This investigation assessed the practicality and tolerability of arterial infusion chemotherapy embolization (AICE) for patients with recurrent or metastatic soft tissue sarcoma (STS), and examined prognostic indicators that could support more personalized treatment planning. This retrospective analysis enrolled 113 individuals with recurrent/metastatic STS who underwent AICE at the Fifth Medical Center of the PLA General Hospital. Key endpoints included progression-free survival (PFS) and overall survival (OS). Survival patterns were illustrated using Kaplan–Meier curves, and potential prognostic factors were evaluated via univariate and multivariate Cox proportional hazards models. Treatment-related adverse events (TRAEs) were categorized following Society of Interventional Radiology (SIR) criteria. In the 113-patient cohort, the median OS reached 19.0 months (95% CI: 12.8–25.3), with a 2-year OS of 45.1%. The median PFS was 11.0 months (95% CI: 8.6–13.4), and the 2-year PFS was 25.7%. The objective response rate (ORR) was 37.2% (95% CI: 28.3%–46.8%), while the disease control rate (DCR) was 76.1% (95% CI: 67.1%–83.6%). Univariate testing identified tumor size, distant metastasis, number of post-operative therapies, pathological grade, and the neutrophil-to-lymphocyte ratio (NLR) as significant predictors of both OS and PFS (P < 0.05). Multivariate Cox modeling further verified that tumor size, metastasis status, number of post-surgical regimens, pathological differentiation, and short-term therapeutic response served as independent determinants of OS (P < 0.05). The most frequent TRAEs included procedure-related pain (23.0%), temporary myelosuppression (15.0%), and post-treatment fever (6.2%). No serious or fatal toxicities, and no treatment-associated deaths, were documented, reflecting excellent tolerability. AICE appears to be a viable and well-tolerated option for recurrent/metastatic STS, providing meaningful disease control and survival benefit in this patient population. Confirmation through larger prospective, multicenter investigations is warranted, along with studies integrating AICE with immune-based or targeted approaches to refine therapeutic strategies for STS.
