Background Despite weak evidence, pulmonary metastasectomy (PM) is widely performed with intent to improve patient survival. Our single-institution analysis aims to evaluate outcomes and to identify factors influencing survival of patients undergoing PM for metastases from wide range of primary tumors.

Materials and Methods All patients undergoing curative-intent PM between 2008 and 2018 were retrospectively analyzed. The impact of factors related to primary tumor, metastases, and associated therapy on overall survival (OS) was evaluated using univariable and multivariable Cox proportional hazard models. Cutoff values of continuous variables were determined by a receiver operating characteristic analysis.

Results In this study, 281 patients (178 male, median age 61 years) underwent PM. Two (0.7%) perioperative deaths and 23 (8.2%) major complications occurred. Median interval between the treatment of primary tumor and PM was 21 months. Median size of largest metastasis was 1.4 cm. After the median follow-up of 29 months, 134 patients (47.7%) had died. Five-year OS rate after first PM was 47.1%. Complete resection was achieved in 274 (97.5%) patients. Multivariable analysis identified genitourinary origin (hazard ratio [HR]: 0.30, 95% confidence interval [CI]: 0.15–0.60, p = 0.0008) as independent positive survival prognosticator; incomplete resection (HR: 3.53, 95% CI: 1.40–8.91, p = 0.0077) and age at PM of ≥66 years (HR: 1.97, 95% CI: 1.36–2.85, p = 0.0003) were negative prognosticators.

Conclusion The use of PM as a part of multimodal treatment is in selected population justified. Our analysis identified age, primary tumor origin, and completeness of resection as independent survival prognosticators.

背景 尽管证据不足，但肺转移瘤切除术 (PM) 被广泛实施，旨在提高患者的生存率。我们的单机构分析旨在评估结果并确定影响接受 PM 治疗的患者生存的因素，这些患者从广泛的原发性肿瘤转移。

材料与方法 回顾性分析2008年至2018年间接受根治性PM的所有患者。使用单变量和多变量 Cox 比例风险模型评估与原发性肿瘤、转移和相关治疗相关的因素对总生存期 (OS) 的影响。连续变量的截止值由接受者操作特征分析确定。

结果 在这项研究中，281 名患者（178 名男性，中位年龄 61 岁）接受了 PM。发生 2 例 (0.7%) 围手术期死亡和 23 例 (8.2%) 主要并发症。原发性肿瘤治疗与 PM 之间的中位间隔为 21 个月。最大转移灶的中位数为 1.4 cm。中位随访 29 个月后，134 名患者（47.7%）死亡。首次 PM 后的五年 OS 率为 47.1%。274 例（97.5%）患者实现了完全切除。多变量分析确定泌尿生殖起源（风险比 [HR]：0.30，95% 置信区间 [CI]：0.15–0.60，p  = 0.0008）是独立的阳性生存预测指标；不完全切除 (HR: 3.53, 95% CI: 1.40–8.91, p  = 0.0077) 和 PM ≥66 岁的年龄 (HR: 1.97, 95% CI: 1.36–2.85, p = 0.0003) 是负面预测因素。

结论 在选定人群中使用 PM 作为多模式治疗的一部分是合理的。我们的分析将年龄、原发性肿瘤起源和切除的完整性确定为独立的生存预后因素。