Luketich J D, Martini N, Ginsberg R J, Rigberg D, Burt M E
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
Ann Thorac Surg. 1995 Dec;60(6):1609-11. doi: 10.1016/0003-4975(95)00760-1.
Recurrence after resection of non-small cell lung carcinoma is generally associated with a poor outcome and is treated with either systemic agents or palliative irradiation. Recently, long-term survival has been reported after resection of isolated brain metastases from non-small cell lung carcinoma, but resection of other metastatic sites has not been explored fully.
We have identified 14 patients who had solitary extracranial metastases treated aggressively after curative treatment of their non-small cell lung carcinoma. The histology was squamous carcinoma in 5, adenocarcinoma in 8, and large cell carcinoma in 1. Initially, 3 patients had stage I, 5 stage II, and 6 stage IIIa disease.
The sites of metastases included extrathoracic lymph nodes (six), skeletal muscle (four), bone (three), and small bowel (one). The median disease-free interval before metastases was 19.5 months (range, 5 to 71 months). Complete surgical resection of the metastatic site was the treatment in 12 of 14 patients. Two patients received only curative irradiation to the metastatic site, with complete response. The overall 10-year actuarial survival (Kaplan-Meier) was 86%. To date, 11 patients are alive and well after treatment of their metastases (17 months to 13 years), 1 has recurrent disease, 1 died of recurrent widespread metastases, and 2 died of unrelated causes.
Long-term survival is possible after treatment of isolated metastases to various sites from non-small cell lung carcinoma, but patient selection is critical.
非小细胞肺癌切除术后复发通常预后较差，治疗方法为全身用药或姑息性放疗。最近，有报道称非小细胞肺癌孤立性脑转移切除术后可长期生存，但其他转移部位的切除尚未得到充分探索。
我们确定了14例非小细胞肺癌根治性治疗后出现孤立性颅外转移并接受积极治疗的患者。组织学类型为鳞状细胞癌5例，腺癌8例，大细胞癌1例。最初，3例患者为Ⅰ期，5例为Ⅱ期，6例为Ⅲa期。
转移部位包括胸外淋巴结（6例）、骨骼肌（4例）、骨（3例）和小肠（1例）。转移前的无病间期中位数为19.5个月（范围5至71个月）。14例患者中有12例对转移部位进行了完整的手术切除。2例患者仅对转移部位进行了根治性放疗，获得完全缓解。总体10年精算生存率（Kaplan-Meier法）为86%。迄今为止，11例患者在转移灶治疗后存活且状况良好（17个月至13年），1例出现复发性疾病，1例死于复发性广泛转移，2例死于无关原因。
非小细胞肺癌出现孤立性转移至不同部位后经治疗有可能长期生存，但患者选择至关重要。
