1- Foreword
In addition to lung cancer, metastatic tumor resection was carried Thoracic Surgery
Up operation. Europe has reached resection of pulmonary metastases Thoracic Surgery Workers
15% to 50% for the amount. Most patients with pulmonary metastases who have undergone acupuncture
Treatment of the primary tumor, usually found in routine examination. Lung turn
Move tumors generally non-specific symptoms. Sometimes the chest wall metastases violations cited
Since chest pain, tumor necrosis can cause a lot of hemoptysis, ultimately,
To mitigate the symptoms had to choose surgery.
In 1997, the International Registry of lung metastases (The International
Registry of Lung Metastases, IRLM) reported from Europe and North America
206 cases of patients with five articles landmark [1-2]. IRLM root
Depending on the primary tumor were divided into 4 groups: germ cell tumors, melanoma
Tumors, sarcomas and epithelial tumors. The study found that: no matter what
Types of tumors, resection of the primary tumor metastasis tumors arise
Intervals longer and fewer metastases in patients with metastases after birth
The longer exist.
In this study 46% of patients with a single solitary metastases, 32%
Lung metastases after an interval of patients with primary tumor resection
Between ≥3 years. Solitary pulmonary metastasis and metastasis interval appears
Longer have heralded surgery patients with good prognosis. The authors reported
18% of the existence of these two characteristics of the patients, the median survival time was 61
Month; on the contrary, the median survival time of only 14 months.
Currently, colorectal cancer
CRC) is advocated surgical resection of lung metastasis of the most common epithelial
Tumors. This review focuses on CR C, breast cancer, sarcoma and melanoma
Surgical treatment of lung tumor metastasis elaborate. Thyroid cancer and kidney cancer
And other rare tumors reported fewer lung metastases, lung cancer
Diagnose metastasis, recurrence or primary again more difficult, so this
Man does not describe separately.
2 diagnosis of pulmonary metastases
Most patients with lung metastases had received for the primary tumor
Treatment, usually on routine postoperative follow-up examination (eg computer
Tomography) found. Some lung metastases in the chest or outpatient examination
When conventional chest radiography examination found, but the diagnosis of metastases most
Oncologist from.
Lung metastases are generally non-specific symptoms. When the tumor invasion of the chest
When the wall may cause chest pain, when a large number of tumor necrosis lesions may
Cause recurrent hemoptysis, or bronchial compression due to cancer support cause
Continued pneumonia, and ultimately had to choose in order to alleviate the symptoms and surgery
Resection.
Tumor markers may help early detection of metastases. Face
The most common is the bed carcinoembryonic antigen (carcino-embryonic antigen,
CEA), which is greater than 5 μg / L of CRC diagnosis specificity, but also
May mesothelioma or other tumors [3]. After radical resection of CRC CE A
Will fall, and then follow-up with the increase in the relative tumor metastasis
Off, especially liver metastases. CE A rise has been reported with CRC risk
Those with poor prognosis of lung metastasis [4]. This indicator may be one pair
Edged sword: CE A rise may indicate the occurrence of lung metastases, but can be
Guide further metastases treatment [5]. Currently, a variety of clinical Lieutenant swollen
Tumor markers in cancer screening, diagnosis and follow-up, but its
Effectiveness has yet to be confirmed.
In 1995, it was suggested that the concept of the transfer of oligonucleotides that exist
Widowed metastasis can actively take curative treatment [6].
Oligonucleotide transfer means ≤5 metastases also occur in multiple organs [7].
However, the concept is not based on oligonucleotide transfer biological entity studied
Out, nor is the transfer of the frequency distribution based on the mathematical analysis derived,
Facilitate the use of ablation therapy when metastases but ≤5 months.
3CRC lung metastases
To date, approximately 100 on CR C pulmonary metastasis
Reported [8], the only randomized controlled trials PulMiCC (pulmonar y
metastasectomy in colorectal cancer) is recruiting in [9]. Come from
Previous Spanish registry reported [10] The most comprehensive information, the paper
Collected from March 2008 to February 2010 32 units were hand-Thoracic Surgery
Resection of single or multiple pulmonary nodules and histologically confirmed lung metastases
543 cases of patients.
