Welter Stefan, Grabellus Florian, Bauer Sebastian, Schuler Martin, Eberhardt Wilfried, Tötsch Martin, Stamatis Georgios
Division of Thoracic Surgery, Ruhrlandklinik, Essen, Germany.
Interact Cardiovasc Thorac Surg. 2012 Oct;15(4):612-7. doi: 10.1093/icvts/ivs269. Epub 2012 Jul 3.
Pulmonary metastasectomy is firmly established in the multidisciplinary management of patients with advanced sarcomas. While the number of metastases, completeness of resection, disease-free interval and grading of the primary sarcoma are well established prognostic factors in metastatic surgery, histological parameters are not widely evaluated. The objective of the present study was to evaluate the prognostic impact of intrapulmonary growth patterns of sarcoma metastases.
We retrospectively analysed the clinicopathological characteristics of 52 sarcoma patients who underwent surgical resection of lung metastases at our centre from January 2006 to January 2009. The histological growth characteristics of all 261 metastases have been categorized and published previously. 'Interstitial growth' was defined as a diffuse spread of the sarcoma cells into the alveolar septae at the transition of the metastasis to the normal lung tissue and was found to be prognostic. 'Pleural penetration' was defined as the infiltration and destruction of all visceral pleural layers by the tumour and was found to be a risk factor for local recurrence.
The median post-metastasectomy overall survival was 50.3 months, and the corresponding 5-year survival rate was 44.7%. Age >55 years at metastasectomy (P = 0.02), the presence of interstitial growth (P = 0.008), size of the largest metastasis >35 mm (P = 0.023) and the presence of tumour recurrence at any site after metastasectomy (P < 0.001) were identified as risk factors for death. Pleural penetration (P = 0.007) and size of the metastasis >5 mm were found to be risk factors for local intrapulmonary recurrence.
Interstitial tumour growth, which is easily detected by light microscopy, can serve as a strong predictor of survival following pulmonary metastasectomy in sarcoma patients. Obvious pleural infiltration indicates the need for larger margins.
肺转移瘤切除术已在晚期肉瘤患者的多学科治疗中得到确立。虽然转移灶数量、切除完整性、无病间期和原发肉瘤分级是转移瘤手术中公认的预后因素，但组织学参数尚未得到广泛评估。本研究的目的是评估肉瘤转移瘤肺内生长模式的预后影响。
我们回顾性分析了2006年1月至2009年1月在本中心接受肺转移瘤手术切除的52例肉瘤患者的临床病理特征。此前已对所有261个转移瘤的组织学生长特征进行了分类和报道。“间质生长”定义为肉瘤细胞在转移瘤与正常肺组织交界处弥漫性扩散至肺泡间隔，发现其具有预后意义。“胸膜侵犯”定义为肿瘤浸润并破坏所有脏层胸膜，发现其是局部复发的危险因素。
转移瘤切除术后的中位总生存期为50.3个月，相应的5年生存率为44.7%。转移瘤切除时年龄>55岁（P = 0.02）、存在间质生长（P = 0.008）、最大转移瘤直径>35 mm（P = 0.023）以及转移瘤切除术后任何部位出现肿瘤复发（P < 0.001）被确定为死亡危险因素。发现胸膜侵犯（P = 0.007）和转移瘤直径>5 mm是肺内局部复发的危险因素。
间质肿瘤生长通过光学显微镜易于检测，可作为肉瘤患者肺转移瘤切除术后生存的有力预测指标。明显的胸膜浸润表明需要更大的切缘。
