Giuliano Katherine, Sachs Teviah, Montgomery Elizabeth, Guzzetta Angela, Brock Malcolm, Pawlik Timothy M, Yang Stephen C, Ahuja Nita
School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States.
Department of Surgery, Boston University, Boston, Massachusetts, United States.
Thorac Cardiovasc Surg. 2016 Mar;64(2):150-8. doi: 10.1055/s-0035-1563538. Epub 2015 Sep 4.
The most common site of metastasis for soft tissue sarcomas (STSs) is the lung. In patients who are candidates for resection, metastasectomy improves survival. Debate remains, however, on approach and patient selection for surgery.
We retrospectively analyzed demographics, tumor characteristics, peri- and postoperative factors for 53 patients who underwent lung metastasectomy for STS from 1989 to 2013. Disease-free intervals (DFIs) and survival were determined. Kaplan-Meier estimates and log-rank test were used for comparison and survival analyses.
Median overall survival (diagnosis to death or last visit) was 59.9 months (IQR: 118.5), with mean follow-up of 85.3 months (SD: 69.5). Post-lung metastasectomy survival was 82.9%, 52.2%, 28.3%, and 13.3% at 1, 3, 5, and 10 years, respectively. Age at diagnosis of less than 50 years (p = 0.037), a low pathologic grade (p = 0.040), and a DFI until metastasis of greater than 13.5 months (p = 0.007) were significant predictors of improved survival.
Patients diagnosed at a younger age with low-grade tumors and those with a longer DFI prior to metastasis diagnosis gain the greatest survival advantage with surgery.
软组织肉瘤（STS）最常见的转移部位是肺。对于适合手术切除的患者，肺转移瘤切除术可提高生存率。然而，关于手术方法和患者选择仍存在争议。
我们回顾性分析了1989年至2013年间53例行肺转移瘤切除术治疗STS患者的人口统计学、肿瘤特征、围手术期和术后因素。确定无病生存期（DFI）和生存率。采用Kaplan-Meier估计法和对数秩检验进行比较和生存分析。
中位总生存期（从诊断到死亡或最后一次随访）为59.9个月（四分位间距：118.5），平均随访85.3个月（标准差：69.5）。肺转移瘤切除术后1年、3年、5年和10年的生存率分别为82.9%、52.2%、28.3%和13.3%。诊断时年龄小于50岁（p = 0.037）、病理分级低（p = 0.040）以及转移前DFI大于13.5个月（p = 0.007）是生存改善的显著预测因素。
诊断时年龄较轻、肿瘤分级低以及转移诊断前DFI较长的患者通过手术获得的生存优势最大。
