Suri Rakesh M, Deschamps Claude, Cassivi Stephen D, Nichols Francis C, Allen Mark S, Schleck Cathy D, Pairolero Peter C
Division of General Thoracic Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
Ann Thorac Surg. 2005 Nov;80(5):1847-52. doi: 10.1016/j.athoracsur.2005.05.004.
Factors affecting recurrence and survival after pulmonary resection for metastatic malignant fibrous histiocytoma (MFH) are not well known.
Records of patients undergoing pulmonary metastasectomy for MFH between January 1976 and January 2000 were analyzed.
There were 103 patients (46 men and 57 women). Median age was 60 years (range, 20 to 86). Malignant fibrous histiocytoma metastasis was solitary in 29 patients (28%), multiple/unilateral in 33 (32%), and multiple/bilateral in 41 (40%). Median time interval from primary tumor resection to metastasectomy was 11 months (range, 0 to 86). Wedge resection was carried out in 87 patients (84%), segmentectomy in 3 (3%), lobectomy in 3 (3%), pneumonectomy in 2 (2%), and a combination of resections in 8 (8%). Resection was complete in 93 patients (90%). Complications occurred in 11 patients (11%) and included prolonged air leak in 7, and pneumonia, empyema, atelectasis, and sepsis in 1 each. One patient died (operative mortality, 1%). Follow-up ranged from 2 weeks to 153 months (median, 18 months). Five-year survival was 21% (95% confidence interval, 14% to 31%). In the 103 patients, incomplete resection (p < 0.0001) was associated with decreased survival. Among the 93 patients with complete resection, factors associated with decreased survival included the presence of extrapulmonary disease at time of metastasectomy (p = 0.01), more than two nodules resected (p = 0.001), and adjuvant therapy after metastasectomy (p = 0.0007).
Pulmonary resection of metastatic MFH is safe. Improved survival was associated with the absence of extrapulmonary disease at time of metastasectomy, with fewer than three pulmonary nodules resected, and with a complete resection.
影响转移性恶性纤维组织细胞瘤（MFH）肺切除术后复发和生存的因素尚不清楚。
分析了1976年1月至2000年1月期间接受MFH肺转移瘤切除术患者的记录。
共有103例患者（46例男性和57例女性）。中位年龄为60岁（范围20至86岁）。恶性纤维组织细胞瘤转移为单发的有29例（28%），多发/单侧的有33例（32%），多发/双侧的有41例（40%）。从原发肿瘤切除到转移瘤切除的中位时间间隔为11个月（范围0至86个月）。87例患者（84%）行楔形切除术，3例（3%）行肺段切除术，3例（3%）行肺叶切除术，2例（2%）行全肺切除术，8例（8%）行联合切除术。93例患者（90%）切除完整。11例患者（11%）发生并发症，其中7例为持续性漏气，1例分别为肺炎、脓胸、肺不张和脓毒症。1例患者死亡（手术死亡率1%）。随访时间为2周至153个月（中位时间18个月）。5年生存率为21%（95%可信区间，14%至31%）。在103例患者中，不完全切除（p<0.0001）与生存率降低相关。在93例切除完整的患者中，与生存率降低相关的因素包括转移瘤切除时存在肺外疾病（p=0.01）、切除的结节超过两个（p=0.001）以及转移瘤切除术后的辅助治疗（p=0.0007）。
转移性MFH的肺切除术是安全的。生存率的提高与转移瘤切除时无肺外疾病、切除的肺结节少于三个以及切除完整有关。
