IMPROVED SURVIVAL AFTER RESECTION OF PULMONARY METASTASES FROM MALIGNANT-MELANOMA
IMPROVED SURVIVAL AFTER RESECTION OF PULMONARY METASTASES FROM MALIGNANT-MELANOMA
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DOI：
10.1016/0003-4975(91)91337-u
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发表时间：
1991-08-01
影响因子：
4.6
通讯作者：
ROTH, JA
中科院分区：
文献类型：
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作者：
GORENSTEIN, LA;PUTNAM, JB;ROTH, JA
回顾性分析了恶性黑色素瘤肺转移瘤切除的价值。在1981年至1989年期间，56例患者（35名男性和21名女性，平均年龄49岁）在原发性肿瘤治疗后，因组织学证实的转移性黑色素瘤进行了65次肺切除术。在开胸手术的患者中，50%（28/56）的患者以肺转移为初始复发部位。28例患者（50%）在肺转移发生前出现局部复发。共进行了8例肺叶切除术、2例肺段切除术和55例楔形切除术。54例患者（54/56，96%）接受了完全切除，无手术死亡。开胸术后5年的精确生存率为25%（中位时间间隔为18个月）。原发肿瘤的位置、组织学类型、肿瘤厚度、Clark水平、局部淋巴结转移或切除类型与生存率的提高无关。开胸手术前无区域淋巴结转移的患者的中位生存期为30个月，而所有其他患者的中位生存期为16个月（p = 0.04）。首次复发部位为肺部的患者的中位生存期为30个月，而首次局部复发患者的中位生存期为17个月（p = 0.038，对数秩检验）。尽管全身扩散，黑色素瘤孤立性肺转移患者可能受益于乳腺切除术。
The value of resecting pulmonary metastases from malignant melanoma was retrospectively examined. Between 1981 and 1989, 56 patients (35 men and 21 women with a mean age of 49 years) had 65 pulmonary resections for histologically proven metastatic melanoma after treatment of the primary tumor. In patients undergoing thoracotomy, 50% (28/56) had pulmonary metastases as the initial site of recurrence. Twenty-eight patients (50%) had local-regional recurrence before the development of lung metastases. Eight lobectomies, two segmentectomies, and 55 wedge excisions were done. Fifty-four patients (54/56, 96%) underwent complete resection, and there were no operative deaths. The postthoracotomy actuarial survival was 25% at 5 years (median interval, 18 months). Location of the primary tumor, histology, thickness, Clark level, local-regional lymph node metastases, or type of resection was not associated with improved survival. Patients without regional nodal metastases before thoracotomy had a median survival of 30 months compared with 16 months for all others (p = 0.04). Patients with lung as the site of first recurrence had a median survival of 30 months compared with 17 months for patients with initial local-regional recurrence (p = 0.038, log-rank test). Despite systemic spread, patients with isolated pulmonary metastases from melanoma may benefit from metastasectomy.