Nevala Riikka, Jäämaa Sari, Tukiainen Erkki, Tarkkanen Maija, Räsänen Jari, Blomqvist Carl, Sampo Mika
Comprehensive Cancer Center, Helsinki University Hospital (HUH), Helsinki, Finland.
Medical Faculty, University of Helsinki, Helsinki, Finland.
J Surg Oncol. 2019 Aug;120(2):168-175. doi: 10.1002/jso.25504. Epub 2019 May 27.
A single-institution experience of pulmonary metastasectomy in soft tissue sarcoma (STS) was retrospectively reviewed. Our specific aim was to examine, whether the resection of pulmonary metastases could be curative. We also compared overall survival (OS) of patients after complete or incomplete pulmonary resection and nonsurgical treatment.
Between 1987 and 2016, 1580 patients were treated for STS with curative intent by Soft Tissue Sarcoma Group at Helsinki University Hospital, Finland. Three hundred forty-seven patients (22%) developed advanced disease and 130 STS patients (9%) developed pulmonary metastases as first systemic relapse. Seventy four patients (5%) were operated for lung metastases.
Fifty-five patients (42%) had a complete and 19 (15%) incomplete resection. Fifty-six (43%) were unoperated. Median OS after complete or incomplete metastasectomy, chemotherapy, or best supportive care was 22, 18, 8, and 5 months, respectively. Twelve patients (9%) developed no further metastases and are alive with no evidence of disease. Disease-free survival (DFS) for completely resected patients was 17% at 5 years. All long-term survivors had oligometastatic disease and they underwent one to three complete metastasectomies.
Complete pulmonary metastasectomy in STS results in 5 years DFS in nearly one-fifth of patients. Most of these patients are probably cured.
回顾性分析了一家机构对软组织肉瘤（STS）进行肺转移瘤切除术的经验。我们的具体目的是研究肺转移瘤切除是否可治愈。我们还比较了肺切除完全或不完全以及非手术治疗患者的总生存期（OS）。
1987年至2016年期间，芬兰赫尔辛基大学医院软组织肉瘤组对1580例有治愈意向的STS患者进行了治疗。347例（22%）患者发生晚期疾病，130例（9%）STS患者发生肺转移作为首次全身复发。74例（5%）患者接受了肺转移瘤手术。
55例（42%）患者完全切除，19例（15%）不完全切除。56例（43%）未手术。完全或不完全切除转移瘤、化疗或最佳支持治疗后的中位OS分别为22个月、18个月、8个月和5个月。12例（9%）患者未发生进一步转移，目前存活且无疾病证据。完全切除患者的无病生存期（DFS）在5年时为17%。所有长期存活者均为寡转移疾病，且接受了一至三次完全性转移瘤切除术。
STS患者行完全性肺转移瘤切除术可使近五分之一的患者获得5年DFS。这些患者中的大多数可能已治愈。
