title: Long-Term Results and Prognostic Factors of Pulmonary Metastasectomy in Patients with Metastatic Transitional Cell Carcinoma.
abstract: ObjectiveWe wanted to assess the prognostic factors and the efficacy of the treatment in patients who underwent lung resections for transitional cell carcinoma metastases.Materials and MethodsThis is a retrospective, multicenter study. Between January 1995 and May 2014, 69 patients underwent lung metastasectomy with curative intent. We evaluated primary site of the tumor, the role of adjuvant chemotherapy after urological operation, disease-free interval (DFI; lower or higher than 24 months), type of lung resection, number of lung metastases, presence of metastatic lymph nodes, and diameter of the metastasis (less or more than 3 cm).ResultsAmong 69 patients, 55 (79%) had bladder as primary site of disease and 12 of them received a transurethral bladder resection. Fourteen (21%) patients developed primary tumor in the renal pelvis or ureter; 53 (76%) patients presented with a single metastasis, 16 (24%) with multiple metastasis. The median DFI was 37 months and the median follow-up was 50 months. Sampling lymphadenectomy was done in 42 patients and nodal metastases were found in 7 patients. The overall 5-year survival was 52%, median 62 months. At univariate analysis, the DFI had a significant impact on survival (5-year survival of 58% for patients with DFI ≥ 24 months vs. 46%;p= 0.048) and diameter of metastasis (5-year survival of 59% for diameter less than 3 cm group vs. 33%;p= 0.001). The multivariate analysis confirmed metastasis' diameter as an independent prognostic factor (p= 0.001).ConclusionOur study found that, in addition to DFI that remains a common prognostic factor in patients with metastatic lung disease, in lung metastases by transitional cell carcinoma, the diameter of the lesion is another significant prognostic factor.
authors.affiliation: Thoracic Surgery Unit, University Hospital of Siena, Siena, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Luzzi
authors.affiliation: Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Marulli
authors.affiliation: Department of Thoracic Surgery, Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom.
authors.forename: Piero
authors.initials: P
authors.lastname: Solli
authors.affiliation: Unit of Thoracic Surgery, Carlo Forlanini Hospital, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cardillo
authors.affiliation: Thoracic Surgery Unit, University Hospital of Siena, Siena, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Ghisalberti
authors.affiliation: Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Mammana
authors.affiliation: Unit of Thoracic Surgery, Carlo Forlanini Hospital, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Carleo
authors.affiliation: Department of Thoracic Surgery, European Institute of Oncology, Milan, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Spaggiari
authors.affiliation: Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Rea
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D059146:Metastasectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D008875:Middle Aged; D015999:Multivariate Analysis; D011013:Pneumonectomy / Q000009:adverse effects / Q000401:mortality; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden; D014571:Urologic Neoplasms / Q000401:mortality / Q000473:pathology*