In this study 55% for a single solitary metastases. Resection
In addition to the interval and metastases occur median 28 months, and
Most patients with low or normal CE A levels. 29% of patients
Pre-existing liver metastases of lung metastases. The literature indicates that 95% of patients
Who realized the R0 resection (edge microscopic residual tumor resection is not
Stay). A review on resection of pulmonary metastases of colorectal cancer [11] Table
Ming, the average age of patients was 65 years of age increased from 60 years old, single
Proportion of patients with metastases decreased from 60% to 55%. However, the previous
Proportions of patients with liver metastasis was significantly increased.
A recent study of the efficacy of CRC resection of pulmonary metastases of systematic reviews
Price and meta-analysis included 25 studies, a total of 2925 patients. That
Study [4] showed that complete resection of pulmonary metastases in patients with a total of five years after surgery
Survival rate was 27% to 68%. Three factors associated with a poor prognosis: 1)
Primary disease-free survival time of tumor resection and lung metastases occur at intervals
Short; 2) multiple metastases; 3) open the chest high CEA level. Hilar and /
Or mediastinal lymph node metastasis, poor patient's expected results,
And if there is nothing to resection of liver metastases history.
Although patients with high selectivity lung resection CR C
Metastases is widely accepted, however, by virtue of thoracic surgeons usually
Choose a better prognosis in patients with posterior surgery, and no baseline water
A case-control study confirmed the level of these patients can survive surgery
Benefit, thus benefiting the patient's survival may not be attributed to the hand
Surgery. Look forward to being able to recruit the RCT PulMiCC clinical reality
Practice to provide more evidence.
4 breast cancer lung metastasis
Suggesting that patients with lung metastasis of breast cancer prognosis is poor, however, for
Highly selective patients may benefit from metastases resection [12].
Some small retrospective studies [12-13] showed that lung metastases of breast cut
In addition to research can benefit, Staren such as patient survival [14] showed Missed
By surgical resection of pulmonary metastases in breast cancer patients, the median 5-year survival
Only 11% of patients undergoing surgical resection was 36%. In recent years,
Reported [15] resection of pulmonary metastases of breast cancer 5-year survival rate was
35% to 62%.
Recently, a prospective study from Germany [12] collected
1982-2007 81 cases of lung metastasis of breast, the study
81.5% of patients achieved a R0 resection. Survival analysis showed that R0,
R1 or R2 resection significantly affect the overall survival of patients (overall
sur v ival, OS) (respectively 103.4,23.6 and 20.2 months).
And R0 resection, the number of metastases (n> 2), size (> 3 cm),
Estrogen receptor (estrogen receptor, ER) and / or progesterone receptor
(progesterone receptor, PR) positive is an independent prognostic factor.
But with age, lymph node metastasis, tumor metastasis interval appears
Independent of the time factor and single lung or lung metastasis.
Pulmonary nodules in patients with breast cancer, if it is difficult adenocarcinoma
Clinical and pathological
With primary lung cancer phase identification. [16] reported a history of breast cancer
Patients appear as solitary pulmonary nodule is 50% of primary lung cancer,
Only 33 percent of lung metastasis of breast cancer, a large part of the remainder is benign
Nodules. Surgical resection help identify pathological type, and can be
To make the corresponding histopathology immunohistochemistry, gene analysis is
Provide the basis for subsequent comprehensive treatment.
In summary, the present study shows that breast cancer resection of pulmonary metastases
It seems that patients can benefit. However, how to select patients and hand
Surgical approach to be further explored.
5 sarcoma lung metastases
Sarcomas, including a variety of pathological entity, lung metastases has been published
Tumor resection in the literature there is no clear distinction between his approach. A return
Retrospective analysis [17] reported 15 cases of initial acceptance of lung metastases resection
Treated patients, including five cases of osteosarcoma, soft tissue sarcoma and 6 cases
Mixed sarcoma four cases.
