Pogrebniak H W, Pass H I
Thoracic Oncology Section, National Cancer Institute, Bethesda, Maryland 20892.
Semin Surg Oncol. 1993 Mar-Apr;9(2):142-9. doi: 10.1002/ssu.2980090213.
The ability to predict which patients will derive a survival benefit from pulmonary metastasectomy is limited. Most patients remain asymptomatic until the disease becomes advanced, and therefore computerized tomography (CT) of the chest has become the standard of care for follow-up of patients at risk for pulmonary metastases. The most important predictor of post-thoracotomy survival in patients at the National Cancer Institute with soft tissue, osteogenic, and pediatric sarcomas as well as melanoma and renal cell carcinoma has been the ability to render the patient disease-free. Tumor histology, disease-free interval, and possibly number of nodules are also determinants of survival. Median sternotomy is the preferred approach for initial and repeat metastasectomies and every effort should be made to preserve pulmonary parenchyma. Resection of pulmonary metastases has become an accepted therapeutic modality, but selection of surgical candidates, and operative planning needs to be individualized.
预测哪些患者能从肺转移瘤切除术获得生存益处的能力有限。大多数患者在疾病进展之前没有症状，因此胸部计算机断层扫描（CT）已成为有肺转移风险患者随访的标准治疗手段。对于患有软组织肉瘤、骨肉瘤、儿童肉瘤、黑色素瘤和肾细胞癌的美国国立癌症研究所患者，开胸术后生存的最重要预测因素是使患者达到无病状态的能力。肿瘤组织学、无病间期以及可能的结节数量也是生存的决定因素。正中胸骨切开术是初次和再次转移瘤切除术的首选方法，应尽一切努力保留肺实质。肺转移瘤切除术已成为一种公认的治疗方式，但手术候选者的选择和手术规划需要个体化。
