|
Histopathologic prognostic factors in resected colorectal lung
metastases.Ann
Thorac Surg. 2005 Jan;79(1):278-82; discussion 283.
BACKGROUND:
Pulmonary metastasectomy is a standard method of treatment for
selective pulmonary metastases of colorectal cancer. However,
the pathologic factors of metastatic lesions that affect
survival and tumor recurrence after pulmonary resection are less
well defined. The pathologic findings of colorectal pulmonary
metastases have not been correlated with clinical outcome. The
study was conducted to clarify the characteristics and identify
the prognostic factors of the pulmonary metastases of colorectal
cancer. METHODS: Between July 1992 and November 2002, 89
patients underwent the complete resection of pulmonary
metastases of primary colorectal carcinoma, and we
pathologically reviewed the surgical specimens of 136 metastatic
lesions from these patients. RESULTS: There were no
perioperative deaths. The overall 5-year survival rate was
61.4%. No clinical factors were associated with the outcome. The
univariate analysis of pathologic factors revealed aerogenous
spread with floating cancer cell clusters (ASFC) (p = 0.004),
vascular invasion (p = 0.002), lymphatic invasion (p = 0.032),
and pleural invasion (p = 0.037) to be prognostic factors. The
multivariate analysis showed vascular invasion (p = 0.02) and
ASFC (p = 0.02) to be independent prognostic factors. The 5-year
survival rate of patients whose lesions were positive for both
ASFC and vascular invasion was 24.7% and much poorer than in the
patients with ASFC without vascular invasion (78.6%), vascular
invasion but without ASFC (80.2%), and patients negative for
both (93.3%) (p = 0.0002). CONCLUSIONS: The morphologic features
of ASFC and vascular invasion at metastatic sites are prognostic
factors for colorectal cancer patients who have undergone
pulmonary metastasectomy.
Prediction of
prognosis and surgical indications for pulmonary metastasectomy
from colorectal cancer.Ann
Thorac Surg. 2006 Jul;82(1):254-60.
BACKGROUND:
Treatment of pulmonary metastases from colorectal cancer by
excision has increased rapidly, but reports on indications and
prognostic factors are inconsistent. We sought to identify poor
prognostic factors preoperatively and to retrospectively
evaluate preoperative clinical indications for surgery. METHODS:
A total of 75 patients with colorectal cancer had pulmonary
metastases excised from 1986 to 2003. Tumor size, number,
laterality, hilar or mediastinal lymphadenopathy, and
carcinoembryonic antigen level were possible risk factors for
metastatic tumors, with primary site of colorectal tumor,
disease-free interval, and hepatectomy for liver metastasis
possible risk factors for primary tumors. Prognostic factors in
univariate and multivariate analyses also included age and sex.
RESULTS: Five-year survival rates were 41.3% after pulmonary
excision and 73.1% after primary colorectal resection. Three
factors identified as significant by univariate log-rank test
for overall survival after pulmonary resection were
carcinoembryonic antigen (p < 0.0001), tumor laterality (p =
0.0205), and number of pulmonary metastases (p = 0.0028).
Multivariate analysis found that carcinoembryonic antigen, tumor
number, tumor size, and patient's age were also independent
prognostic factors. In contrast, carcinoembryonic antigen,
number of metastases, and disease-free interval predicted
prognosis after primary colorectal resection. Prior hepatectomy
for metastases did not influence prognosis after pulmonary
metastasectomy. CONCLUSIONS: Elevated carcinoembryonic antigen
level and multiple metastases are preoperative predictors of
poor prognosis after resection of pulmonary metastases from
colorectal cancer. Survival rate is sufficient to justify
pulmonary metastasectomy if there is no local or distant
metastatic lesion other than in the liver; if needed, sequential
pulmonary and hepatic metastasectomy can be performed.
Pulmonary metastases in children with solid tumours--own
experiences]
Med Wieku Rozwoj. 2006 Jul-Sep;10(3 Pt 1):665-75.
