘤患者，可能需要额外的全身治疗。
