Results of lung metastasectomy from breast cancer: prognostic criteria on the basis of 467 cases of the International Registry of Lung Metastases.
OBJECTIVE
Metastatic breast cancer is still defined as an incurable disease. Although the prognosis after resection of isolated metastases to the lung is much better than after chemotherapy most oncologists and gynecologists disapprove of lung metastasectomy.


METHODS
In order to summarize the experience of pulmonary metastatic surgery and to achieve more relevant data by an increased number of cases, we evaluate the data of the International Registry of Lung Metastases of 467 patients having lung metastases from breast cancer with regard to long-term survival and prognostic factors.


RESULTS
In 84% a complete metastatic resection was possible. The survival rates are 38% after 5 years, 22% after 10 years, and 20% after 15 years. Prognostic factors are a disease-free interval of > or = 36 months with 5-year survival of 45%, a 10-year survival of 26% and a 15-year survival of 21% (P=0.0001), solitary lung metastasis is associated with a survival rate of 44% after 5 years and of 23% after 10 and 15 years, but this is not statistically significant compared to multiple metastases. When establishing prognostic groups as suggested by Pastorino and the International Registry of Lung Metastases based on the risk factors disease-free interval, number of metastases and complete resection the group with the best prognosis showed 5-year survival of 50%, 10- and 15-year survival of 26% with a median survival of 59 months.


CONCLUSIONS
Considering the low morbidity and mortality rate, we think that lung metastasectomy today is the best treatment option in selected cases of lung metastases from breast cancer.
Department of Thoracic Surgery, Klink Schillerhoehe, Solitudestrasse 18, D-70839 Gerlingen, Germany. friedel@klinik-schillerhoehe.de
Godehard
G
Friedel
Ugo
U
Pastorino
Robert J
RJ
Ginsberg
Peter
P
Goldstraw
Micheal
M
Johnston
Harvey
H
Pass
Joe B
JB
Putnam
Heikki
H
Toomes
D001943:Breast Neoplasms / Q000473:pathology*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008875:Middle Aged; D011379:Prognosis; D012042:Registries; D012307:Risk Factors; D015996:Survival Rate