Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan.
Department of Otorhinolaryngology/Head and Neck Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.
Gen Thorac Cardiovasc Surg. 2021 Aug;69(8):1214-1221. doi: 10.1007/s11748-021-01611-7. Epub 2021 Mar 23.
The innovation of novel systemic chemo/immunotherapy for metastatic head and neck cancer might contribute to prognostic improvement. We aimed to clarify the recent characteristics and outcomes of pulmonary metastasectomy for head and neck cancer.
Twenty-five patients who underwent pulmonary metastasectomy from January 2011 to December 2016 were included. The clinicopathological factors and survival were assessed by retrospective chart reviews.
The median follow-up period was 39 months (range, 7-94 months). The median age was 66 years (range, 20-89 years), and 23 males were included. The primary tumor locations were as follows: pharynx (n = 12), nasal/paranasal cavity (n = 5), larynx (n = 4), and others (n = 4). The 5-year overall survival rate was 49%. In the univariate analysis, a history of local recurrence before pulmonary metastasis was an independent predictor of a poor prognosis. In 90% of patients with recurrence after pulmonary metastasectomy, the site of recurrence was the lung. Eight patients achieved long-term survival without any evidence of recurrence (median: 45 months). Molecular targeting chemotherapy and immune-checkpoint inhibitors were used in five patients with systemic recurrence after pulmonary metastasectomy, leading to preferable survival.
In the current era of advances in systemic chemotherapy and immunotherapy, surgical indication has not changed for resectable pulmonary metastases and selected patients can still benefit from pulmonary metastasectomy. Further investigation is needed to clarify the significance of systemic therapy in patients with pulmonary metastasis of head and neck cancer.
新型全身化疗/免疫疗法治疗转移性头颈部癌的创新可能有助于改善预后。我们旨在阐明头颈部癌肺转移瘤切除术的最新特征和结果。
纳入 2011 年 1 月至 2016 年 12 月期间接受肺转移瘤切除术的 25 例患者。通过回顾性病历审查评估临床病理因素和生存情况。
中位随访时间为 39 个月（范围，7-94 个月）。中位年龄为 66 岁（范围，20-89 岁），包括 23 名男性。原发肿瘤部位如下：咽（n=12）、鼻/副鼻窦（n=5）、喉（n=4）和其他部位（n=4）。5 年总生存率为 49%。单因素分析显示，肺转移前局部复发史是预后不良的独立预测因素。在肺转移瘤切除术后复发的 90%患者中，复发部位为肺部。8 例患者无复发证据，长期生存（中位：45 个月）。肺转移瘤切除术后全身复发的 5 例患者接受了分子靶向化疗和免疫检查点抑制剂治疗，生存情况较好。
在全身化疗和免疫治疗进展的当前时代，对于可切除的肺转移灶，手术指征没有改变，仍有选择的患者可以从肺转移瘤切除术获益。需要进一步研究以阐明全身治疗对头颈部癌肺转移患者的意义。
