Outcome and Survival Analysis of Multicenter Lung Metastasectomy for Primary Liver Tumor with Pulmonary Metastasis
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Study Patient Characteristic Factors
2.3. Statistical Analysis
3. Results
3.1. Clinical Features
3.2. Pathological Features
3.3. Perioperative Outcome
3.4. Factors Correlated with Overall Survival
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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n (%) or Mean ± SD (Range) | |
---|---|
Total Patients | 147 (100%) |
Age, yr | 58.4 ± 11.5 (33–84) |
Male | 121 (82.3%) |
ECOG | |
0 | 142 (96.6%) |
≥1 | 5 (3.4%) |
Smoking status | |
Smoker | 31 (21.1%) |
Non-smoker | 116 (78.9%) |
Viral hepatitis | |
Absent | 53 (36.1) |
Present | 94 (63.9) |
HBV | 81 (55.1) |
HCV | 11 (7.5) |
HBV + HCV | 2 (1.3) |
Comorbidities | 57 (38.8) |
DM | 31 (21.1) |
HTN | 38 (25.9) |
ESRD | 7 (4.8) |
Cardiac diseases | 9 (6.1) |
Initial TNM stage of primary liver tumor a | |
I | 28 (19.0) |
II | 33 (22.4) |
III | 37 (25.2) |
IV | 11 (7.5) |
Loss data | 38 (25.9) |
Initial BCLC stage of primary liver tumor a | |
A | 36 (24.5) |
B | 52 (35.4) |
C | 11 (7.5) |
Loss data | 48 (32.6) |
Initial treatment method for primary liver tumor | |
Surgery | 110 (74.8) |
Non-surgery | 37 (25.2) |
RFA b | 17 (11.6) |
TAE b | 20 (13.6) |
n (%) or Mean ± SD (Range) | |
---|---|
Total patients | 147 (100.0%) |
Disease-free interval after liver surgery (mo) | 22.3 ± 28.7 (0~206) |
Synchronous tumor (liver, lung) | 9 (6.1) |
Non-synchronous tumor | 138 (93.9) |
Liver-to-lung interval (mo) | 36.4 ± 40.4 (1~232) |
Liver tumor local recurrence at the time of lung metastasectomy | 84 (57.1) |
Variables at the time of lung metastasectomy | |
Child–Pugh class | |
Child A | 142 (96.6) |
Child B | 5 (3.4) |
Abnormal AFP a | 75 (51.0) |
Abnormal Bilirubin b | 37 (25.2) |
Abnormal AST/ALT b | 66 (44.9) |
Abnormal INR level b | 10 (6.8) |
MELD-Na score | 8.79 ± 3.3 (6.4~26.4) |
Complete resection of all metastatic nodules | 84 (57.1) |
Number of resected metastatic nodules | |
1 | 51 (34.7) |
2 | 32 (21.8) |
3 | 25 (17.0) |
4 | 13 (8.8) |
≥5 | 26 (17.7) |
Maximum size of the metastatic nodules (mm) | 20.0 ± 13.9 (0.4 mm~85 mm) |
Laterality | |
Unilateral metastasis | 68 (46.3) |
Bilateral metastasis | 79 (53.7) |
Resection margin a | |
Positive | 7 (4.8) |
Negative | 126 (85.7) |
Loss data | 14 (9.5) |
Lymph node metastasis | |
No LND | 106 (72.1) |
Perform LND | 41 (27.9) |
Positive | 8 (5.5) |
Negative | 33 (22.4) |
n (%) or Mean ± SD (Range) | |
---|---|
Total patients | 147 (100%) |
Surgical method | |
Sublobar resection | 127 (86.4) |
Lobectomy | 18 (12.2) |
Bilobectomy, pneumonectomy | 2 (1.4) |
Approach method | |
Thoracotomy | 15 (10.2) |
VATS | 132 (89.8) |
Uniportal VATS | 44 (29.9) |
Sequential metastasectomy for bilateral metastasis | 5 (3.4) |
Non-intubated anesthesia | 11 (7.5) |
Dye localization a | 18 (12.2) |
Operative time, min | 119.3 ± 75.1 (30~407) |
Operative bleeding, mL | 22.1 ± 93.2 (minimum~800) |
Conversion | 0 |
Length of hospital stay, day | 5.0 ± 4.7 (1~41) |
Postoperative ICU stay, day | 0.7 ± 1.5 (0~14) |
Chest tube duration, day | 2.6 ± 2.7 (0~18) |
Morbidities | 13 (8.8) |
Minor | 10 (6.8) |
Prolonged air leak | 5 (3.4) |
Arrhythmia | 2 (1.4) |
Subcutaneous emphysema | 1 (0.7) |
Hemothorax | 0 |
Chylothorax | 0 |
Hoarseness | 0 |
Significant pleural effusion b | 1 (0.7) |
Urinary retention | 2 (1.4) |
Major | 2 (1.4) |
Stroke | 1 (0.7) |
PEA, CPR | 1 (0.7) |
30-day mortality | 2 (1.4) |
Variables | Patient Number | Hazard Ratio | 95% CI | p Value |
---|---|---|---|---|
