Radulescu I M, Popescu R, Cirstoiu M M, Cordos I, Mischianu D, Cirstoiu C F
Clinic of Thoracic Surgery, "Marius Nasta" National Institute of Pneumology, Bucharest.
Urology Department, "Dr. Carol Davila" Central Military University Emergency Hospital, Bucharest.
J Med Life. 2014 Sep 15;7(3):358-62. Epub 2014 Sep 25.
The malignant disease's ability to metastasize remains one of the major obstacles when treating patients with cancer. The indication of metastasectomy is currently limited to patients undergoing treatment of the primary tumor. Resections for lung metastases of high selected patients with urogenital cancer present minimal risks and can prolong survival. Prognostic factors that determine which patients will benefit from surgery are still unclear.
This article presents a retrospective analysis of patients who underwent lung metastases resection between 2008 and 2013 in our clinic. Among 148 patients, 8 (5.41%) had lung metastases after urologic cancers (UC), 18 (12.16%) after genital cancers (GC), 13 (8.78%) after breast tumors and 109 (73.65%) had lung metastases from other type of tumors. The overall 6 months survival was 100% for UC, 94.44 for GC, 84.62% for BC and 87.16% for others.
The criteria for surgery proved to have a positive predictive value and what should be considered are the following: prolonged disease-free interval (DFI), unilateral disease, the absence of systemic pathologies, oncological margins resecability and less than 3 radioimagistic detectable metastases. A negative prognosis was observed in those with primary tumor in the cervix, at least 3 metastases and a tumor larger than 3 cm. To determine how to select surgical candidates for pulmonary metastasectomy more precisely, further analysis of prognostic factors is evident and the need for a prospective, randomized, multicenter study is clear.
恶性疾病的转移能力仍然是治疗癌症患者时的主要障碍之一。目前，肺转移瘤切除术的适应症仅限于接受原发性肿瘤治疗的患者。对高度选择的泌尿生殖系统癌症患者的肺转移灶进行切除，风险极小，且可延长生存期。然而，目前仍不清楚哪些预后因素能决定哪些患者将从手术中获益。
本文对2008年至2013年在我院接受肺转移瘤切除术的患者进行了回顾性分析。148例患者中，8例（5.41%）为泌尿生殖系统癌症（UC）后发生肺转移，18例（12.16%）为生殖系统癌症（GC）后发生肺转移，13例（8.78%）为乳腺肿瘤后发生肺转移，109例（73.65%）为其他类型肿瘤发生肺转移。UC患者的总体6个月生存率为100%，GC患者为94.44%，BC患者为84.62%，其他患者为87.16%。
手术标准被证明具有阳性预测价值，应考虑以下因素：无病生存期（DFI）延长、单侧病变、无全身病变、肿瘤切缘可切除性以及影像学检查可发现的转移灶少于3个。宫颈原发性肿瘤、至少3个转移灶且肿瘤大于3 cm的患者预后较差。为了更精确地确定如何选择肺转移瘤切除术的手术候选者，显然需要进一步分析预后因素，并且开展一项前瞻性、随机、多中心研究的必要性也很明确。
