Prognostic factors for long-term survival in patients with thoracic metastatic disease: a 10-year experience.
OBJECTIVE
To compare survival results after resection in patients with thoracic parenchymal metastatic disease versus non-parenchymal metastatic disease and to identify prognostic factors for survival.


METHODS
From 1990 to 2002, we retrospectively studied 134 procedures performed on 93 patients (3-84 years old). There were 73 patients with parenchymal resection and 20 patients with non-parenchymal resection. Tumor histology was epithelial in 62 patients, sarcoma in 21 patients, and teratomas and melanoma in 6 and 4 patients, respectively. Sixty-five patients underwent a metastasectomy once, whereas 28 had their metastatic disease repeatedly resected.


RESULTS
Follow-up was 100% complete with a mean time of 43 months (range 1-169). In-hospital mortality was 2.2% (3/134 procedures) and major morbidity 5.5%. Median survival was 39 months (95% CI: 21-56 months). Overall, the actuarial survival at 1, 3, and 5 years were 84%, 55%, and 44%, respectively. For the entire group, by univariate analysis, among the 13 predictor variables selected, only the number of metastases (Hazard Ratio (HR)=3.4 [95% CI: 1.9-6.1]) and completeness of resection (HR=2.3 [95% CI: 1.3-4.2]) were found to be significant for death whereas repeated metastasectomy was found to be a significant predictor for survival (HR=0.25 [95% CI: 0.12-0.55]). In the group of parenchymal metastatic disease, a size greater than 3cm was a predictor for death (HR=2 [95% CI: 1.1-3.7]). In the subgroup of patients with colorectal metastasis, bilateral disease was also found to be a significant predictor for death (HR=3.6, [95% CI: 1.2-11.1]).


CONCLUSIONS
This study supports our current aggressive approach to metastatic thoracic disease. Indeed, patient's survival is improved while a low mortality and morbidity is achieved. The most beneficial impact on long-term survival is correlated to the completeness of the surgery whereas the increasing number and size of the metastasis inversely correlate with survival.
Poncelet
Alain Jean
AJ
Department of Cardio-Vascular and Thoracic Surgery, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium.
Lurquin
Antoine
A
Weynand
Birgit
B
Humblet
Yves
Y
Noirhomme
Philippe
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008482:Mediastinum; D008875:Middle Aged; D011013:Pneumonectomy; D011379:Prognosis; D012008:Recurrence; D013899:Thoracic Neoplasms / Q000556:secondary* / Q000601:surgery