Tumor Immunology Section, Surgery Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Md 20892, USA.
J Thorac Cardiovasc Surg. 2010 Dec;140(6):1276-82. doi: 10.1016/j.jtcvs.2010.05.020. Epub 2010 Jul 2.
Although refractory to chemotherapy, metastatic melanoma may respond to adoptive immunotherapy. As novel treatments evolve, surgeons may be asked to perform metastasectomy not only for palliation or potential cure but also for isolation of tumor-infiltrating lymphocytes. This study was undertaken to examine outcomes of patients with melanoma undergoing thoracic metastasectomy in preparation for investigational immunotherapy.
A retrospective review identified 107 consecutive patients who underwent 116 thoracic metastasectomy procedures from April 1998 to July 2009. Indications for surgical intervention included procurement of tumor-infiltrating lymphocytes, rendering of patients to no evaluable disease status, palliation, and diagnosis. Response Evaluation Criteria in Solid Tumors criteria were used to assess tumor response.
Thoracotomy, lobectomy, and video-assisted thoracoscopic surgery with nonanatomic resection were the most common procedures. Major complications included 1 death and 1 coagulopathy-induced hemothorax. Seventeen patients were rendered to no evaluable disease status. Virtually all patients with residual disease had tumor specimens cultured for tumor-infiltrating lymphocytes; approximately 70% of tumor-infiltrating lymphocyte cultures exhibited antitumor reactivity. Of the 91 patients with residual or recurrent disease, 24 (26%) underwent adoptive cell transfer of tumor-infiltrating lymphocytes, of whom 7 exhibited objective responses (29% response rate and 8% based on intent to treat). Rapid disease progression precluded tumor-infiltrating lymphocyte therapy in most cases. Actuarial 1- and 5-year survival rates for patients rendered to no evaluable disease status or receiving or not receiving tumor-infiltrating lymphocytes were 93% and 76%, 64% and 33%, and 43% and 0%, respectively.
Relatively few patients currently having thoracic metastasectomy undergo adoptive cell transfer. Continued refinement of tumor-infiltrating lymphocyte expansion protocols and improved patient selection might increase the number of patients with melanoma benefiting from these interventions.
转移性黑色素瘤虽然对化疗有耐药性，但可能对过继免疫治疗有反应。随着新疗法的发展，外科医生可能不仅需要进行转移灶切除术以缓解症状或潜在治愈，还需要分离肿瘤浸润淋巴细胞。本研究旨在探讨为接受过继免疫治疗而接受胸转移灶切除术的黑色素瘤患者的结局。
回顾性分析 1998 年 4 月至 2009 年 7 月期间连续 107 例患者的 116 例胸转移灶切除术。手术干预的指征包括获取肿瘤浸润淋巴细胞、使患者达到无可评估疾病状态、缓解症状和诊断。采用实体瘤反应评价标准评估肿瘤反应。
最常见的手术方法是开胸手术、肺叶切除术和非解剖性电视辅助胸腔镜手术。主要并发症包括 1 例死亡和 1 例凝血功能障碍性血胸。17 例患者达到无可评估疾病状态。几乎所有有残留疾病的患者均进行了肿瘤标本培养以获取肿瘤浸润淋巴细胞；约 70%的肿瘤浸润淋巴细胞培养显示抗肿瘤反应。在 91 例有残留或复发性疾病的患者中，24 例（26%）接受了肿瘤浸润淋巴细胞过继细胞转移，其中 7 例（29%的有效率，基于意向治疗的 8%）显示出客观反应。大多数情况下，疾病快速进展使肿瘤浸润淋巴细胞治疗无法进行。达到无可评估疾病状态或接受或不接受肿瘤浸润淋巴细胞治疗的患者的 1 年和 5 年生存率分别为 93%和 76%、64%和 33%、43%和 0%。
目前仅有相对较少的胸转移患者接受过继细胞转移。不断完善肿瘤浸润淋巴细胞扩增方案和改进患者选择，可能会增加受益于这些干预措施的黑色素瘤患者数量。
