Resection of Pulmonary and Extrapulmonary Sarcomatous Metastases Is Associated With Long-Term Survival
Resection of Pulmonary and Extrapulmonary Sarcomatous Metastases Is Associated With Long-Term Survival
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DOI：
10.1016/j.athoracsur.2009.04.144
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发表时间：
2009-09-01
影响因子：
4.6
通讯作者：
Mehran, Reza
中科院分区：
文献类型：
--
作者：
Blackmon, Shanda H.;Shah, Nipam;Mehran, Reza
背景肺外肉瘤转移的存在历来是肺转移瘤切除术的禁忌症。因此，我们回顾了我们的经验，切除肺转移瘤的患者谁记录肺外转移，以确定长期的结果。自1998年至2006年，234例患者接受了肺动脉瓣切除术。它们被归类如下：A组（单纯肺外转移瘤切除术）; B1组（同期或先行肺外转移瘤切除术）; B2组（同期或先行肺外转移瘤非手术治疗）; C1组（晚期肺外转移瘤切除术）; C2组（晚期肺外转移瘤未切除）。A、B1和B2组分别包括147例（62.8%）、26例（11.1%）和13例（5.6%）患者。A组、B1组和B2组从肺叶切除术开始的中位生存期分别为35.5、37.8和13.5个月。三组之间的比较显示，A组与B1组的生存率无显著差异（p = 0.96），但A组与B2组（p <0.001）和B1组与B2组（p <0.001）的生存率存在差异。增加生存率的预后因素包括3次或更多次再次肺手术，肺复发之间的平均时间大于12个月，胸外复发之间的平均时间大于24个月，以及无病间期延长。生存率下降的预后因素包括3个或更多的肺转移和B2组患者。这些结果提示肺外转移瘤不应再被视为肉瘤性肺转移瘤切除的禁忌症。当肺和肺外转移瘤都可以完全切除时，可以实现长期生存。(Ann Thorac Surg 2009; 88：877 - 85）（C）2009年，胸外科医师协会
Background. The presence of extrapulmonary sarcomatous metastases has traditionally been a contraindication for the resection of pulmonary metastases. We, therefore, reviewed our experience with resection of pulmonary metastases in patients who had documented extrapulmonary metastases to determine long-term outcome.Methods. From 1998 to 2006, 234 patients underwent pulmonary metastasectomy. They were grouped as follows: group A (lung metastasectomy only); group B1 (with either synchronous or prior extrapulmonary metastasectomy); group B2 (with nonsurgical treatment of synchronous or prior extrapulmonary metastases); group C1 (with later extrapulmonary metastasectomy); group C2 (with later extrapulmonary metastasis which was not resected).Results. Groups A, B1, and B2 consisted of 147 (62.8%), 26 (11.1%), and 13 (5.6%) patients, respectively. The median survival from lung metastasectomy date was 35.5, 37.8, and 13.5 months in groups A, B1, and B2, respectively. Comparison among the three groups showed no significant survival difference in groups A versus B1 (p = 0.96), but a survival difference was found comparing groups A versus B2 (p < 0.001) and B1 versus B2 (p < 0.001). Prognostic factors for increased survival included 3 or greater redo pulmonary operations, greater than 12 month mean time between pulmonary recurrences, greater than 24 month mean time between extrathoracic recurrences, and a prolonged disease-free interval. Prognostic factors for decreased survival included 3 or greater pulmonary metastases and group B2 patients.Conclusions. These results suggest extrapulmonary metastases should no longer be viewed as a contraindication to resection of sarcomatous pulmonary metastases. Long-term survival can be achieved when a complete resection is possible for both the pulmonary and extrapulmonary metastases. (Ann Thorac Surg 2009; 88: 877-85) (C) 2009 by The Society of Thoracic Surgeons