Impact of pulmonary metastasectomy timing and nodule characteristics on survival outcomes in patients with pediatric sarcoma

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Background/aim: Pulmonary metastasectomy (PM) is a crucial intervention for patients with metastatic sarcomas, particularly among pediatric populations. The timing of PM and its impact on survival outcomes remain a subject of debate in the literature. This study aims to evaluate the impact of PM on survival outcomes. Materials and methods: This retrospective study included pediatric patients diagnosed with sarcomas who underwent pulmonary metastasectomy. Demographic and clinical characteristics, including age, sex, primary malignancy type, metastasis presence at diagnosis, chemotherapy response, and PM details (e.g., number and laterality of metastatic nodules, time from metastasis detection to surgery) were analyzed. Survival data were assessed using Kaplan-Meier curves and Cox regression analysis, and statistical significance was determined using log-rank tests. Results: A total of 29 patients (51.7% male, 48.3% female) were included, with 55.2% presenting with metastasis at diagnosis. Overall, 47 surgical procedures were performed. The 5-year survival rate following PM was significantly higher for patients who underwent surgery within 30 days of metastasis detection (75.26%) compared to those who had surgery later (35.88%, p = 0.031). In univariate analysis, both 5-year survival after nodule detection and 5-year survival after metastasectomy were better in patients who underwent PM within the first 30 days (p = 0.022 and p = 0.039, respectively). Additionally, the number of metastatic nodules (< 10 versus ≥ 10) and the number of nodules per operation (< 3 versus ≥ 3) were significant factors influencing survival. Patients with fewer metastatic nodules exhibited better 5-year survival rates. The survival outcomes were comparable across different sarcoma subtypes, including osteosarcoma, Ewing sarcoma, and synovial sarcoma. Conclusion: Our study suggests that early pulmonary metastasectomy, performed within 30 days of metastasis detection, improves 5-year survival in pediatric sarcoma patients. The number of metastatic nodules and the timing of surgery are critical factors in determining survival outcomes. These findings highlight the importance of timely surgical intervention and careful evaluation of metastasis extent in optimizing patient prognosis.

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