Division of Thoracic Surgery, The Brigham and Women's Hospital, Boston, MA, USA.
Ann Thorac Surg. 2011 Oct;92(4):1202-7. doi: 10.1016/j.athoracsur.2011.05.052. Epub 2011 Aug 25.
Sarcoma frequently metastasizes to the lungs, and pulmonary metastasectomy is the only treatment modality that can provide a cure for these patients. We attempted to determine the clinicopathologic features and survival determinants of a common subset of patients who undergo pulmonary metastasectomy for leiomyosarcoma.
All patients undergoing pulmonary metastasectomy at The Brigham and Women's Hospital from 1989 to 2004 were reviewed retrospectively. Analyzed variables included number, size, pathology, and location of metastases, age, gender, location of primary tumor, disease-free interval (DFI), surgical approach, margin status, adjuvant therapy, recurrence, number of metastasectomies, and disease-free and overall survival.
Eighty-two patients underwent pulmonary metastasectomy for metastases from sarcoma. Leiomyosarcoma was the most common histologic finding (n = 31; 38%). Fifteen patients with leiomyosarcoma (48%) underwent repeated pulmonary metastasectomy. Patients with leiomyosarcoma were more commonly female (77% versus 43%; p = 0.031), less frequently received chemotherapy for their primary tumor (48% versus 71%, p = 0.041), and presented with fewer number of pulmonary metastases than did patients with nonleiomyosarcoma metastases (1.9 ± 1.5 standard deviation [SD] versus 3.6 ± 4.4; p = 0.033). Although there was no difference in disease-free survival, patients with leiomyosarcoma demonstrated improved overall survival compared with those with nonleiomyosarcoma metastases (70 versus 24 months; p = 0.049). In multivariate analyses, the DFI from primary tumor resection to pulmonary metastases and the DFI from pulmonary metastasectomy to second pulmonary recurrence were identified as independent predictors of survival.
Leiomyosarcoma is a common subset of sarcomatous pulmonary metastases that behave more indolently compared with other pulmonary metastases from sarcoma. Long-term survival is achievable with an aggressive approach toward pulmonary metastasectomy and repeated pulmonary metastasectomy.
肉瘤常转移至肺部，而肺转移切除术是唯一能够治愈这些患者的治疗方式。我们试图确定一组常见的接受肺转移切除术治疗平滑肌肉瘤的患者的临床病理特征和生存决定因素。
回顾性分析 1989 年至 2004 年在布里格姆妇女医院接受肺转移切除术的所有患者。分析的变量包括转移灶的数量、大小、病理学和位置、年龄、性别、原发肿瘤的位置、无病间期（DFI）、手术方式、切缘状态、辅助治疗、复发、转移切除术的数量、无病生存和总生存。
82 例患者因肉瘤转移而行肺转移切除术。平滑肌肉瘤是最常见的组织学发现（n = 31；38%）。15 例平滑肌肉瘤患者（48%）接受了重复肺转移切除术。与非平滑肌肉瘤转移患者相比，平滑肌肉瘤患者更常见于女性（77%比 43%；p = 0.031），较少接受原发性肿瘤的化疗（48%比 71%，p = 0.041），且肺转移灶的数量也较少（1.9 ± 1.5 标准差[SD]比 3.6 ± 4.4；p = 0.033）。尽管无病生存率无差异，但与非平滑肌肉瘤转移患者相比，平滑肌肉瘤患者的总生存率有所提高（70 比 24 个月；p = 0.049）。在多变量分析中，原发性肿瘤切除至肺转移的无病间隔和肺转移切除至第二次肺复发的无病间隔被确定为生存的独立预测因素。
平滑肌肉瘤是肉瘤性肺转移的一个常见亚组，其行为比其他肉瘤性肺转移更为惰性。通过积极的肺转移切除术和重复肺转移切除术，可实现长期生存。
