Marulli Giuseppe, Mammana Marco, Comacchio Giovanni, Rea Federico
Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Padova, Italy.
J Thorac Dis. 2017 Oct;9(Suppl 12):S1305-S1315. doi: 10.21037/jtd.2017.03.177.
Sarcomas are a heterogeneous group of malignancies with a marked propensity to metastasize to the lungs. Chemotherapy offers only a limited benefit in metastatic disease, whereas lung metastasectomy, in selected cases, can lead to long-term survival. Other local ablative techniques and hybrid therapies have been proposed. A multidisciplinary setting is of paramount importance for choosing the most appropriate treatment for each case. There is no randomized controlled trial providing formal evidence of the effectiveness of lung metastasectomy. Main areas of controversy concern the selection of surgical candidates, the operative approach and the role of chemotherapy. Five-year survival rates range from 15% to 50.9%, as reported mainly in retrospective case-series in which several prognostic factors were identified. In this article, the authors review the surgical management of sarcoma metastases to the lung, with a particular focus on the outcomes and prognostic factors associated with long-term survival after resection. The role of chemotherapy and other adjunctive therapies is also discussed.
肉瘤是一组异质性恶性肿瘤，具有明显的转移至肺部的倾向。化疗对转移性疾病仅提供有限的益处，而在某些病例中，肺转移瘤切除术可带来长期生存。其他局部消融技术和综合治疗方法也已被提出。多学科协作对于为每个病例选择最合适的治疗方法至关重要。尚无随机对照试验提供肺转移瘤切除术有效性的正式证据。主要的争议领域涉及手术候选者的选择、手术方式以及化疗的作用。据主要在回顾性病例系列中报道，五年生存率在15%至50.9%之间，其中确定了几个预后因素。在本文中，作者回顾了肉瘤肺转移的外科治疗，特别关注切除术后与长期生存相关的结果和预后因素。还讨论了化疗和其他辅助治疗的作用。