Age, yr | ||||
<65 | 99 | 1 | ||
≥65 | 48 | 0.78 | 0.520–1.172 | 0.231 |
Sex | ||||
Female | 26 | 1 | ||
Male | 121 | 1.101 | 0.653–1.859 | 0.718 |
ECOG | ||||
0 | 142 | 1 | ||
≥1 | 5 | 1.154 | 0.365–3.648 | 0.808 |
Smoking status | ||||
Non-smoker | 116 | 1 | ||
Smoker | 31 | 1.256 | 0.735–2.146 | 0.405 |
Viral hepatitis | ||||
Absent | 53 | 1 | ||
Present | 94 | 0.913 | 0.613–1.360 | 0.655 |
Comorbidities | ||||
Absent | 90 | 1 | ||
Present | 57 | 0.609 | 0.462–1.029 | 0.069 |
Initial TNM stage of primary liver tumor a | ||||
I–II | 51 | 1 | ||
III–IV | 48 | 1.298 | 0.809–2.081 | 0.279 |
Initial BCLC stage of primary liver tumor a | ||||
A–B | 88 | 1 | ||
C | 11 | 0.904 | 0.258–3.172 | 0.335 |
Initial treatment method for primary liver tumor | ||||
Surgery | 110 | 1 | ||
Non-surgery | 37 | 1.897 | 1.229–2.929 | 0.004 |
Disease-free interval after liver surgery | ||||
<12 months | 70 | 1.521 | ||
≥12 months | 77 | 1 | 1.027–2.251 | 0.036 |
Liver-to-lung interval | ||||
<12 months | 48 | 1 | ||
≥12 months | 99 | 1.373 | 0.911–2.07 | 0.130 |
Liver tumor local recurrence at the time of lung metastasectomy | ||||
Absent | 62 | 1 | ||
Present | 85 | 1.818 | 1.207–2.736 | 0.004 |
MELD-Na score | ||||
≤20 | 144 | 1 | ||
>20 | 3 | 3.372 | 0.093–0.096 | 0.044 |
AFP level a | ||||
Normal | 55 | 1 | ||
Abnormal | 75 | 1.202 | 0.799–1.807 | 0.378 |
Complete resection of all metastatic lung nodules | ||||
No | 63 | 1.13 | ||
Yes | 84 | 1 | 0.761–1.679 | 0.544 |
Number of resected metastatic nodules | ||||
1–2 | 83 | 1 | ||
≥3 | 64 | 0.793 | 0.532–1.183 | 0.256 |
Maximum size of the metastatic nodules | ||||
<2 cm | 83 | 1 | ||
≥2 cm | 62 | 0.964 | 0.649–1.433 | 0.857 |
Unilateral or bilateral lung metastasis | ||||
Unilateral | 68 | 1 | ||
Bilateral | 79 | 1.312 | 0.888–1.940 | 0.173 |
Surgical method | ||||
Sublobar resection | 127 | 1 | ||
Lobectomy, | 18 | 1.265 | 0.175–9.125 | 0.816 |
≥Bilobectomy | 2 | 0.617 | 0.77–4.921 | 0.649 |
Approach method | ||||
Thoracotomy | 15 | 1 | ||
VATS | 132 | 1.400 | 0.765–2.563 | 0.276 |
LN dissection | ||||
No | 106 | 1 | ||
Yes | 41 | 1.363 | 0.499–3.725 | 0.545 |
Margin a | ||||
Free | 126 | 1 | ||
Involvement | 7 | 0.906 | 0.332–2.473 | 0.847 |
Variables | Hazard Ratio | 95% CI | p Value |
---|---|---|---|
Initial treatment method for primary liver tumor | |||
Surgery | 1 | ||
Non-surgery | 1.865 | 1.177–2.958 | 0.008 |
Disease-free interval after liver surgery | |||
<12 months | 1 | ||
≥12 months | 0.674 | 0.446–1.019 | 0.061 |
Liver tumor local recurrence at the time of lung metastasectomy | |||
Absent | 1 | ||
Present | 1.393 | 0.894–2.171 | 0.143 |
MELD-Na score | |||
≤20 | 1 | ||
>20 | 3.977 | 1.188–13.316 | 0.025 |
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Chang, Y.-C.; Chiang, X.-H.; Tseng, Y.-T.; Kuo, S.-W.; Huang, P.-M.; Lin, M.-W.; Hsu, H.-H.; Chen, J.-S. Outcome and Survival Analysis of Multicenter Lung Metastasectomy for Primary Liver Tumor with Pulmonary Metastasis. Cancers 2024, 16, 3007. https://doi.org/10.3390/cancers16173007
Chang Y-C, Chiang X-H, Tseng Y-T, Kuo S-W, Huang P-M, Lin M-W, Hsu H-H, Chen J-S. Outcome and Survival Analysis of Multicenter Lung Metastasectomy for Primary Liver Tumor with Pulmonary Metastasis. Cancers. 2024; 16(17):3007. https://doi.org/10.3390/cancers16173007
Chicago/Turabian StyleChang, Yu-Cheng, Xu-Heng Chiang, Yu-Ting Tseng, Shuenn-Wen Kuo, Pei-Ming Huang, Mong-Wei Lin, Hsao-Hsun Hsu, and Jin-Shing Chen. 2024. "Outcome and Survival Analysis of Multicenter Lung Metastasectomy for Primary Liver Tumor with Pulmonary Metastasis" Cancers 16, no. 17: 3007. https://doi.org/10.3390/cancers16173007