肺转移瘤切除术的长期疗效：一项多中心分析。

Long-term outcomes of pulmonary metastasectomy: a multicentre analysis.

机构信息

Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia.

Department of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.

出版信息

ANZ J Surg. 2021 Jun;91(6):1260-1265. doi: 10.1111/ans.16866. Epub 2021 Apr 18.

DOI:10.1111/ans.16866

PMID:33870609

Abstract

BACKGROUND

Many extrapulmonary neoplasms metastasize to the lungs. We conducted a retrospective review of all patients who underwent pulmonary metastasectomy for oligometastatic disease at two centres in order to determine long-term outcomes.

METHODS

The study institutions' thoracic surgery databases were searched for all patients who underwent pulmonary metastasectomy from 2000 to 2017.

RESULTS

There were a total of 476 patients who underwent pulmonary metastasectomy. Mean age at time of surgery was 57.2 ± 15.9 years. Mean number of pulmonary lesions was 1.9 ± 1.6. Mean disease-free interval (DFI) was 3.6 ± 4.3 years. The most common primary neoplasms were colorectal cancer (CRC) in 35.1% (167/476), sarcoma in 23.9% (114/476), melanoma in 16.2% (77/478), renal cell carcinoma (RCC) in 7.3% (35/476) and germ cell tumour (GCT) in 4.4% (21/476). Hospital mortality was 0.4% (2/476). Mean follow-up time was 3.8 ± 2.9 years. Survival was 88.9% (95% confidence interval 85.77-91.5) at 1 year and 49.6% (95% confidence interval 44.4-54.6) at 5 years. On multivariate Cox-regression analysis GCT (P = 0.004), CRC (P = 0.03), DFI of 36+ months (P = 0.007), R0 resection (P = 0.002) and non-anatomical, sub-lobar (wedge) resection (P = 0.002) were protective against mortality.

CONCLUSION

Pulmonary metastasectomy is associated with survival of 50% at 5-year follow-up. DFI of over 36 months, R0 resections, lesions resectable by wedge resection rather than anatomic resection and GCT and CRC primary cancers were associated with improved survival.

摘要

背景

许多肺外肿瘤转移到肺部。我们对两家中心的所有接受寡转移疾病肺转移切除术的患者进行了回顾性分析，以确定长期结果。

方法

研究机构的胸外科数据库中检索了 2000 年至 2017 年期间接受肺转移切除术的所有患者。

结果

共有 476 例患者接受了肺转移切除术。手术时的平均年龄为 57.2 ± 15.9 岁。平均肺部病变数为 1.9 ± 1.6。无疾病间隔（DFI）平均为 3.6 ± 4.3 年。最常见的原发性肿瘤是结直肠癌（CRC）占 35.1%（167/476），肉瘤占 23.9%（114/476），黑色素瘤占 16.2%（77/478），肾细胞癌（RCC）占 7.3%（35/476），生殖细胞瘤（GCT）占 4.4%（21/476）。院内死亡率为 0.4%（2/476）。平均随访时间为 3.8 ± 2.9 年。1 年生存率为 88.9%（95%置信区间 85.77-91.5），5 年生存率为 49.6%（95%置信区间 44.4-54.6）。多变量 Cox 回归分析显示，GCT（P=0.004）、CRC（P=0.03）、DFI 超过 36 个月（P=0.007）、R0 切除（P=0.002）和非解剖性、亚叶（楔形）切除（P=0.002）与死亡率降低相关。