Surgical Treatment For Pulmonary Metastases And Prognostic Factors Analysis

Objective To investigate the indications, operative methods and prognostic factors of surgical resection for pulmonary metastases.Materials and methods Retrospectively analyze the clinical data of 214 patients with pulmonary metastases who underwent operations in Cancer Hospital, Chinese Academy of Medical Science from February,1998 to February,2010. Colorectal cancer is the most common of primary tumor, and the others are soft tissue sarcoma, renal cell carcinoma and breast cancer. Of all the patients gender, age, complete resection or not, surgical approaches, disease-free interval(DFI), number of metastatic tumor, solitary metastasis size, lymph node status and adjuvant chemotherapy were analyzed. Actuarial survival after pulmonary resection was calculated according to Kaplan-Meier method. The influence of variables on survival was analyzed by the log-rank Test. Multivariate analysis was carried out by Cox-proportional hazard model. A p-value of 0.05 or less was considered significant.Results There is no perioperative mortality.206 cases were followed up and 8 cases (3.7%) were lost. Follow-up time was 1-134 months.1,3,5-year survival rates are 84.7%, 62.4%and 39.3%respectively. For the 178(82.3%) patients whose pulmonary metastases were resected completely, the 5-year survival rate is 41.9%while the 5-year survival rate is only 13.0%for 36 incomplete resection patients. Multivariate analysis showed that DFI and lymph node status are the independent prognostic determinants.Conclusion 1. Surgical treatment for resectable pulmonary metastases is feasible and long-term survival can be improved in combination with adjuvant chemotherapy for chemotherapy-sensitive tumors.2. Complete resection is the most important prognostic factor.3. Surgery is the first choice for lung metastases from renal cell carcinoma and sarcoma because these tumors are not sensitive to chemotherapy.4. High-resolution, thin-section helical CT scans and PET-CT scanning can improve the early diagnosis of lung metastases and define tumor location, size and number so that the possibility of complete resection can be improved.5. DFI and lymph node status are the independent prognostic factors.6. Selection of operative method should ensure complete removal of all metastases. VATS should be recommended for solitary single lung metastasis.