Pulmonary Metastasectomy For Uterine Cervical Cancer:Long-term Outcomes And Prognostic Factors

Objective:The aim of this study was to investigate the long-term outcomes of cervical cancer patients undertaking pulmonary metastasectomy and factors associated with survival after the procedure.Methods:A retrospective study was set to analyze clinical data of 38 patients with cervical cancer who undertook pulmonary metastasectomy with curative intent in Department of Thoracic Surgical Oncology,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College during January 2000 and January 2017.All the patients were conformed to have pulmonary metastases from cervix.This study analyzed the following perspectives to investigate the prognostic and relapse factors:the stage of primary cancer,treatment of primary cancer,treatment of pulmonary metastases,SCC level before pulmonary metastasectomy,DFI,location,number and maximum diameter of metastases,lymph node metastasis from CT,approach,resection range,mediastinal lymph node resection and lymph node metastasis from postoperative histology.All statistical analyses were performed using SPSS25.0 Version(IBM Co.,Armonk,NY,USA).Survival curves were generated by Kaplan-Meier method.To evaluate the significance of prognostic and relapse variables,the Log-rank and COX proportional hazards model were used for univariate and multivariate analysis,respectively.Categorical variables were tested by χ2 test.A P<0.05 was considered statistically significant.The variates P<0.1 in univariate were used in multivariate test.Results:The 1,3,5,8 year overall survival rates of all patients after pulmonary metastasectomy were 92.1%,60.5%,45.4%,and 36.4%,while the relapse rates were 92.1%,60.5%,38.7%and 31%.The median overall survival was 49.0±16.4 months and median relapse time 46.0±5.8 months.The prognostic factors for all patients were SCC level(P=0.000),DFI(P=0.014),number of metastasis(P=0.025),maximum diameter(P=0.004),suspicious lymph node metastasis from CT(P=0.001),resection(P=0.027),relapse(P=0.000).Only the maximum diameter was the independent prognostic influence factor(HR=4.7,95%CI,1.3-16.9,P=0.019).The factors associated with relapse were:SCC level(P=0.000),DFI(P=0.014),number of metastasis(P=0.004),maximum diameter(P=0.004),suspicious lymph node metastasis from CT(P=0.001),resection(P=0.033).On multivariate analysis,the favorable significant relapse variables were normal SCC level(HR=20.3,95%CI 3.4-122.4,P=0.001),only one metastasis(HR=3.7,95%CI 1.2-11.0,P=0.020)and resection of mediastinal lymph node(HR=0.212,95%CI 0.047-0.952,P=0.043).Conclusion:Cervical cancer patients with pulmonary metastases after initial treatment could expect to gain long-term overall survival by pulmonary metastasectomy when there is only one metastasis.An elevation of SCC before pulmonary metastasectomy,more than one metastasis and without mediastinal lymph node resection are the factors indicting relapse.