Division of Surgical Oncology, Department of Surgery, Virginia Commonwealth University and Massey Cancer Center, Richmond, Virginia, USA.
J Thorac Dis. 2012 Aug;4(4):420-4. doi: 10.3978/j.issn.2072-1439.2012.07.16.
Breast cancer is the second leading cause of cancer death among women in the United States. Patients with metastatic disease have a median survival of 12 to 24 months and most present with disseminated disease; however, some present with isolated pulmonary metastases which may benefit from surgical resection. Although the initial experience with resection of pulmonary metastases in the late 19th and early 20th centuries produced some encouraging results, patient selection criteria for resection were strict until the mid-1960's when a significant improvement in survival resulted from aggressive management of pulmonary metastasis in osteosarcoma patients. The application of this approach to breast cancer patients similarly produced encouraging results, with five year survival rates in select patients ranging from 36-54%, but this was not without controversy. In this review, we discuss the evaluation of the breast cancer patient with a pulmonary nodule, the historical evolution of the role of surgery in the management of pulmonary metastasis, as well as the latest evidence to guide patient selection and management.
乳腺癌是美国女性癌症死亡的第二大主要原因。转移性疾病患者的中位生存期为 12 至 24 个月，大多数患者表现为播散性疾病；然而，一些患者表现为孤立性肺转移，可能受益于手术切除。尽管 19 世纪末和 20 世纪初切除肺转移的初步经验取得了一些令人鼓舞的结果，但直到 20 世纪 60 年代中期，当骨肉瘤患者的肺转移得到积极治疗后，患者的生存时间显著延长，肺转移切除术的患者选择标准才变得严格。同样，将这种方法应用于乳腺癌患者也取得了令人鼓舞的结果，选择性患者的五年生存率为 36-54%，但这并非没有争议。在这篇综述中，我们讨论了对有肺结节的乳腺癌患者的评估、手术在管理肺转移中的作用的历史演变，以及指导患者选择和管理的最新证据。
