Pulmonary metastasectomy in uterine malignancy: outcomes and prognostic factors

Abstract

ObjectiveThe aim of this study was to investigate outcomes in uterine cancer patients undergoing pulmonary metastasectomy and prognostic factors associated with survival after the procedure.MethodsA retrospective study was performed in 29 uterine cancer patients who underwent surgical resection of pulmonary metastatic lesions at Samsung Medical Center between June 1995 and December 2011.ResultsHistopathology showed carcinoma in 17 patients (58.6%) and sarcoma in 12 patients (41.4%). Of the 29 patients, 17 (58.6%) had less than three pulmonary metastatic lesions. Eight (27.6%) had symptoms related to lung metastasis. The 5-year survival rate after pulmonary metastasectomy for the entire cohort was 48.2%. On univariate and multivariate analysis, the presence of pulmonary symptoms and more than three lesions of metastasis were associated with poor survival after pulmonary metastasectomy.ConclusionPulmonary metastasectomy for uterine cancer is an acceptable treatment in selected patients. Patients with more than three pulmonary metastatic lesions and pulmonary symptoms related to lung metastasis could expect to have worse prognosis after pulmonary metastasectomy.

Retrospective Analysis of Outcome of Patients with Metastatic Leiomyosarcoma in a Tertiary Referral Center

“…These results might be at least partially explained by a selection bias, since frail patients with limited life expectancy are often not offered aggressive multimodality treatment. Nevertheless, these results support the concept of individualizing treatment strategies and offering surgery and/or radiotherapy to carefully selected patients even in the presence of metastatic disease [24,25]. More prospective evidence is necessary to elucidate which patients would qualify for such an approach.…”

“…In most cases, the choice of the systemic therapy is based on data arising from historical series involving multiple STS subtypes [14]. Some series suggest prolonged survival with metastasectomy in oligometastatic cases of LMS [4,8,24,25].…”

Pulmonary metastasectomy in uterine malignancy: outcomes and prognostic factors

“…Despite the fact that histology was sarcoma in 41% of cases, that 41% had more than three nodules and 28% had metastasesrelated symptoms, 5-year for the whole cohort was still 48% with a median overall survival of 26 months. At multivariate and univariate analyses, presence of symptoms and number of metastases greater than 3 negatively affected survival, while DFI <12 months also did but not significantly (8).…”

“…Lung dissemination is the most common site of extrapelvic disease, especially for locally advanced cases, although it may occur in early stage disease (4). It is however relatively rare with reports ranging between 2.3-4.6% of cases depending on the series (8).…”

“…A limited number of case reports or small series followed in the years (4,8,13), but the first larger surgical series to appear was a study from Memorial Sloan Kettering Cancer Centre in 1992 (14). Forty-five patients with pulmonary metastases from uterine sarcomas were resected (29% bilaterally).…”