Revue des maladies respiratoires · 2012
[The place of surgery in metastatic non-small cell lung cancer].
Оценочное исследованиеСтатьяНазвание и аннотация: Перевод пока не подготовлен
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Le Pimpec Barthes F, Mordant P, Pricopi C, Foucault C, Dujon A, Riquet M
Аннотация
BACKGROUND: Metastatic lung cancer may be M1a (contralateral lung nodule, malignant pleural or pericardial effusion or pleural nodules) or M1b (distant metastases). Surgery is not usually considered in their treatment.
METHOD: After exclusion of contralateral lung nodules, we reviewed the demographics, management, survival and prognostic factors in M1 patients, among a total of 4668 patients who underwent surgery for lung cancer between January 1983 and December 2006.
RESULTS: There were 164 patients (70 M1a, 94 M1b). Surgical procedures included exploratory thoracotomy (n=40), lobectomy (n=88), and pneumonectomy (n=38). Histology revealed adenocarcinoma (n=97), squamous cell carcinoma (n=36) or other (n=27). Nodal extension was N0 (n=60), N1 (n=23), N2 (n=64), or not available (n=17). Overall median survival was 14 months and 5-year survival was 12.7%. In M1a median survival was 15 months and 5-year survival 9%. In M1b, median survival was 11 months and 5-year survival 15%, regardless of whether the metastasis was resected or not. The 5-year survival rates were 0% after exploratory thoracotomy, 3.9% after pneumonectomy, 14.8% after lobectomy; 15.2% in adenocarcinoma, 30.4% after induction chemotherapy, and 31.5% in N0 patients. In cases of M1a disease, complete surgical resection resulted in a 5-year survival rate of 16.2%. In case of M1b disease undergoing pulmonary resection, surgical metastasis management did not change the prognosis, with 5-year survival rates of 16.7% in case of metastasis resection (n=66) versus 15.6% without resection (n=19, P=0.67).
CONCLUSION: In patients with M1a disease, complete surgical resection allowed some long-term survivals, suggesting that surgery may be underestimated. Conversely, in patients with M1b disease undergoing pulmonary resection, surgical resection of the metastasis is not associated with better survival than non-surgical management, suggesting that surgery may be overestimated.
METHOD: After exclusion of contralateral lung nodules, we reviewed the demographics, management, survival and prognostic factors in M1 patients, among a total of 4668 patients who underwent surgery for lung cancer between January 1983 and December 2006.
RESULTS: There were 164 patients (70 M1a, 94 M1b). Surgical procedures included exploratory thoracotomy (n=40), lobectomy (n=88), and pneumonectomy (n=38). Histology revealed adenocarcinoma (n=97), squamous cell carcinoma (n=36) or other (n=27). Nodal extension was N0 (n=60), N1 (n=23), N2 (n=64), or not available (n=17). Overall median survival was 14 months and 5-year survival was 12.7%. In M1a median survival was 15 months and 5-year survival 9%. In M1b, median survival was 11 months and 5-year survival 15%, regardless of whether the metastasis was resected or not. The 5-year survival rates were 0% after exploratory thoracotomy, 3.9% after pneumonectomy, 14.8% after lobectomy; 15.2% in adenocarcinoma, 30.4% after induction chemotherapy, and 31.5% in N0 patients. In cases of M1a disease, complete surgical resection resulted in a 5-year survival rate of 16.2%. In case of M1b disease undergoing pulmonary resection, surgical metastasis management did not change the prognosis, with 5-year survival rates of 16.7% in case of metastasis resection (n=66) versus 15.6% without resection (n=19, P=0.67).
CONCLUSION: In patients with M1a disease, complete surgical resection allowed some long-term survivals, suggesting that surgery may be underestimated. Conversely, in patients with M1b disease undergoing pulmonary resection, surgical resection of the metastasis is not associated with better survival than non-surgical management, suggesting that surgery may be overestimated.