# Prognostic Impact of Pulmonary Metastasectomy for Uterine Malignancies: A Retrospective Analysis of 38 Cases

## TL;DR

This study shows that removing lung metastases from uterine cancer can improve survival, similar to benefits seen in other cancers.

## Contribution

The study provides evidence that pulmonary metastasectomy may offer prognostic benefits for uterine malignancies.

## Key findings

- Pulmonary metastasectomy was associated with better postoperative outcomes than chemotherapy ± immune checkpoint inhibitors.
- The 5-year recurrence-free survival rate after metastasectomy was 55.6%.
- Advanced-stage tumors, early recurrence, and sarcoma were identified as poor prognostic factors.

## Abstract

The efficacy of pulmonary metastasectomy for patients with uterine malignancies is uncertain. This study was conducted to evaluate the efficacy of pulmonary metastasectomy for patients with primarily treated uterine malignancies and recurrence with pulmonary metastases and showed good postoperative prognosis compared to patients who received chemotherapy ± immune checkpoint inhibitors. Considering our study’s findings and those of previous studies, pulmonary metastasectomy may confer prognostic benefits in patients with uterine malignancies, similar to those observed in patients with colorectal and renal cancers.

Background: Uterine malignancies frequently metastasize to the lungs. Pulmonary metastasectomy has demonstrated survival benefits in some malignancies; however, its efficacy for uterine malignancies remains unclear. Methods: We retrospectively analyzed 38 patients who underwent pulmonary metastasectomy for uterine malignancies at the Kanagawa Cancer Center between 2010 and 2020. The primary endpoint was recurrence-free survival (RFS) after pulmonary resection. Results: The median patient age was 63 years. The primary sites were the cervical uteri (n = 22) and corpus uteri (n = 16). The FIGO stages at the time of treatment for the primary tumor were I, II, III, IV, and unknown in 20, 7, 9, 1, and 1 patient, respectively. The median disease-free interval (DFI), defined as the interval between primary treatment and first recurrence, was 26.5 months. Most patients had single metastasis (n = 32). The procedures for metastasectomy included lobectomy, segmentectomy, and wedge resection (n = 15, 8, and 15, respectively), and two cases resulted in microscopically incomplete resection. The median follow-up period after pulmonary metastasectomy was 57 months, with 16 patients experiencing recurrence after pulmonary metastasectomy (5-year RFS rate: 55.6%). Univariate analysis identified FIGO stage ≥ III, DFI < 12 months, presence of synchronous extrapulmonary recurrence, and uterine sarcoma as poor prognostic factors. No prognostic differences were found between cervical and corpus uteri cancers. Conclusions: Pulmonary metastasectomy may confer prognostic benefits in patients with uterine malignancies. Careful consideration is warranted for patients with advanced-stage primary tumors, early recurrence after primary treatment, synchronous extrapulmonary recurrence, and uterine sarcoma.