Pleural Metastasis of Bone and Soft Tissue Sarcomas: A Review

Pleural metastasis represents a significant pattern of advanced disease in bone and soft tissue sarcomas, commonly presenting with malignant pleural effusion (MPE) and indicating a poor prognosis. This comprehensive review synthesizes current knowledge on the epidemiology, mechanisms, clinical manifestations, diagnosis, and management of sarcoma pleural metastases. The metastatic process involves complex pathways including hematogenous spread, direct invasion, and lymphatic dissemination, with notable heterogeneity across histological subtypes. Diagnosis relies on a multimodal approach integrating imaging techniques such as CT, PET-CT, and ultrasound with pathological confirmation through cytology, histology, and molecular pathology. Recent advances in molecular techniques, particularly liquid biopsy for detecting circulating tumor cells (CTCs) and circulating tumor DNA (ctDNA), show promise for minimally invasive diagnosis and dynamic monitoring. Noncoding RNAs, including circDOCK1, have emerged as potential diagnostic biomarkers and therapeutic targets. Management requires a multidisciplinary strategy. Systemic therapy remains the cornerstone, incorporating chemotherapy, targeted agents such as tyrosine kinase inhibitors and EZH2 inhibitors, and immunotherapies including immune checkpoint inhibitors and adoptive cell therapies, with efficacy varying across subtypes. Local interventions, including thoracentesis, indwelling pleural catheters, pleurodesis, and radiotherapy, are essential for symptom palliation and local disease control. Emerging nanoparticle-based approaches demonstrate potential for enhancing targeted drug delivery and improving imaging sensitivity. Despite these advances, overall survival remains limited. Future directions should prioritize elucidating molecular mechanisms, discovering novel biomarkers, developing personalized treatment strategies based on multi-omics profiling, optimizing local therapies, and designing innovative clinical trials. Global collaborations leveraging artificial intelligence may accelerate the analysis of large-scale data, further facilitating diagnostic and therapeutic advancements.