Risk-adjusted hazard analysis of survival after pulmonary metastasectomy for uterine malignancies in 319 casesCentral MessagePerspective
Yuya Nobori, MD,
Masaki Anraku, MD,
Yoshikane Yamauchi, MD,
Mingyon Mun, MD,
Ichiro Yoshino, MD,
Jun Nakajima, MD, PhD,
Norihiko Ikeda, MD,
Haruhisa Matsuguma, MD,
Takekazu Iwata, MD,
Yasushi Shintani, MD,
Mitsuo Nakayama, MD,
Takahiko Oyama, MD,
Masayuki Chida, MD,
Hiroaki Kuroda, MD,
Hiroshi Hashimoto, MD,
Yoko Azuma, MD,
Kazuhito Funai, MD,
Makoto Endoh, MD,
Yukari Uemura, PhD,
Masafumi Kawamura, MD
Affiliations
Yuya Nobori, MD
Department of Thoracic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Masaki Anraku, MD
Department of Thoracic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Thoracic and Thyroid Surgery, Kyorin University School of Medicine, Tokyo, Japan; Address for reprints: Masaki Anraku, MD, Department of Thoracic and Thyroid Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan.
Yoshikane Yamauchi, MD
Division of General Thoracic Surgery, Teikyo University, School of Medicine, Tokyo, Japan
Mingyon Mun, MD
Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Tokyo, Japan
Ichiro Yoshino, MD
Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
Jun Nakajima, MD, PhD
Department of Thoracic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Norihiko Ikeda, MD
Division of Thoracic and Thyroid Surgery, Tokyo Medical University, Tokyo, Japan
Haruhisa Matsuguma, MD
Division of Thoracic Surgery, Tochigi Cancer Center, Tochigi, Japan
Takekazu Iwata, MD
Division of General Thoracic Surgery, Chiba Cancer Center, Chiba, Japan
Yasushi Shintani, MD
Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
Mitsuo Nakayama, MD
Department of General Thoracic Surgery, Saitama Medical Center, Saitama, Japan
Takahiko Oyama, MD
Department of General Thoracic Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
Masayuki Chida, MD
Department of General Thoracic Surgery, Dokkyo Medical University, Tochigi, Japan
Hiroaki Kuroda, MD
Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
Hiroshi Hashimoto, MD
Department of Thoracic Surgery, National Defense Medical College, Saitama, Japan
Yoko Azuma, MD
Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, Tokyo, Japan
Kazuhito Funai, MD
First Department of Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan
Makoto Endoh, MD
Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan
Yukari Uemura, PhD
Department of Data Science, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
Masafumi Kawamura, MD
Division of General Thoracic Surgery, Teikyo University, School of Medicine, Tokyo, Japan
Objective: There is little evidence of the outcome of pulmonary metastasectomy for uterine tumors when comparing different histologies. This study aimed to delineate the primary histology that leads to more favorable outcomes after pulmonary metastasectomy. Methods: The database of the Metastatic Lung Tumor Study Group of Japan for 1984 to 2016 was used to analyze the outcomes of patients with gynecologic malignancies who underwent pulmonary metastasectomy. Prognostic factors and long-term outcomes were compared according to the histology of the primary uterine tumors, specifically adenocarcinoma, squamous cell carcinoma, and sarcoma. The adjusted hazard risks according to disease-free intervals (DFIs) and the number and maximum size of resected tumors were also analyzed to delineate the pattern of risk trends. Results: A total of 319 patients were included in the analysis (122 with adenocarcinomas, 113 with squamous cell carcinomas, 46 with sarcomas, and 38 with other types). The 5-year survival rate was 66.5% for the entire cohort, 71.6% for the patients with adenocarcinoma, 61.3% for those with squamous cell carcinoma, and 55.4% for those with sarcoma. Multivariate analyses identified the positive prognostic factors as DFI ≥12 months in adenocarcinoma and sarcoma and the primary site (corpus) of uterine tumors in adenocarcinoma. The nonlinear adjusted hazard risks indicated that a shorter DFI was associated with an elevated risk of death in patients with adenocarcinoma and sarcoma. Conclusions: The survival outcome after pulmonary metastasectomy varies according to primary tumor histology, and the prognostic factors differ among histologic subtypes. Surgical indications should be determined based on the prognostic factors for each histology.