BACKGROUND:
The most frequent reasons of relapses in solid tumours among
children are lung metastases. AIM: Analysis of lung metastatic
cases among children with solid tumours treated from 1995-2005.
MATERIAL AND METHODS: 26 lung metastatic cases (17 males, 9
females) were analysed. At the moment of the diagnosis lung
metastases were present in 19.2% of patients while in the rest
(80.8%) occurred during and after treatment. The most often lung
metastases were recognised in osteosarcoma (15-57.8%) and
carcinoma embryonale (3-11.6%). Secondary metastases in lungs
occurred within 4-48 months after the diagnosis. In 57.7% were
bilateral. 36 thoracotomies (average 1.7/ a child) were
performed. The after-surgery chemotherapy for tumour recurrence
was introduced in each case. RESULTS: In the analysed group 14
(53.8%) children are alive with the overall survival time 8-120
months. The rest 12 (46.2%) are dead with the survival time 6-24
months. The statistically significant difference was found in
comparison of complete surgery versus incomplete (p=0.02), no
significance was found in primary or secondary metastases
(p=0.27). Time of occurrence was statistically insignificant
(p=0.26). CONCLUSIONS: The occurrence of metastases in children
solid tumours worsened the prognosis. The active search for lung
metastases at the moment of diagnosis, treatment and follow-up
combined with complete surgery procedures may prolong survival.
There is a need to find new methods of lung metastases
treatment.
Pulmonary metastasis of endometrial stromal
sarcoma.Kurume
Med J. 2006;53(3-4):95-7.
Multiple
round opacities suggestive of metastatic lung tumors were
incidentally found on a chest x-ray film in a 43-year-old woman.
The patient underwent hysterectomy for "myoma uteri" three years
previously. Extensive examinations could not specify the primary
neoplastic lesions. Morphological characteristics of the
thracoscopically resected lung tumors suggested low-grade
endometrial stromal sarcoma (ESS), and immunostaining revealed
that the tumor cells were positive for progesterone and estrogen
receptors, CD10 and vimentin, confirming a diagnosis of ESS. ESS
is an uncommon uterine neoplasm, however, may be mistaken as
benign tumors such as epithelioid leiomyoma, and occasionally
metastasizes to remote organs such as lungs even after long
disease-free period, posing diagnostic challenge.
A case of prostatic cancer discovered from lung
metastatic lesions.
Hinyokika
Kiyo. 2006 Feb;52(2):147-9.
We report a
case in a 70-year-old patient indicated to have a metastatic
lesion from a chest X-ray taken during a medical examination.
His blood prostatic specific antigen level was very high at 100
ng/ml (normal, less than 4.0 ng/ml). Palpation of the prostate
disclosed enlargement to hen's egg size with an irregular
surface and indurations bilaterally. Transrectal sextant needle
biopsy of the prostate was performed, revealing moderately
differentiated adenocarcinoma. Computed tomography (CT) scan and
bone scintigraphy showed intrapelvic lymphnode adenopathy and
metastasis to the right pubic bone. Under a diagnosis of stage
D2 prostate cancer, we initiated endocrine therapy (luteinizing
hormone-releasing hormone analogue depot every 4 weeks and
bicalutamide). Androgen blockage was very effective and after 6
months, the PSA level had decreased markedly to below 0.2 ng/ml.
Sixteen months later, pulmonary metastasis completely
disappeared. He is currently free from recurrence and
progressing well.
Pulmonary
metastasectomy for osteosarcomas and soft tissue sarcomas.
