CLASSIFICATION OF PULMONARY METASTASES: POTENTIAL APPLICATION IN CLINICAL PRACTICE

Background. There is currently no information on the results of randomized studies evaluating the surgical treatment outcomes in patients with pulmonary metastases. Therefore, there is a strong need for a staging system that can permit the stratification of patients with intrapulmonary metastasis. Aim: To analyze the overall survival of patients who underwent pulmonary metastasectomy using a new classification taking account the extent of pulmonary metastasis. Material and methods. The study included 568 lung cancer patients who underwent pulmonary metastasectomy. All patients were stratified according to a new classification taking into account the number of metastatic sites and the extent of lymph node involvement. The median age of the patients was 49 years (range: 18 to 81 years). Results. Histological study revealed no evidence of metastases in 72 patients. In patients having no lymph node involvement, better results were observed in patients with a solitary site of metastasis (M_s ), with a median survival of 58 months. In patients with oligometastatic lesions (up to 5 sites) and limited metastatic sites (6–24 sites), the median survival was 36 and 26 months, respectively. In patients with multiple metastatic lesions (more than 25 sites), the median survival was 12 months. Among patients with lymph node metastases, the median survival was 32 months for patients with a solitary metastasis (M_s) and 27 months for patients with oligometastases (M_o ). In patients with limited number of metastatic sites (6–24 sites), the median survival was 12 months. In patients with multiple metastases (M_m), the median survival was 6 months (p=0.00012). Conclusion. A new classification will help to stratify patients into identical subgroups. Its use should be considered as one of the selection criteria in future multicentre randomized trials.

1. Downey R.J. Surgical treatment of pulmonary metastases. Surg Oncol Clin N Am. 1999; 8 (2): 341.

2. Migliore M., Lees B., Treasure T., Fallowfield L.J. Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC International). Oncologist. 2013; 18 (5): 637. doi: 10.1634/theoncologist.2012 0476.

3. Reinersman J.M., Wigle D.A. Lymphadenectomy During Pulmonary Metastasectomy. Thorac Surg Clin. 2016 Feb; 26 (1): 35–40. doi:10.1016/j. thorsurg.2015.09.005.

4. Dominguez-Ventura A., Nichols F.C., 3rd. Lymphadenectomy in metastasectomy. Thorac Surg Clin. 2006 May; 16 (2): 139–43. doi: 10.1016/j.thorsurg.2005.12.001

5. Shiono S., Matsutani N., Okumura S., Nakajima J., Horio H., Kohno M., Ikeda N., Kawamura M.; Metastatic Lung Tumor Study Group of Japan. The prognostic impact of lymph node dissection on lobectomy for pulmonary metastasis. Eur J Cardiothorac Surg. 2015; 48 (4): 616–21; discussion 621. doi: 10.1093/ejcts/ezu533.

6. Mineo T.C., Ambrogi V. Lung metastasectomy: an experience based therapeutic option. Ann Transl Med. 2015; 3 (14): 194. doi: 10.3978/j. issn.2305 5839.2015.08.15.

7. Chissov V.I., Trakhtenberg A. Kh., Parshin V.D., Pikin O.V. Surgical treatment of metastatic lung lesions: state of art. Surgery. Journal of them. N.I. Pirogova. 2009; 9: 4–12.[in Russian]

8. Weichselbaum R.R., Hellman S. Oligometastases revisited. Nat Rev Clin Oncol. 2011; 8 (6): 378–82. doi: 10.1038/nrclinonc.2011.44

9. Rolle A., Koch R., Alpard S.K., Zwischenberger J.B. Lobe sparing resection of multiple pulmonary metastases with a new 1318 nm Nd:YAG laser first 100 patients. Ann Thorac Surg. 2002; 74 (3): 865–869.

