| Objective: To analyze and explore the diagnosis,operation,prognosis and prognostic factors of pulmonary metastasis from various primary tissue sources.Data and methods: A retrospective analysis of the clinical data of 61 patients underwent surgical treatment of thoracic surgery from January 2007 to January 2017 at the first Affiliated Hospital of Dalian University,and the clinical data of the 61 patients were perfect and postoperative pathology proved to be pulmonary metastasis.The source of lung metastases is complex,including many tissues and organs,colon or rectum of which the primary tumor is most common,for 30 cases,10 cases of renal carcinoma,soft tissue sarcoma in 7 cases,breast cancer in 5 cases,endometrial carcinoma 3 cases,hepatocellular carcinoma 2 cases,thyroid carcinoma 2 cases,giant cell tumor of bone in 1 cases,salivary gland-derived tumor 1 cases,Among them,5 patients did not find the primary tumor before surgery,pathology confirmed that the lung tumor as the source of metastasis,so the primary tumor in the lung metastasis after resection of the diagnosis and treatment.The gender of the whole group of cases,age,DFI(absence of tumor),primary tumor resection,number of secondary tumors,maximum tumor diameter,imaging manifestations of secondary tumors(atypical pulmonary metastasis manifestations or typical pulmonary metastasis manifestations),surgical modalities(open surgery or thoracoscopic surgery),The surgical resection range(partial lobectomy or lobectomy),tumor resection properties(palliative or complete excision),lymph node metastasis,postoperative adjuvant radiotherapy and chemotherapy were analyzed statistically,and the SPSS23.0 statistics software was used to deal with it.Survival rate and prognostic factor analysis using Kaplan-meier method,the difference between group survival rate by Log-rank method,Cox regression proportional risk model for multifactor analysis,p?0.05 considered statistically significant.Results: The complete clinical data of the 61 patients were obtained by telephone follow-up and the treatment of patients in our hospital,the whole group underwent operation successfully.By looking at the surgical records,it was found that 5 patients were not completely resected because of tumor invasion of the esophagus or the large blood vessels of the heart.There were 1 patients who were bleeding after surgery and then underwent thoracotomy and died of clotting disorder.In addition to peri-operative deaths,other patients were discharged after effective treatment.The survival rates of 1,3 and 5 years were 88.4%,35.8% and 15.9% in the whole group of patients for 1-120 months.Multivariate analysis revealed that DFI(no tumor-free period)and lymph node metastasis were independent factors affecting survival rate.Conclusion: 1.Surgical treatment is necessary for solitary or limited pulmonary metastasis,which is expected to complete resection of the tumor.2.For patients with a history of malignancy,it is not possible to rule out the possibility of a secondary lung tumor,regardless of whether the image is characteristic of a typical pulmonary metastasis.3.Whether the lung metastases can be completely resected has an important effect on the prognosis of patients,so the choice of surgical methods and scope should be based on the complete resection of the tumor.4.DFI long,and postoperative pathology proved that lymph nodes were negative patients with better prognosis.5.No patients with primary or primary tumor were found to have poor prognosis before operation.6.After resection of lung metastases,patients with chemotherapy syndromes combined with chemotherapy can benefit some patients.7.If the pulmonary solitary nodule can be confirmed as the source of metastasis,the lung should be resected and the pulmonary function of the patient should be preserved as much as possible.8.Patients with colorectal-derived pulmonary metastasis,if the preoperative CEA(carcinoembryonic antigen)level is higher,often suggest poor prognosis. |
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