Gan To Kagaku Ryoho. 2004
Sep;31(9):1319-23
To evaluate
the efficacy of aggressive pulmonary metastasectomy for treating
osteosarcomas and soft tissue sarcomas, we reviewed 105 cases
treated in our hospital between 1990 and 2002. There were 57
males and 48 females, 44 osteosarcomas (OS), 21 synovial
sarcomas (Syno), 16 malignant fibrous histiocytomas (MFH), 4
leiomyosarcomas (Leio), 4 alveolar soft part sarcomas (ASPS) and
16 others (including chondrosarcoma and liposarcoma). A total of
904 metastases were resected (8.6(0-49)/patients) and 244
thoracotomies (2.3/patients) were performed. Mean number of
initial metastasectomies was 3.7 (0-26), disease-free interval (DFI)
was 13. 8 months (0-96), and mean diameter of maximum resected
metastases for one patient was 20.4 (5-90) mm. Five-and 10-year
survival rates of all cases were 44.9% and 32.0% respectively.
Those of OS were 45.8% and 38.5%, and those of soft tissue
sarcomas were 44.2% and 25.5%, respectively. The highest 5-and
10-year survival rates among soft tissue sarcomas was attained
in ASPS and Leio (75%), and others (51.6% and 38.7%), followed
by Syno (42.9% and 12.4%). Long-term survival was not attained
in MFH (30.9%: 5 years). Analysis of histological types of the
tumors and numbers of resected pulmonary metastases showed that
the largest number of metastases were resected in ASPS (16/case)
and Syno (13.8/case), followed by OS (9.0/case). MFH had the
largest (27.1 mm) mean diameter of maximum resected metastases,
followed by Leio (27.0 mm). Analysis of prognostic factors
indicated that curativity was the most important prognostic
factor: curative cases 42.2% (10-year survival) vs noncurative
cases 4.2% (6-year survival). Number of resected metastases and
mean diameter of maximum tumor size also affected the patient
survival.
Pulmonary
metastases in children: an analysis of surgical spectrum.Eur
J Pediatr Surg. 2002
Jun;12(3):151-8.
Pulmonary
surgery is frequently used for the treatment of metastasis or
nodules in children with various types of malignancies. However,
the indications and effectiveness of pulmonary metastatectomy
have not been evaluated recently. Therefore, a retrospective
study was conducted to analyse the results of pulmonary
metastatectomy in children. Children who underwent pulmonary
metastatectomy at our department between 1990 and 2000 were
reviewed. Eighteen children consisting of 11 boys and 7 girls
(age range, 3 to 18 years) underwent thoracotomy for pulmonary
metastasis excision. The primaries were osteosarcoma (n = 2),
synovial sarcoma (n = 1), fibrosarcoma (n = 1), Ewing's sarcoma
(n = 2), mesenchymal chondrosarcoma (n = 1), Wilms' tumour (n =
4), clear-cell sarcoma (n = 1), Hodgkin lymphoma (n = 3),
hepatoblastoma (n = 1), hepatocellular carcinoma (n = 1) and
haemangioendotheliosarcoma (n = 1). Pulmonary metastases were
encountered either at the time of initial diagnosis (22 %) or
occurred within 6 months to 5 years. They were frequently
nodular (94 %), unilateral (94 %) and located in the right lung
(70 %). The number of metastases were frequently one (56 %) or
two (28 %). Excision was done by means of wedge resection (88
%), segmentectomy (6 %), and lobectomy + wedge resection (6 %).
The nodules contained tumour cells in most cases (n = 14) (78
%), mature nephrogenic elements (6 %) and no tumour tissue (16
%) in the remaining cases. Histology was similar to that of the
original tumour in 12 cases. However, synovial sarcoma was
encountered in metastasis in one case with fibrosarcoma primary.
Re-thoracotomy was performed in 22 % of cases for the recurrent
lesion, which in only one case was a true local recurrence.
Overall disease-free survival rate was 56 % during the follow-up
period (mean, 36.4 +/- 31.8 months). Pulmonary metastatectomy
may increase survival in carefully selected children, though it
is unlikely to cure the patient. Therefore combined therapies
such as chemotherapy and/or radiotherapy should be continued in
the postoperative period.
|
