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Prognostic factors and survival after resection of lung metastases from epithelial tumours

Division of Thoracic Surgery, Department of General Surgery and Surgical Specialities, Policlinico di Modena. University of Modena and Reggio Emilia, Largo del Pozzo 71, 41100, Modena, Italy

*Corresponding author. Tel.: +39-59-4222257; fax: +39-59-360159.

E-mail address: u.morandi{at}unimo.it (U. Morandi).

Lung metastasectomy is an accepted treatment for selected patients with pulmonary metastases. Resectability, disease-free interval and number of metastases are well characterised prognostic indicators after lung metastasectomy. Patients treated with lung metastasectomy for epithelial tumours were retrospectively reviewed. One hundred and forty-two patients were reviewed. The rate of mediastinal node metastases was 12%. Overall 5-year survival rate was 36% with a median survival time of 47 months. Recurrence rate after lung metastasectomy was 50%. Five-year disease-free survival was 26% with a median of 29 months. Mediastinal nodal status negatively affected survival at univariate analysis (5-years 32% for N+ and 40% for N–, P=0.013). Disease-free survival was significantly different according to nodal status: 5-year disease-free survival 17 and 28% for N+ and N–, respectively (P=0.053). Systemic recurrences were more frequent in patients with nodal involvement (P=0.058). Mediastinal nodal involvement resulted in a significant prognostic factor at multivariate analysis (N+: RRD=3.0; 95% CI 1.3–6.7). Patients with pulmonary metastases and nodal involvement had a poor prognosis and relapsed early after pulmonary metastasectomy. Nodal status should be considered in the selection of patients for lung metastasectomy.

Key Words: DFI: disease-free interval; DFS: disease-free survival; MST: median survival time; MLD: mediastinal lymph node dissection; SS: systematic sampling; PET: positron emission tomography; CT: computed tomography; RRD: relative risk of death