THE SIGNIFICANCE OF PROGNOSTIC FACTORS FOR THE RESECTION OF PULMONARY METASTASES OF BREAST-CANCER

Breast cancer is the most common malignant disease in women in Europe. In 15-25 % of cases, the isolated formation of pulmonary metastases occurs, To date these metastases have been treated mainly by chemotherapy, radiotherapy, or hormone therapy. However, good results through pulmonary metastatic resection have been reported increasingly in recent times. From 1979 to 1992, 103 breast-cancer patients underwent surgery for suspected pulmonary metastases in our clinic. Intraoperatively in 88 % of the whole group the metastases were confirmed, but in the other 12 % they proved to be benign tumors or primary bronchial carcinomas. The operative therapy is standardized in our clinic. The approach is via a median or transverse sternotomy. Wedge resection is the normal procedure, undertaken in 55 % of the cases. Complications, which were completely reversible in all cases, occurred in 3 %. The 30-day mortality rate was 0 %. In the whole patient population, the actuarial 5-year survival was 27 %; it was 31 % among the completely resected women, whereas no patient undergoing incomplete resection survived 5 years. Taking prognostic criteria into account, there are clear trends. When the disease-free interval exceeded 2 years, the actuarial 5-year survival was 33 %, and if the receptor status of the primary tumor was positive, the 3-year survival was 61 % compared to 38 % for cases with negative receptor status. If a solitary metastasis was removed, the actuarial 5-year survival was 35 % as opposed to 0 % in cases with more than five metastases. For cases with a combination of the favorable criteria of solitary metastasis and a disease-free interval of 2 years and more, the actuarial 5-year survival was 40 %. There were significant differences between the results of partially and completely resected patients. Taking these results into account, it is concluded that resection of pulmonary metastases is a worthwhile and effective form of therapy, at least in the group of patients with positive receptor status, a disease-free interval of 2 years and longer, and not more than five metastases.