Confined to the lung metastasis of sarcoma, metastatic resection is a
Effective way. Osteosarcoma Study Group found that there turn
Move tumors in 202 patients, 81% of lung metastases, and 62% of patients
Only those with lung metastasis [18]. Osteosarcoma a European research institutions (the
European Osteosarcoma Intergroup, EOI) on chemotherapy
R CT analysis [19] showed that 564 patients had recurrence, 307
Only patients with lung metastases.
A retrospective study included 18 review [17], reported
From 1991 to 2010 sarcoma patients undergoing resection of pulmonary metastases
Surgery result, 1196 patients were initially accepted metastases resection,
1357 43% of patients subsequently underwent resection of metastases, partial
Thoracotomy patients ≥10 times. So far, no RCTs or
His comparative analysis of the form. About postoperative symptoms or quality of life
Data also been reported.
Bone and soft tissue sarcomas, for the first time in patients with metastases resection
The 5-year survival rates were 34% and 25%. Research reports, metastases
The longer the fewer the number of metastases and the emergence of the interval, the patient's
Survive longer. From 1995 to 2004 between the Thames Cancer Register
All blood centers metastasis in patients with 5-year survival rate was 25%,
Soft tissue sarcoma metastasis was 15%
[20].
Given resection of pulmonary metastases commonly used in a small number of highly selective
Patients, resection of metastases showed benefit in sarcoma patients
Can not be enlarged. Although metastases resection is the treatment of sarcoma comprehensive treatment
An integral part of, but little evidence of clinical benefit.
6 melanoma lung metastasis
From 1971 to 1993 between John Wayne Cancer Institute (Jo hn
Wayne Cancer Institute, JWCI) reported six 129 cases [19],
1970 to 2004 Duke University reported 14 057 cases [21]. At least
There is an incidence of lung metastases was 16% and 12%, respectively. Lung
Metastases in patients with lung metastases resection were 11% and 18%,
This difference reflects the subsequent 10 years, people resection of pulmonary metastases
Increased interest. These data allow us to look at from the perspective of digital
Melanoma lung metastases resection of the application in the United States [11].
Duke University reported sarcoma lung metastases in median survival time
7.3 months. Wherein the number of disease-free survival time, metastases, is
No presence of pleural metastasis, and whether or not to accept the transfer of tumor resection is a pre-
Independent risk factors for post. Meanwhile, the study pointed out, for disease-free
Survive longer than five years and does not exist outside of metastases in patients with chest surgery
Intervention survival benefit in patients with respectively 12 and 10 months.
JW CI reported 45 cases followed by regular chest X-ray meter
In the body of the doubling time, the study considered the tumor [22] show doubling time
The shorter the worse the prognosis of patients, it also shows that do not consider metastases
Resection of the role of the biological characteristics of the tumor are important prognostic
Decisive factor.
In short, visible sarcoma resection of lung metastases feasible.
However, should be strictly limited melanoma lung metastases resected
Indications [23]. European Society of Thoracic Surgeons (European Society of
Thoracic Surgeons, ESTS) experts believe that mere evidence also
Can not give a reasonable proposal [24].
Less than 7 metastases resection evidence
Currently, the vast majority of lung metastases resection of evidence-based review
Research, inevitably there is a serious bias [25]. IRLM data missing
Lack of clear standards. Most surgical patients were followed only for complete hand
Data patients undergoing treatment. Only 2% to 3% of patients with lung metastasis
Tumors, ie, every 30 to 50 patients had only one case of lung
Metastases resection. Meanwhile, the choice of surgical resection in patients with a good
Good prognostic features, such as a single or a few metastases, primary tumor
Resection of the tumor to metastasis long intervals occur [26].
Resection of pulmonary metastases reported defect is difficult to distinguish between the common
Prognostic and predictive factors. Regardless of whether or not to accept the surgical treatment of patients
Therapy, patients with good prognostic factors may survive longer, pre-
Testability factors can determine whether patients benefit from a particular therapy.
