Stork Theresa, Hegedüs Balazs, Guder Wiebke, Hamacher Rainer, Hardes Jendrik, Kaths Moritz, Plönes Till, Pöttgen Christoph, Schildhaus Hans-Ulrich, Streitbürger Arne, Treckmann Juergen, Bauer Sebastian, Aigner Clemens, Collaud Stéphane
Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany.
German Cancer Consortium (DKTK), Center Essen, Germany.
Ann Surg Oncol. 2022 May 12;29(7):4429-36. doi: 10.1245/s10434-022-11806-8.
Leiomyosarcoma (LMS) most frequently metastasizes to the lung. Metastatic LMS is considered incurable. Selected patients may benefit from pulmonary metastasectomy (PM) within multimodal therapy. This study analyzed the prognostic relevance of clinicopathologic factors in these patients.
Patients with metastatic LMS to the lung treated in our center from 2004 to 2020 were included in this single-center retrospective study. Overall survival (OS), progression-free survival (PFS), and prognostic factors were analyzed.
The study had 64 patients (33 males, 52%) with metastatic LMS to the lung. The 5-year OS was 55% after the diagnosis of pulmonary metastases. Age older than 60 years at the primary tumor diagnosis, primary tumor larger than 70 mm, and five or more lung metastases were associated with poorer OS. Of the 64 patients, 44 underwent PM. The postoperative mortality rate was 0%. The patients selected for PM were younger and had smaller primary tumors, fewer metastases, and metastases that more often were metachronous. Metastasis grade (G1 vs. G2/3) and size (20-mm cutoff) were significant prognostic factors for OS (p = 0.05) and PFS (p = 0.028) after PM, respectively. The 44 patients who underwent PM had a survival benefit compared with the patients who were selected but did not undergo PM (n = 6) and the patients who were not selected for PM (n = 14). Three patients (7%) were alive and free of disease at the last follow-up visit respectively 5.5, 9, and 12 years after PM.
For patients with leiomyosarcoma, PM is safe. Despite aggressive multimodal treatment, most patients will experience recurrence and eventually die of their disease. However, a small subgroup of patients could potentially be cured after PM.
平滑肌肉瘤（LMS）最常转移至肺部。转移性LMS被认为无法治愈。部分患者可能在多模式治疗中受益于肺转移瘤切除术（PM）。本研究分析了这些患者中临床病理因素的预后相关性。
本单中心回顾性研究纳入了2004年至2020年在我们中心接受治疗的肺转移性LMS患者。分析总生存期（OS）、无进展生存期（PFS）及预后因素。
该研究纳入了64例肺转移性LMS患者（33例男性，占52%）。肺转移诊断后的5年总生存率为55%。原发肿瘤诊断时年龄大于60岁、原发肿瘤大于70mm以及存在五个或更多肺转移与较差的总生存率相关。64例患者中，44例接受了PM。术后死亡率为0%。被选择接受PM的患者更年轻，原发肿瘤更小，转移灶更少，且转移灶更常为异时性。转移瘤分级（G1与G2/3）和大小（以20mm为界）分别是PM术后总生存率（p = 0.05）和无进展生存率（p = 0.028）的显著预后因素。与被选择但未接受PM的患者（n = 6）以及未被选择接受PM的患者（n = 14）相比，接受PM的44例患者有生存获益。分别在PM术后5.5年、9年和12年的最后一次随访时，有3例患者（7%）存活且无疾病。
对于平滑肌肉瘤患者，PM是安全的。尽管进行了积极的多模式治疗，但大多数患者仍会复发并最终死于该疾病。然而，一小部分患者在PM术后有可能被治愈。
