Division of Thoracic Surgery, Tochigi Cancer Center, Utsunomiya, Tochigi, Japan.
Ann Thorac Surg. 2011 Aug;92(2):449-53. doi: 10.1016/j.athoracsur.2011.03.097.
Systemic chemotherapy remains the standard treatment for metastatic transitional cell carcinoma (TCC) of the urinary tract. For pulmonary metastases of several malignancies, surgical therapy for selected patients has become a treatment of choice to achieve cure. However, data on pulmonary metastasectomy for urinary TCC remain limited.
From 1990 to 2005, 2,288 patients who underwent pulmonary metastasectomy for all types of malignancy were registered in the Metastatic Lung Tumor Study Group of Japan. Of these, we extracted 32 patients with TCC who underwent pulmonary metastasectomy with a curative intent from the database. We investigated the surgical outcomes of the patients, focusing on long-term progression-free survival (PFS) and modified PFS as a parameter for achieving a cure. In modified PFS, when the disease-free status had continued for longer than two years after repeated resection at the last follow-up, the first recurrence was not considered as an event.
The five-year overall survival and PFS rates were 50% and 26%, respectively. Including 3 patients who underwent a second pulmonary metastasectomy for recurrence, 9 patients survived without recurrence for more than 5 years, resulting in a modified five-year PFS rate of 40%. Multivariate analysis revealed that a pulmonary metastasis greater than 3 cm was a significantly poor prognostic factor. The modified five-year PFS rate for patients with a pulmonary metastasis smaller than 3 cm in diameter was 65%.
Pulmonary metastasectomy may have a curative role in the treatment of metastatic TCC in appropriately selected patients, especially those with a small solitary pulmonary metastasis.
全身化疗仍然是治疗转移性尿路移行细胞癌（TCC）的标准方法。对于多种恶性肿瘤的肺转移，手术治疗已成为某些患者的治疗选择，以达到治愈的目的。然而，有关 TCC 肺转移瘤切除术的数据仍然有限。
1990 年至 2005 年，日本转移性肺肿瘤研究组登记了 2288 例接受各种恶性肿瘤肺转移瘤切除术的患者。从数据库中提取了 32 例有治愈意图的 TCC 患者。我们研究了患者的手术结果，重点关注长期无进展生存（PFS）和改良 PFS 作为治愈参数。在改良 PFS 中，当在最后一次随访时进行了多次重复切除后无疾病状态持续两年以上时，第一次复发不视为事件。
五年总生存率和 PFS 率分别为 50%和 26%。包括 3 例因复发而再次进行肺转移切除术的患者，9 例患者无复发且生存时间超过 5 年，因此改良五年 PFS 率为 40%。多变量分析显示，肺转移灶大于 3cm 是一个明显的预后不良因素。直径小于 3cm 的肺转移灶患者的改良五年 PFS 率为 65%。
在适当选择的患者中，肺转移瘤切除术可能对转移性 TCC 的治疗具有治愈作用，尤其是那些具有孤立性小肺转移灶的患者。
