Department of Thoracic Surgery, Thoraxklinik at the University of Heidelberg, Amalienstr 5, D-69126 Heidelberg, Germany.
Lung Cancer. 2010 Sep;69(3):251-8. doi: 10.1016/j.lungcan.2010.05.003.
Patients with stage IV metastatic non-small cell lung cancer (NSCLC) are generally believed to have an incurable disease. Patients with oligometastatic disease represent a distinct subset of patients among those with metastatic disease. There is evidence that these patients have synchronous or metachronous satellite nodules in different pulmonary lobes or have solitary extrapulmonary metastases. In these cases, evidence has shown that surgical resection may provide patients with survival benefit. This article discusses the biology of the oligometastatic state in patients with lung cancer and the selection of patients for surgery, as well as the prognostic factors that influence survival of the patient. To properly select patients for an aggressive local treatment regime, accurate clinical staging is of prime importance. The use of FDG-PET should be considered for restaging if oligometastatic disease is suspected based on a patient's CT scan. A limitation of retrospective clinical studies for oligometastatic disease is that it is difficult to summarize and evaluate the available evidence for the effectiveness of surgical resection due to selection bias, and to a high degree of variability among different clinical studies. Nevertheless, we can certainly learn from the clinical experience acquired from retrospective case series to identify prognostic factors. Following surgical resection, the overall 5-year actuarial survival rate is about 28% for patients with satellite nodules and 21% for patients with ipsilateral nodules. Patients with resected brain metastasis achieve 5-year survival rates between 11% and 30%, and those with adrenalectomy for adrenal metastasis achieve 5-year survival rates of 26%.
患有 IV 期转移性非小细胞肺癌（NSCLC）的患者通常被认为患有无法治愈的疾病。寡转移疾病患者是转移性疾病患者中的一个独特亚组。有证据表明，这些患者在不同的肺叶中存在同步或异时卫星结节，或存在单发肺外转移。在这些情况下，有证据表明手术切除可为患者带来生存获益。本文讨论了肺癌寡转移状态的生物学特征以及患者选择手术的依据，以及影响患者生存的预后因素。为了正确选择接受积极局部治疗方案的患者，准确的临床分期至关重要。如果根据 CT 扫描怀疑存在寡转移疾病，则应考虑使用 FDG-PET 进行重新分期。寡转移疾病的回顾性临床研究存在一个局限性，即由于选择偏倚以及不同临床研究之间存在高度变异性，难以总结和评估手术切除有效性的现有证据。然而，我们当然可以从回顾性病例系列中获得的临床经验中吸取教训，以确定预后因素。手术后，卫星结节患者的 5 年总生存率约为 28%，同侧结节患者的 5 年生存率约为 21%。接受脑转移切除术的患者 5 年生存率在 11%至 30%之间，接受肾上腺切除术治疗肾上腺转移的患者 5 年生存率为 26%。
