The role of pulmonary metastasectomy for pulmonary metastasis from head and neck cancer

The risk and prognostic factors for lung metastases in oral squamous cell carcinoma: A population-based analysis of the SEER database

PURPOSE

This study aimed to describe the risk and prognostic factors associated with lung metastases among oral squamous cell carcinoma (OSCC) patients, further to establish a nomogram model to predict the risk of lung metastases.

METHODS

Data on OSCC patients was retrieved from the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2019. Univariable and multivariable logistic and Cox regression models were used to explore the risk factors for developing lung metastases, further the predictive nomogram was constructed.

RESULTS

19, 606 OSCC patients meets the inclusion criteria and were enrolled into this study. Of which, 221 cases have lung metastases at initial diagnosis. Multivariate logistic regression analysis indicated race, T stage, N stage as well as bone metastases, liver metastases were independently associated the development of lung metastases. The diagnostic nomogram for developing lung metastases was constructed, the c-index for this model was 0.830 (0.804-0.856). Both the ROC curve and calibration curves revealed accurate predictability. DCA curve displayed the established nomogram model had good clinical applicability for the prediction of lung metastases. The median OS of OSCC patients with lung metastases was 7.0 months (6.0-9.0), and the 6-months, 12-months, 24-month OS rates were 54.5%, 30.9%, 17.7%, respectively. The multivariate Cox analysis showed that chemotherapy and liver metastases were independently associated with both OS and CSS.

CONCLUSION

This study determined the risk and prognostic factors for lung metastases among OSCC patients and the established nomogram had good calibration and discrimination for predicting lung metastases.

Oncologic Outcome after Pulmonary Metastasectomy as Part of Multidisciplinary Treatment in a Tertiary Oncological Center

(1) Background: Pulmonary metastases are encountered in approximately one-third of patients with malignancies, especially from colorectal, lung, breast, and renal cancers, and sarcomas. Pulmonary metastasectomy is the ablative approach of choice, when possible, as part of the multidisciplinary effort to integrate and personalize the oncological treatment. (2) Methods: The study includes 58 consecutive cases of pulmonary metastasectomies, retrospectively analyzed, performed in 12 consecutive months, in which the pathology reports confirmed lung metastases. (3) Results: Most frequent pathological types of metastases were: 14 of colorectal cancer, 10 breast, 8 lung, and 8 sarcomas. At the time of primary cancer diagnosis, 14 patients (24.14%) were in the metastatic stage. The surgical approach was minimally invasive through uniportal VATS (Video-Assisted Thoracic Surgery) in 3/4 of cases (43 patients, 74%). Almost 20% of resections were typical (lobectomy, segmentectomy). Lymphadenectomy was associated in almost 1/2 of patients and lymph node metastases were found in 11.11% of cases. The mortality rate (intraoperative and 90 days postoperative) is zero. The OS after pulmonary metastasectomy is 87% at 18 months, and the estimated OS for cancer is 90% at 5 years. The worst outcome presents the patients with sarcomas and the best outcome-colorectal and lung cancer. The patients with 1 or 2 resected metastases presented 96% survival at 24 months. (4) Conclusions: After pulmonary metastasectomy, survival is favored by the small number of metastases resected (1 or 2), and by the dimension of metastases under 20.5 mm. The non-anatomic (wedge) type of lung resection may present a lower risk of death compared to lobectomy. No statistical significance on survival has the presence of lymphadenectomy, the laterality right/left lung, the upper/lower lobes. In the future, longer follow-up and prospective randomized trials are needed for drawing definitive conclusions.

Lung Metastases: Current Surgical Indications and New Perspectives

Pulmonary metastasectomy is an established treatment that can provide improved long- term survival for patients with metastatic tumor(s) in the lung. In this mini-review, we discuss the state of the art of thoracic surgery in surgical management of lung metastases which actually occurs for a large part of surgical activity in thoracic surgery department. We describe the principles of surgical therapy that have been defined across the time, and that should remain the milestones of lung metastases treatment: a radical surgery and an adequate lymphadenectomy. We then focus on current surgical indications and report the oncological results according to the surgical approach (open vs. mini-invasive), the histological type and number of lung metastases, and in case of re-metastasectomy. Finally, we conclude with a brief overview about the future perspectives in thoracic surgery in treatment of lung metastases.

Discrimination Between Primary Lung Cancer and Lung Metastases by Genomic Profiling

Introduction

In cases of lung tumors that occur after treatment for malignancies in other organs, the tumor may represent either a primary lung cancer or a solitary pulmonary metastasis from the other tumor. Because some lung tumors are difficult to differentiate on the basis of imaging and pathologic findings, treatment selection is often difficult. In this study, we attempted to make a genomic diagnosis of primary and metastatic lung tumors by analyzing tumor samples using next-generation sequencing and evaluated the efficacy and validity of the genomic diagnosis.

Methods

A total of 24 patients with a solitary lung nodule and a history of other malignancies were enrolled in this study. Tumor cells were selected from tissue samples using laser capture microdissection. DNA was extracted from those cells and subjected to targeted deep sequencing of 53 genes.

Results

The driver mutation profiles of the primary lung tumors were discordant from those of the primary tumors in other sites, whereas the mutation profiles of pulmonary metastases and previous malignancies were concordant. In all 24 patients, we could diagnose either primary lung cancer (six patients) or lung metastases (18 patients) on the basis of whether gene mutation profiles were concordant or discordant. In 12 patients (50.0%), discrepancies were observed between the genomic and clinical or histopathologic diagnoses.

Conclusions

In patients with a solitary lung lesion and a history of cancer, tumor-specific mutations can serve as clonal markers, affording a more accurate understanding of the pathological condition and thus possibly improving both treatment selection and patient outcome.