Nobori Yuya, Anraku Masaki, Yamauchi Yoshikane, Mun Mingyon, Yoshino Ichiro, Nakajima Jun, Ikeda Norihiko, Matsuguma Haruhisa, Iwata Takekazu, Shintani Yasushi, Nakayama Mitsuo, Oyama Takahiko, Chida Masayuki, Kuroda Hiroaki, Hashimoto Hiroshi, Azuma Yoko, Funai Kazuhito, Endoh Makoto, Uemura Yukari, Kawamura Masafumi
Department of Thoracic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Department of Thoracic and Thyroid Surgery, Kyorin University School of Medicine, Tokyo, Japan.
JTCVS Open. 2023 Jan 30;13:411-422. doi: 10.1016/j.xjon.2023.01.014. eCollection 2023 Mar.
There is little evidence of the outcome of pulmonary metastasectomy for uterine tumors when comparing different histologies. This study aimed to delineate the primary histology that leads to more favorable outcomes after pulmonary metastasectomy.
The database of the Metastatic Lung Tumor Study Group of Japan for 1984 to 2016 was used to analyze the outcomes of patients with gynecologic malignancies who underwent pulmonary metastasectomy. Prognostic factors and long-term outcomes were compared according to the histology of the primary uterine tumors, specifically adenocarcinoma, squamous cell carcinoma, and sarcoma. The adjusted hazard risks according to disease-free intervals (DFIs) and the number and maximum size of resected tumors were also analyzed to delineate the pattern of risk trends.
A total of 319 patients were included in the analysis (122 with adenocarcinomas, 113 with squamous cell carcinomas, 46 with sarcomas, and 38 with other types). The 5-year survival rate was 66.5% for the entire cohort, 71.6% for the patients with adenocarcinoma, 61.3% for those with squamous cell carcinoma, and 55.4% for those with sarcoma. Multivariate analyses identified the positive prognostic factors as DFI ≥12 months in adenocarcinoma and sarcoma and the primary site (corpus) of uterine tumors in adenocarcinoma. The nonlinear adjusted hazard risks indicated that a shorter DFI was associated with an elevated risk of death in patients with adenocarcinoma and sarcoma.
The survival outcome after pulmonary metastasectomy varies according to primary tumor histology, and the prognostic factors differ among histologic subtypes. Surgical indications should be determined based on the prognostic factors for each histology.
在比较不同组织学类型时，关于子宫肿瘤肺转移瘤切除术的结果的证据很少。本研究旨在确定哪种原发性组织学类型在肺转移瘤切除术后能带来更有利的结果。
使用日本转移性肺肿瘤研究组1984年至2016年的数据库，分析接受肺转移瘤切除术的妇科恶性肿瘤患者的结果。根据原发性子宫肿瘤的组织学类型，特别是腺癌、鳞状细胞癌和肉瘤，比较预后因素和长期结果。还分析了根据无病间期（DFI）以及切除肿瘤的数量和最大尺寸调整后的风险比，以描绘风险趋势模式。
共有319例患者纳入分析（腺癌122例，鳞状细胞癌113例，肉瘤46例，其他类型38例）。整个队列的5年生存率为66.5%，腺癌患者为71.6%，鳞状细胞癌患者为61.3%，肉瘤患者为55.4%。多因素分析确定腺癌和肉瘤中DFI≥12个月以及腺癌中子宫肿瘤的原发部位（宫体）为阳性预后因素。非线性调整后的风险比表明，较短的DFI与腺癌和肉瘤患者死亡风险升高相关。
肺转移瘤切除术后的生存结果因原发性肿瘤组织学类型而异，不同组织学亚型的预后因素也不同。应根据每种组织学类型的预后因素确定手术指征。