Clinicians in the absence of a clear case of the control group will receive transfer
Move tumor resection and prognosis in patients with stage IV cancer patients compared to believe that the transfer of
Tumor resection allows patients survival benefit. However, the acceptance of metastases cut
In addition to the patient is usually no obvious metastasis when the primary tumor resection
Stove, and the average transfer occurs in 2 to 3 years after. These patients should not
Only patients with a simple start to appear metastases were compared.
Patients usually advocates react to chemotherapy or no progress was
Metastases resection or metastatic tumor resection again. In some patients
Can not distinguish between specific interventions effect, but in metastases resection
Group whose survival benefit seems to be attributed to the surgery. On the surface of the patient in order to
Survival accept metastases resection instead of metastases resection itself
Prolong survival time of patients. This is the eternal time bias [27].
Generally considered the second or third metastases resection can be controlled again
Or "reset tumor clock" [28], but they ignore the transfer is reduced lung
Move resection standards.
8 Conclusion
In summary, lung metastases in lung metastases most common CR C,
Although repeated resection and ablation, but no reliable evidence. Milk
Adenocarcinoma of the lung metastases resection seems to enable patients to benefit. However, the risk of
Selector and surgical approach should be further explored. Sarcoma turn
Move the main target organ is the lung, bone and soft tissue sarcoma lung metastases
Resection conventional treatment options, but not the number of randomized clinical trials
According to the support. Melanoma prognosis is poor, but in no other treatment
When the program may be considered optional resection of pulmonary metastases.
Although there are many retrospective studies, but resection of pulmonary metastases
Surgery is still insufficient evidence. Due to the heterogeneity of the disease, progressive
And the diversity of treatment, to identify useful information from mixed
Information is more difficult. More urgently R C Ts confirmed pulmonary metastases cut
In addition to the effectiveness of surgery.
References
1. Pastorino U, Buyse M, Friedel G, et al. Long-term results of lung
metastasectomy: prognostic analyses based on 5206 cases [J] J Thorac.
Cardiovasc Surg, 1997, 113 (1): 37-49.
2. Pastorino U. The development of an international registry [J]. J Thorac
Oncol, 2010, 5 (6 Suppl 2): S196-S197.
3. Sturgeon CM, Lai LC, Duffy MJ Serum tumour markers:. How to order
and interpret them [J] BMJ, 2009, 339:. b3527.
4. Gonzalez M, Poncet A, Combescure C, et al. Risk factors for survival
after lung metastasectomy in colorectal cancer patients: a systematic
. review and meta-analysis [J] Ann Surg Oncol, 2013, 20 (2): 572-579.
5. Treasure T. Carcinoma embryonic antigen: its place in decision making
for pulmonary metastasectomy in colorectal cancer [J]. J Thorac Oncol
2010, 5 (6 Suppl 2): S179-S181.
6. Hellman S, Weichselbaum RR. Oligometastases [J]. J Clin Oncol, 1995,
13 (1): 8-10.
7. Weichselbaum RR, Hellman S. Oligometastases revisited [J]. Nat Rev
Clin Oncol, 2011, 8 (6): 378-382.
8. Fiorentino F, Vasilakis C, Treasure T. Clinical reports of pulmonary
metastasectomy for colorectal cancer: a citation network analysis [J] Br.
J Cancer, 2011, 104 (7): 1085-1097.
9. Treasure T, Fallow field L, Lees B. Pulmonar y metastasectomy in
colorectal cancer:. the PulMiCC trial [J] J Thorac Oncol, 2010,
5 (6 Suppl 2): S203-S206.
10. Embun R, Fiorentino F, Treasure T, et al. Pulmonary metastasectomy
in colorectal cancer: a prospective study of demography and clinical
characteristics of 543 patients in the Spanish colorectal metastasectomy
registry (GECMP-CCR) [J] BMJ Open, 2013, 3 (5) pii:.. e002787.
