Pfannschmidt Joachim, Hoffmann Hans, Muley Thomas, Krysa Sabine, Trainer Christine, Dienemann Hendrik
Department of Thoracic Surgery, Thoraxklinik-Heidelberg, Germany.
Ann Thorac Surg. 2002 Nov;74(5):1653-7. doi: 10.1016/s0003-4975(02)03803-1.
Pulmonary resection in metastatic renal cell carcinoma is an accepted method of treatment. The purpose of this study was to determine the clinical course, outcome, and prognostic factors after surgery.
Between 1985 and 1999, 191 patients (145 men, 46 women) with pulmonary metastases from a renal cell carcinoma underwent surgical resection. Inclusion criteria for the study were the absence of primary tumor recurrence and other extrapulmonary metastases. Complete resection (CR) was achieved in 149 patients.
The overall 5-year survival rate was 36.9%. The 5-year survival rate after complete metastasectomy and incomplete resection was 41.5% and 22.1%, respectively. In patients with pulmonary or mediastinal lymph node metastases, we observed after complete resection a 5-year survival rate of 24.4%, whereas the rate was 42.1% in patients without lymph node involvement. A significantly longer survival was observed for patients with fewer than seven pulmonary metastases compared with patients with more than seven metastases (46.8% vs 14.5%). For surgically rendered complete resection (CR) patients with a disease-free interval of 0 to 23 months, the 5-year survival rate was 24.7% compared with 47% for those with more than a 23-month disease-free interval. By multivariate analyses, we showed that the number of pulmonary metastases, the involvement of lymph node metastases, and the length of the disease-free interval were all predictors of survival after complete resection.
We conclude that pulmonary resection in metastatic renal cell carcinoma is a safe and effective treatment that offers improved survival benefit. Prognosis-related criteria are identified that support patient selection for surgery.
转移性肾细胞癌的肺切除术是一种公认的治疗方法。本研究的目的是确定手术后的临床病程、结局和预后因素。
1985年至1999年间，191例（145例男性，46例女性）肾细胞癌肺转移患者接受了手术切除。本研究的纳入标准为无原发肿瘤复发及其他肺外转移。149例患者实现了完全切除（CR）。
总体5年生存率为36.9%。完全切除转移灶和不完全切除后的5年生存率分别为41.5%和22.1%。在有肺或纵隔淋巴结转移的患者中，我们观察到完全切除后的5年生存率为24.4%，而无淋巴结受累患者的这一比例为42.1%。与有七个以上转移灶的患者相比，肺转移灶少于七个的患者观察到显著更长的生存期（46.8%对14.5%）。对于手术实现完全切除（CR）且无病间期为0至23个月的患者，5年生存率为24.7%，而无病间期超过23个月的患者为47%。通过多变量分析，我们表明肺转移灶数量、淋巴结转移情况和无病间期长度均为完全切除后生存的预测因素。
我们得出结论，转移性肾细胞癌的肺切除术是一种安全有效的治疗方法，可提高生存获益。确定了与预后相关的标准，以支持手术患者的选择。