10. Rolle A., Pereszlenyi A., Koch R., Richard M., Baier B. Is surgery for multiple lung metastases reasonable? A total of 328 consecutive patients with multiple laser metastasectomies with a new 1318 nm Nd:YAG laser. J Thorac Cardiovasc Surg. 2006; 131 (6): 1236–1242. doi: 10.1016/j. jtcvs.2005.11.053

11. Kanzaki R., Higashiyama M., Fujiwara A., Tokunaga T., Maeda J., Okami J., Nishimura K., Kodama K. Long term results of surgical re section for pulmonary metastasis from renal cell carcinoma: a 25 year single institution experience. Eur J Cardiothorac Surg. 2011 Feb; 39 (2): 167–72. doi: 10.1016/j.ejcts.2010.05.021

12. Kaprin A.D., Galkin V.N., Zhavoronkov L.P., Ivanov V.K., Ivanov S.A., Romanko Yu.S. Synthesis of basic and applied research is the basis of obtaining high quality findings and translating them into clinical practice. Radiation and Risk. 2017; 26 (2): 26–40. doi: 10.21870/0131 3878 2017 26 2 26 40.[in Russian]

13. Saito Y., Omiya H., Kohno K., Kobayashi T., Itoi K., Teramachi M., Sasaki M., Suzuki H., Takao H., Nakade M. Pulmonary metastasectomy for 165 patients with colorectal carcinoma: A prognostic assessment. J Thorac Cardiovasc Surg. 2002 Nov; 124 (5): 1007–13.

14. Higashiyama M., Kodama K., Higaki N., Takami K., Murata K., Kameyama M., Yokouchi H. Surgery for pulmonary metastases from colorectal cancer: the importance of prethoracotomy serum carcinoem bryonic antigen as an indicator of prognosis. Jpn J Thorac Cardiovasc Surg. 2003; 51 (7): 289–296.

15. Inoue M., Ohta M., Iuchi K., Matsumura A., Ideguchi K., Yasumitsu T., Nakagawa K., Fukuhara K., Maeda H., Takeda S., Minami M., Ohno Y., Matsuda H.; Thoracic Surgery Study Group of Osaka University. Benefits of surgery for patients with pulmonary metastases from colorec tal carcinoma. Ann Thorac Surg. 2004; 78 (1): 238–244. doi: 10.1016/j. athoracsur.2004.02.017

16. Iida T., Nomori H., Shiba M., Nakajima J., Okumura S., Horio H., Matsuguma H., Ikeda N., Yoshino I., Ozeki Y., Takagi K., Goya T., Kawamura M., Hamada C., Kobayashi K.; Metastatic Lung Tumor Study Group of Japan. Prognostic factors after pulmonary metastasectomy for colorectal cancer and rationale for determining surgical indications: a retrospective analysis. Ann Surg. 2013; 257 (6): 1059–1064. doi:10.1097/ SLA.0b013e31826eda3b

17. Watanabe K., Nagai K., Kobayashi A., Sugito M., Saito N. Factors influencing survival after complete resection of pulmonary metastases from colorectal cancer. Br J Surg. 2009; 96 (9): 1058–1065. doi: 10.1002/ bjs.6682

18. Shiono S., Kawamura M., Sato T., Okumura S., Nakajima J., Yoshino I., Ikeda N., Horio H., Akiyama H., Kobayashi K. Metastatic Lung Tumor Study Group of Japan. Pulmonary metastasectomy for pulmonary metastases of head and neck squamous cell carcinomas. Ann Thorac Surg. 2009 Sep; 88 (3): 856–60. doi: 10.1016/j.athoracsur.2009.04.040.

19. Anraku M., Yokoi K., Nakagawa K., Fujisawa T., Nakajima J., Akiyama H., Nishimura Y., Kobayashi K.; Metastatic Lung Tumor Study Group of Japan. Pulmonary metastases from uterine malignancies: results of surgical resection in 133 patients. J Thorac Cardiovasc Surg. 2004; 127 (4): 1107–1112.