11. Fiorentino F, Hunt I, Teoh K, et al. Pulmonary metastasectomy in
colorectal cancer:. a systematic review and quantitative synthesis [J] JR
Soc Med, 2010, 103 (2): 60-66.
12. Meimarakis G, Rüttinger D, Stemmler J, et al. Prolonged overall survival
after pulmonary metastasectomy in patients with breast cancer [J]. Ann
Thorac Surg, 2013, 95 (4): 1170-1180.
13. Meimarakis G, Angele M, Staehler M, et al. Evaluation of a new
prognostic score (Munich score) to predict long-term survival after
resection of pulmonary renal cell carcinoma metastases [J]. Am J Surg,
2011, 202 (2): 158-167.
14. Staren ED, Salerno C, Rongione A, et al. Pulmonary resection for
metastatic breast cancer [J] Arch Surg, 1992, 127 (11):. 1282-1284.
15. Kycler W, Laski P. Surgical approach to pulmonary metastases from
. breast cancer [J] Breast J, 2012, 18 (1): 52-57.
16. Pagani O, Senkus E, Wood W, et al. International guidelines for
management of metastatic breast cancer: can metastatic breast cancer
be cured [J] J Natl Cancer Inst, 2010, 102 (7):? 456-463.
17. Treasure T, Fiorentino F, Scarci M, et al. Pulmonary metastasectomy
for sarcoma: a systematic review of reported outcomes in the context of
Thames Cancer Registry data [J] BMJ Open, 2012, 2 (5) pii:.. E001736.
18. K ager L, Z oubek A, Potschger U, et al. Pr imar y metastat ic
osteosarcoma: presentation and outcome of patients treated on
neoadjuvant Cooperative Osteosarcoma Study Group protocols [J].
J Clin Oncol, 2003, 21 (10): 2011-2018.
19. Taf ra L, Dale PS, Wanek LA, et al. R esect ion and ad juvant
immunotherapy for melanoma metastatic to the lung and thorax [J]. J
Thorac Cardiovasc Surg, 1995, 110 (1): 119-128; discussion 129.
20. Treasure T, Utley M. Surgical removal of asymptomatic pulmonary
metastases: time for better evidence [J] BMJ, 2013, 346:. f824.
21. Petersen RP, Hanish SI, Haney JC, et al. Improved sur vival with
pulmonar y metastasectomy: an analysi s of 1720 patients w ith
pulmonary metastatic melanoma [J]. J Thorac Cardiovasc Surg, 2007,
133 (1): 104-110.
. 22. Ollila DW, Stern SL, Morton DL Tumor doubling time: a selection
factor for pulmonary resection of metastatic melanoma [J]. J Surg
Oncol, 1998, 69 (4): 206-211.
23. Oliaro A, Filosso PL, Bruna MC, et al. Pulmonary metastasectomy for
. melanoma [J] J Thorac Oncol, 2010, 5 (6 Suppl 2): S187-S191.
Clinical and
1. Pastorino U, Buyse M, Friedel G, et al. Long-term results of lung
metastasectomy: prognostic analyses based on 5206 cases[ J]. J Thorac
Cardiovasc Surg, 1997, 113(1): 37-49.
2. Pastorino U. The development of an international registry[ J]. J Thorac
Oncol, 2010, 5(6 Suppl 2): S196-S197.
3. Sturgeon CM, Lai LC, Duffy MJ. Serum tumour markers: how to order
and interpret them[ J]. BMJ, 2009, 339: b3527.
4. Gonzalez M, Poncet A, Combescure C, et al. Risk factors for survival
after lung metastasectomy in colorectal cancer patients: a systematic
review and meta-analysis[ J]. Ann Surg Oncol, 2013, 20(2): 572-579.
5. Treasure T. Carcinoma embryonic antigen: its place in decision making
for pulmonary metastasectomy in colorectal cancer[ J]. J Thorac Oncol
2010, 5(6 Suppl 2): S179-S181.
