Dudek Wojciech, Schreiner Waldemar, Mykoliuk Iurii, Higaze Mostafa, Sirbu Horia
Department of Thoracic Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.
J Thorac Dis. 2019 Aug;11(8):3369-3376. doi: 10.21037/jtd.2019.08.10.
Pulmonary metastasectomy (PM) has commonly been performed in patients with controlled metastatic sarcoma. We reviewed our single-institution experience with pulmonary resections for sarcoma to analyse clinical outcome and to identify prognostic factors associated with patient survival.
All sarcoma patients undergoing curative intent PM between 2008 and 2014 were retrospectively analysed. Factors related to primary tumour, metastases, applied therapy, systematic inflammation and preoperative nutritional condition, associated with survival after PM were evaluated using the univariable Cox proportional hazard model. Cut-off values of continuous variables were determined by a receiver operating characteristic (ROC) analysis.
In total, 33 patients (19 male and 14 female, median age 55 years) underwent PM for metastatic sarcoma. There were no perioperative deaths; major complications occurred in 5 (15.2%) patients. The median interval between the treatment of primary tumour and PM was 16 months (range, 0-171 months). The median size of the largest pulmonary lesion was 1.3 cm. Mean follow-up was 37 months (range, 1-100 months) and the 5-year overall survival (OS) rate after first PM was 40.4%. Resection was complete (R0) in 31 (93.9%) patients. In univariable analysis, a shorter interoperative interval [<30 months, hazard ratio (HR) 5.05, 95% confidence interval (CI): 1.15-22.19] and grade 3 (G3) sarcoma (HR 3.52, 95% CI: 1.01-12.25) were significant negative prognosticators.
Despite the lack of randomized controlled trials PM for sarcomatous disease is a reasonable therapeutic option with acceptable survival in a selected patient population. In sarcoma patients with a shorter interoperative interval and G3 tumour, shorter survival after PM can be expected.
肺转移瘤切除术（PM）常用于转移性肉瘤得到控制的患者。我们回顾了我们单机构对肉瘤患者进行肺切除术的经验，以分析临床结果并确定与患者生存相关的预后因素。
对2008年至2014年间所有接受根治性意图PM的肉瘤患者进行回顾性分析。使用单变量Cox比例风险模型评估与PM后生存相关的与原发性肿瘤、转移、应用治疗、全身炎症和术前营养状况相关的因素。连续变量的临界值通过受试者工作特征（ROC）分析确定。
共有33例患者（19例男性和14例女性，中位年龄55岁）接受了转移性肉瘤的PM。无围手术期死亡；5例（15.2%）患者发生主要并发症。原发性肿瘤治疗与PM之间的中位间隔为16个月（范围0 - 171个月）。最大肺部病变的中位大小为1.3 cm。平均随访37个月（范围1 - 100个月），首次PM后的5年总生存率（OS）为40.4%。31例（93.9%）患者切除完全（R0）。在单变量分析中，较短的手术间隔[<30个月，风险比（HR）5.05，95%置信区间（CI）：1.15 - 22.19]和3级（G3）肉瘤（HR 3.52，95% CI：1.01 - 12.25）是显著的不良预后因素。
尽管缺乏随机对照试验，但对于肉瘤疾病，PM是一种合理的治疗选择，在特定患者群体中具有可接受的生存率。在手术间隔较短和肿瘤为G3的肉瘤患者中，可预期PM后生存期较短。
