Kurativer chirurgischer Therapieansatz bei solitär pulmonal metastasierten nicht-kleinzelligen Lungenkarzinomen (NSCLC)

Abstract

The treatment of synchronous solitary lung metastasis in non-small cell lung cancer (NSCLC) remains controversial. Satellite lesions in the same lobe are now classified as T3 which may result in stage IIB (T3N0M0). In contrast, ipsilateral lesions in different lobes are associated with a worse prognosis and classified as T4 tumors (stage IIIA), but operation is usually withheld from these patients. Contralateral lung metastases have been classified more recently as M1a which usually results in a conservative therapy. We analysed survival data of all patients with primary lung tumour and synchronous pulmonary metastasis outside of the tumour-bearing lobe, who underwent surgery. Between 1997 - 2007 we operated on 57 patients with NSCLC and simultaneous second (solitary) malignant lesions of the lung, outside of the tumour-bearing lobe, after informed consent. Survival was documented and analysed by Kaplan-Meier statistics (log-rank). The primary tumour was treated in 67 % of cases by lobectomy, in 9 % by pneumonectomy, by bilobectomy in 2 % and in 22 % by segment or wedge resection. The second malignant lesion, and thus potential solitary metastasis, was treated in 83 % by segment or wedge resection. The overall survival of all patients (n = 57) was a median of 82 months (75 - 89 95%CI). In the synchronous second primaries (n = 7) the median survival was 76 months (0.1 to 151 95%CI) and in the synchronous metastases (n = 50) 82 months (95 % CI 75 - 88). This results in a 5-year survival rate of 56 % and 77 %, respectively. The median survival of patients with solitary metastasis, ipsilateral (T4 after UICC7) was 79 months (76 - 82 95 %CI) and with contralateral metastasis (M1a according UICC7) 84 months (60 - 107 95 %CI, p = 0.634). This analysis shows that patients with solitary pulmonary metastasis (outside of the tumour-bearing lobe) and otherwise operable NSCLC may profit from surgical intervention comprising resection of the primary tumour, lymphadenectomy, and resection of the solitary pulmonary metastasis. Long-term survival can be achieved independent of the localisation of lung metastases (ipsilateral vs. contralateral lung).