6. Hellman S, Weichselbaum RR. Oligometastases[ J]. J Clin Oncol, 1995,
13(1): 8-10.
7. Weichselbaum RR , Hellman S. Oligometastases revisited[ J]. Nat Rev
Clin Oncol, 2011, 8(6): 378-382.
8. Fiorentino F, Vasilakis C, Treasure T. Clinical reports of pulmonary
metastasectomy for colorectal cancer: a citation network analysis[ J]. Br
J Cancer, 2011, 104(7): 1085-1097.
9. Treasure T, Fallow field L, Lees B. Pulmonar y metastasectomy in
colorectal cancer: the PulMiCC trial[ J]. J Thorac Oncol, 2010,
5(6 Suppl 2): S203-S206.
10. Embun R, Fiorentino F, Treasure T, et al. Pulmonary metastasectomy
in colorectal cancer: a prospective study of demography and clinical
characteristics of 543 patients in the Spanish colorectal metastasectomy
registry (GECMP-CCR) [ J]. BMJ Open, 2013, 3(5). pii: e002787.
11. Fiorentino F, Hunt I, Teoh K , et al. Pulmonary metastasectomy in
colorectal cancer: a systematic review and quantitative synthesis[ J]. J R
Soc Med, 2010, 103(2): 60-66.
12. Meimarakis G, Rüttinger D, Stemmler J, et al. Prolonged overall survival
after pulmonary metastasectomy in patients with breast cancer[ J]. Ann
Thorac Surg, 2013, 95(4): 1170-1180.
13. Meimarakis G, Angele M, Staehler M, et al. Evaluation of a new
prognostic score (Munich score) to predict long-term survival after
resection of pulmonary renal cell carcinoma metastases[ J]. Am J Surg,
2011, 202(2): 158-167.
14. Staren ED, Salerno C, Rongione A , et al. Pulmonary resection for
metastatic breast cancer[ J]. Arch Surg, 1992, 127(11): 1282-1284.
15. Kycler W, Laski P. Surgical approach to pulmonary metastases from
breast cancer[ J]. Breast J, 2012, 18(1): 52-57.
16. Pagani O, Senkus E, Wood W, et al. International guidelines for
management of metastatic breast cancer: can metastatic breast cancer
be cured[ J]? J Natl Cancer Inst, 2010, 102(7): 456-463.
17. Treasure T, Fiorentino F, Scarci M, et al. Pulmonary metastasectomy
for sarcoma: a systematic review of reported outcomes in the context of
Thames Cancer Registry data[ J]. BMJ Open, 2012, 2(5). pii: e001736.
18. K ager L , Z oubek A , Potschger U, et al . Pr imar y metastat ic
osteosarcoma: presentation and outcome of patients treated on
neoadjuvant Cooperative Osteosarcoma Study Group protocols[ J].
J Clin Oncol, 2003, 21(10): 2011-2018.
19. Taf ra L , Dale PS, Wanek L A , et al . R esect ion and ad juvant
immunotherapy for melanoma metastatic to the lung and thorax[ J]. J
Thorac Cardiovasc Surg, 1995, 110(1): 119-128; discussion 129.
20. Treasure T, Utley M. Surgical removal of asymptomatic pulmonary
metastases: time for better evidence[ J]. BMJ, 2013, 346: f824.
21. Petersen RP, Hanish SI, Haney JC, et al. Improved sur vival with
pulmonar y metastasectomy: an analysi s of 1720 patients w ith
pulmonary metastatic melanoma[ J]. J Thorac Cardiovasc Surg, 2007,
133(1): 104-110.
22. Ollila DW, Stern SL, Morton DL. Tumor doubling time: a selection
factor for pulmonary resection of metastatic melanoma[ J]. J Surg
Oncol, 1998, 69(4): 206-211.
23. Oliaro A, Filosso PL, Bruna MC, et al. Pulmonary metastasectomy for
melanoma[ J]. J Thorac Oncol, 2010, 5(6 Suppl 2): S187-S191.
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