Pulmonary Resection for Metastatic Malignant Fibrous Histiocytoma: An Analysis of Prognostic Factors

• Published in: The Annals of thoracic surgery Vol. 80; no. 5; pp. 1847 - 1852
• Main Authors: Suri, Rakesh M., Deschamps, Claude, Cassivi, Stephen D., Nichols, Francis C., Allen, Mark S., Schleck, Cathy D., Pairolero, Peter C.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.11.2005; Elsevier Science
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Combined Modality Therapy; Female; Histiocytoma, Malignant Fibrous - mortality; Histiocytoma, Malignant Fibrous - pathology; Histiocytoma, Malignant Fibrous - surgery; Humans; Lung Neoplasms - secondary; Lung Neoplasms - surgery; Male; Medical sciences; Middle Aged; Neoplasm Recurrence, Local - surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the respiratory system; Survival Analysis; 11; Pseudotumor; Factor analysis; Prognosis; Sarcoma; Respiratory disease; Lung; Surgical resection; Thorax; Malignant tumor; Metastasis; Fibrous histiocytoma; Treatment; Surgery; Malignant histiocytoma; Xanthogranuloma; Metastatic; Benign neoplasm
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2005.05.004

Factors affecting recurrence and survival after pulmonary resection for metastatic malignant fibrous histiocytoma (MFH) are not well known. Records of patients undergoing pulmonary metastasectomy for MFH between January 1976 and January 2000 were analyzed. There were 103 patients (46 men and 57 women). Median age was 60 years (range, 20 to 86). Malignant fibrous histiocytoma metastasis was solitary in 29 patients (28%), multiple/unilateral in 33 (32%), and multiple/bilateral in 41 (40%). Median time interval from primary tumor resection to metastasectomy was 11 months (range, 0 to 86). Wedge resection was carried out in 87 patients (84%), segmentectomy in 3 (3%), lobectomy in 3 (3%), pneumonectomy in 2 (2%), and a combination of resections in 8 (8%). Resection was complete in 93 patients (90%). Complications occurred in 11 patients (11%) and included prolonged air leak in 7, and pneumonia, empyema, atelectasis, and sepsis in 1 each. One patient died (operative mortality, 1%). Follow-up ranged from 2 weeks to 153 months (median, 18 months). Five-year survival was 21% (95% confidence interval, 14% to 31%). In the 103 patients, incomplete resection (p < 0.0001) was associated with decreased survival. Among the 93 patients with complete resection, factors associated with decreased survival included the presence of extrapulmonary disease at time of metastasectomy (p = 0.01), more than two nodules resected (p = 0.001), and adjuvant therapy after metastasectomy (p = 0.0007). Pulmonary resection of metastatic MFH is safe. Improved survival was associated with the absence of extrapulmonary disease at time of metastasectomy, with fewer than three pulmonary nodules resected, and with a complete resection.