Assessment of metastasectomy and prognostic factors in the treatment of metastatic lung tumors

Abstract

Background: The aim of the study was to evaluate the prognostic factors influencing survival following pulmonary metastasectomy and the importance of thoracic computed tomography (TCT) in detecting pulmonary metastases. Methods: The study included 25 patients (16 males, 9 females; mean age 46.4 years) who underwent metastasectomy for secondary lung tumors and 10 control patients (6 males, 4 females; mean age 56.5 years) who were not eligible for surgery. Primary tumors included carcinoma in 17 patients (48.6%), sarcoma in 17 patients, and malignant melanoma in one patient (2.9%). Staging was made according to the system of the International Registry of Lung Metastases. A total of 31 operations were performed (24 wedge resections, 5 lobectomies, 1 enucleation, 1 debulking surgery). The two groups were compared with respect to survival and prognostic factors for metastasectomy patients were assessed. Results: Operative mortality was seen in one patient (3.2%). The mean number of nodules detected by preoperative TCT was 2.7 +/- 2.4, compared to 7.6 +/- 10.5 nodules found at surgery (p=0.04). The accuracy of TCT in detecting nodules was 54.8%. One-year survival rate was 68% in metastasectomy patients, and 70% in the control group (p=0.707). The corresponding survival rates for three years were 44% and 0% (p=0.171). Patients with a single metastatic nodule exhibited significantly higher survival rates than patients having multiple nodules (for 1 year: 91.9% vs. 83.3%, p=0.023; for 3 years: 46.2% vs. 7.7%, p<0.001). The mean survival was significantly shorter in patients with stage III disease (p=0.002). One-year survival rates for stages I to III were 100%, 81.8%, and 50%, and three-year survival rates were 100%, 72.7%, and %8.3, respectively. Survival was not influenced by the following: cell type, disease-free interval, nodule diameter, number of resections, type of surgery, and postoperative chemotherapy. Conclusion: Pulmonary metastasectomy improves survival in patients with a locally controlled primary tumor and no other metastases. As the stage increases, survival decreases. We believe that the staging system should be used widely in the prediction of survival.