Chudgar Neel P, Brennan Murray F, Tan Kay See, Munhoz Rodrigo R, D'Angelo Sandra P, Bains Manjit S, Huang James, Park Bernard J, Adusumilli Prasad S, Tap William D, Jones David R
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York.
Ann Thorac Surg. 2017 Dec;104(6):1837-1845. doi: 10.1016/j.athoracsur.2017.07.024. Epub 2017 Nov 2.
Because recurrence is high after pulmonary metastasectomy (PM) for soft tissue sarcoma (STS), repeat PM is commonly performed. Our objective was to define the selection criteria for repeat PM among patients experiencing recurrence and to identify factors associated with survival.
We reviewed a prospectively maintained database of 539 patients undergoing PM for STS. Characteristics of the primary tumor, metastatic disease, treatment, and recurrence were examined. Multivariable Cox models were constructed to identify factors associated with the likelihood of operative selection after recurrence. Overall survival between patients with or without repeat PM was estimated using the Kaplan-Meier method, with prognostic factors identified using Cox models. Both analyses incorporated propensity score-matching weights. Factors associated with survival after repeat PM were assessed with multivariable Cox models among patients who underwent repeat PM.
After initial PM, 63% of patients (n = 341) experienced pulmonary recurrence; 141 (41%) underwent repeat PM. Patients who were younger (p = 0.033) underwent minimally invasive resection at first PM (p = 0.041), had a longer disease-free interval after first PM (p = 0.009), were without extrapulmonary disease (p < 0.001), and had fewer nodules on recurrence (p < 0.001) were more likely to undergo repeat PM. Comparison between the repeat and non-repeat PM groups demonstrated an increased hazard of death among patients managed nonoperatively. Factors associated with an increased hazard of death after second PM included preoperative chemotherapy (p = 0.008) and R1/R2 metastasectomy (p < 0.001).
Although operative selection occurs, when prognostic factors are controlled for, repeat PM for STS remains independently associated with prolonged overall survival.
由于软组织肉瘤（STS）肺转移瘤切除术后（PM）复发率较高，因此通常会进行再次PM。我们的目的是确定复发患者再次PM的选择标准，并确定与生存相关的因素。
我们回顾了一个前瞻性维护的数据库，其中包含539例接受STS-PM的患者。检查了原发肿瘤、转移性疾病、治疗和复发的特征。构建多变量Cox模型以识别复发后手术选择可能性的相关因素。使用Kaplan-Meier方法估计接受或未接受再次PM患者的总生存期，并使用Cox模型确定预后因素。两项分析均纳入倾向评分匹配权重。在接受再次PM的患者中，使用多变量Cox模型评估与再次PM后生存相关的因素。
初次PM后，63%的患者（n = 341）出现肺复发；141例（41%）接受了再次PM。年龄较小（p = 0.033）、初次PM时接受微创切除（p = 0.041）、初次PM后无病间期较长（p = 0.009）、无肺外疾病（p < 0.001）以及复发时结节较少（p < 0.001）的患者更有可能接受再次PM。再次PM组与未再次PM组的比较表明，非手术治疗患者的死亡风险增加。第二次PM后死亡风险增加的相关因素包括术前化疗（p = 0.008）和R1/R2转移瘤切除术（p < 0.001）。
尽管进行了手术选择，但在控制预后因素后，STS再次PM仍与总体生存期延长独立相关。
