Meacci Elisa, Nachira Dania, Congedo Maria Teresa, Porziella Venanzio, Chiappetta Marco, Ferretti Gianmaria, Iaffaldano Amedeo, Ciavarella Leonardo Petracca, Margaritora Stefano
Department of General Thoracic Surgery, A. Gemelli University Hospital, Catholic University of Sacred Heart of Rome, Rome, Italy.
J Thorac Dis. 2017 Oct;9(Suppl 12):S1267-S1272. doi: 10.21037/jtd.2017.05.04.
The lung is one of the sites most frequently affected by metastatic renal cell carcinoma (mRCC). Nonsurgical therapy for mRCC has limited efficacy, while the 5-year survival rates data published in literature after pulmonary surgery for metastasectomy, emphasize the role of surgery as the treatment that guarantees the best effectiveness in pulmonary resectable metastases.
From January 2000 to March 2016, 27 patients underwent pulmonary metastasectomy for metastatic renal cancer was retrospectively reviewed. Primary renal cancer was controlled in all patients and there was no other metastatic site in addition to the lung, at the time of metastasectomy. The aim of the study was to identify outcomes and prognostic factors in association with survival after complete pulmonary resection of metastases in a subgroup of patients with isolated pulmonary metastases from RCC.
Five- and 10-year overall survival (OS) from first pulmonary metastasectomy was 75% and 59%, respectively. Independent prognostic factor influencing survival were: dimension of pulmonary metastases ≥2 cm (3-year survival: 67% . 100%; P=0.014) and disease free interval (DFI) ≥5 years (3-year survival: 94% . 28%; P=0.05). The only independent prognostic factors affecting DFI was the dimension of pulmonary metastases ≥2 cm (5-year DFI: 67% . 89%; P=0.03) at univariate analysis.
Considering the good results based on high long-term efficacy and low morbidity after metastases surgical resection, we always recommend metastasectomy in patients with technically resectable metastases, especially in case of long DFI and reduced dimension of pulmonary lesions.
肺是转移性肾细胞癌（mRCC）最常受累的部位之一。mRCC的非手术治疗疗效有限，而文献中公布的肺转移瘤切除术后5年生存率数据强调了手术作为保证肺可切除转移瘤最佳疗效的治疗方法的作用。
回顾性分析2000年1月至2016年3月期间27例行肺转移瘤切除术治疗转移性肾癌的患者。所有患者的原发性肾癌均得到控制，在转移瘤切除时，除肺部外无其他转移部位。本研究的目的是确定孤立性肺转移的肾癌患者亚组中，肺转移瘤完全切除术后与生存相关的结局和预后因素。
首次肺转移瘤切除术后5年和10年总生存率（OS）分别为75%和59%。影响生存的独立预后因素为：肺转移瘤直径≥2 cm（3年生存率：67%对100%；P=0.014）和无病间期（DFI）≥5年（3年生存率：94%对28%；P=0.05）。单因素分析显示，影响DFI的唯一独立预后因素是肺转移瘤直径≥2 cm（5年DFI：67%对89%；P=0.03）。
考虑到转移瘤手术切除后长期疗效高、发病率低的良好结果，我们始终建议对技术上可切除转移瘤的患者进行转移瘤切除术，尤其是在DFI长且肺部病变尺寸减小的情况下。
