General Thoracic Surgery Department, Georges Pompidou European Hospital, Paris, France.
Eur J Cardiothorac Surg. 2012 Mar;41(3):617-22. doi: 10.1093/ejcts/ezr042. Epub 2012 Jan 4.
OBJECTIVES; Patients with extrathoracic synchronous solitary metastasis and non-small cell lung cancer (NSCLC) are rare. The effectiveness of both tumour sites resection is difficult to evaluate because of the high variability among clinical studies. We reviewed our experience regarding the management and prognosis of these patients.
The charts of 4668 patients who underwent lung cancer surgery from 1983 to 2006 were retrospectively reviewed. We analysed the epidemiology, treatment, pathology and prognostic characteristics of those with extrathoracic synchronous solitary metastasis amenable to lung cancer surgery on a curative intend.
There were 94 patients (sex ratio M/F 3.2/1, mean age 56 years). Surgery included pneumonectomy (n = 27), lobectomy (n = 65) and exploratory thoracotomy (n = 2). Pathology revealed adenocarcinomas (n = 57), squamous cell carcinoma (n = 20), large cell carcinoma (n = 14) and other NSCLC histology (n = 3). Lymphatic extension was N0 (n = 46), N1 (n = 17) and N2 (n = 31). Metastasis involved the brain (n = 57), adrenal gland (n = 12), bone (n = 14), liver (n = 5) and skin (n = 6). Sixty-nine metastases were resected. Five-year survival rate was 16% (median 13 months). Induction therapy, adenocarcinoma, N0 staging and lobectomy were criteria of better prognosis, but metastasis resection was not.
These results suggest that extrathoracic synchronous solitary metastasis of pN0 adenocarcinoma may achieve long-term survival in the case of lung resection with or without metastasis resection. This pattern may reflect a specific tumour biology whose solitary metastasis benefits both from surgical or non-surgical treatment.
胸腔外同步单发转移且患有非小细胞肺癌（NSCLC）的患者较为罕见。由于临床研究间的高度变异性，两处肿瘤部位切除术的效果难以评估。我们回顾了此类患者的管理和预后经验。
回顾性分析了 1983 年至 2006 年间接受肺癌手术的 4668 例患者的病历。我们分析了这些以治愈为目的、可接受肺癌手术的胸腔外同步单发转移患者的流行病学、治疗、病理学和预后特征。
共有 94 例患者（男女比例 3.2:1，平均年龄 56 岁）。手术包括肺切除术（n=27）、肺叶切除术（n=65）和剖胸探查术（n=2）。病理显示为腺癌（n=57）、鳞癌（n=20）、大细胞癌（n=14）和其他 NSCLC 组织学（n=3）。淋巴结扩展为 N0（n=46）、N1（n=17）和 N2（n=31）。转移累及脑（n=57）、肾上腺（n=12）、骨（n=14）、肝（n=5）和皮肤（n=6）。切除了 69 处转移灶。5 年生存率为 16%（中位生存时间为 13 个月）。诱导治疗、腺癌、N0 分期和肺叶切除术是预后较好的标准，但转移灶切除术不是。
这些结果表明，在有或无转移灶切除术的情况下，行肺切除术可使胸腔外同步单发转移的 pN0 腺癌获得长期生存。这种模式可能反映了一种特定的肿瘤生物学，其单发转移既受益于手术治疗，也受益于非手术治疗。
