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Objectives <p>Pulmonary metastasectomy is considered the local treatment in selected patients, as it improves long-term survival. This study aims to investigate the prognostic factors of pulmonary metastasectomy for recurrence-free survival (RFS) and overall survival (OS).</p> Methods <p>A retrospective evaluation was conducted of those who underwent pulmonary metastasectomy between 2011 and 2021 in a tertiary referral center. Variables were screened using univariable and multivariable Cox regression analysis. Prognostic nomogram models were constructed using the multivariable Cox analysis results to determine 5-year RFS and OS probabilities.</p> Results <p>The study cohort included 159 patients. The median follow-up period was 45 months. 5-year RFS was 27.7%, and OS was 50.4%. Largest tumor size ≥ 15&#xa0;mm was statistically significant prognostic factor for RFS (hazard ratio HR: 1.583; <i>p</i> = 0.031) in the univariable analysis. The total sum of tumor size ≥ 15&#xa0;mm emerged as the strongest adverse prognostic factor for RFS (HR, 2.440; <i>p</i> &lt; 0.001) and OS (HR, 1.870; <i>p</i> = 0.038) in the multivariable analysis. Patients with a disease-free interval (DFI) ≤ 24 months had significantly shorter RFS (HR: 2.965; <i>p</i> &lt; 0.001) and OS (HR: 2.280; <i>p</i> &lt; 0.001) in the multivariable analysis.</p> Conclusion <p>In patients with a primary histology of sarcoma, more than five metastatic nodules, the total sum of tumor size ≥ 15&#xa0;mm, and a DFI of less than two years, metastasectomy should be considered with caution. Furthermore, when planning surgery for multiple metastases, whether a negative surgical margin can be achieved for each lesion should be carefully considered. The possible candidates for re-metastasectomy surgery should be selected with caution.</p>

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Total tumor size as a robust prognostic factor for pulmonary metastasectomy

  • 期刊论文

  • 发表日期：

    2026年3月4日

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  • Buse Mine Konuk Balcı,
  • Gökhan Kocaman,
  • Yusuf Kahya,
  • Bülent Mustafa Yenigün,
  • Atilla Halil Elhan,
  • Serkan Enön

摘要

Objectives

Pulmonary metastasectomy is considered the local treatment in selected patients, as it improves long-term survival. This study aims to investigate the prognostic factors of pulmonary metastasectomy for recurrence-free survival (RFS) and overall survival (OS).

Methods

A retrospective evaluation was conducted of those who underwent pulmonary metastasectomy between 2011 and 2021 in a tertiary referral center. Variables were screened using univariable and multivariable Cox regression analysis. Prognostic nomogram models were constructed using the multivariable Cox analysis results to determine 5-year RFS and OS probabilities.

Results

The study cohort included 159 patients. The median follow-up period was 45 months. 5-year RFS was 27.7%, and OS was 50.4%. Largest tumor size ≥ 15 mm was statistically significant prognostic factor for RFS (hazard ratio HR: 1.583; p = 0.031) in the univariable analysis. The total sum of tumor size ≥ 15 mm emerged as the strongest adverse prognostic factor for RFS (HR, 2.440; p < 0.001) and OS (HR, 1.870; p = 0.038) in the multivariable analysis. Patients with a disease-free interval (DFI) ≤ 24 months had significantly shorter RFS (HR: 2.965; p < 0.001) and OS (HR: 2.280; p < 0.001) in the multivariable analysis.

Conclusion

In patients with a primary histology of sarcoma, more than five metastatic nodules, the total sum of tumor size ≥ 15 mm, and a DFI of less than two years, metastasectomy should be considered with caution. Furthermore, when planning surgery for multiple metastases, whether a negative surgical margin can be achieved for each lesion should be carefully considered. The possible candidates for re-metastasectomy surgery should be selected with caution.