Clinical features of surgical resection for pulmonary metastasis from breast cancer F. Chen a , T. Fujinaga a , K. Sato a , M. Sonobe a , T. Shoji a , H. Sakai a , R. Miyahara a , T. Bando a , K. Okubo a , T. Hirata a , M. Toi b , H. Date a, * a Department of Thoracic Surgery, Kyoto University, Kyoto, Japan b Surgery (Breast Surgery), Kyoto University, Kyoto, Japan Accepted 9 May 2008 Available online 18 June 2008 Abstract Background and objectives: Metastatic breast cancer has been defined as a systemic disease. The discussion concerning the resection of lung metastases in patients with breast cancer is controversial. To confirm the role of resection of pulmonary metastases from breast cancer and to identify possible prognostic factors, we reviewed our institutional experience. Methods: Between 1991 and 2007, 41 patients with pulmonary metastases from breast cancers underwent complete pulmonary resection. All patients had obtained or had obtainable locoregional control of their primary tumors. Various perioperative variables were investigated retrospectively to confirm the role of metastasectomy and to analyze prognostic factors for overall survival after metastasectomy. Results: All patients were female with a median age of 55 years (range, 35e81 years). The overall survival rate after metastasectomy was 51% at 5 and 10 years. On multivariate analysis, fewer than four pulmonary metastases and a disease-free interval of more than 3 years were significantly favorable prognostic factors for overall survival ( p ¼ 0.023 and 0.024, respectively). Conclusions: The current practice of pulmonary metastasectomy for breast cancers in our institution was well justified. Pulmonary meta- stasectomy in patients with previous breast cancer might be justified when fewer than four pulmonary metastases or a disease-free interval of more than 3 years. Ó 2008 Published by Elsevier Ltd. Keywords: Breast cancer; Metastasectomy; Pulmonary metastasis; Prognosis Introduction Pulmonary metastases are common features in patients with breast cancer. 1,2 Patients with metastatic breast cancer including pulmonary metastases are usually treated with systemic chemotherapy, 1 but some clinical studies have suggested the significance of surgical resection for such patients. 2e5 Systemic chemotherapies applied to date have achieved little progress in terms of prolongation of life. Median survival after chemotherapy is 10e20 months. 5 Although high-dose chemotherapy with stem-cell trans- plantation has been applied in trials, median survival is only 20e30 months with a very high therapy-associated mortality of up to 5%. 6,7 More effective chemotherapy, in- cluding an anti-HER2 antibody, has recently been devel- oped so the prognosis of metastatic breast cancer patients has also dramatically improved; 8 however, such therapies are still under observation in preclinical or clinical trials. Resection of lung metastases in patients with previous breast cancer is therefore a controversial issue. We re- viewed the clinical data of patients with breast cancer treated with pulmonary metastasectomy in our hospital to determine the long-term results and the prognostic predic- tors of survival in this subset of patients. Materials and methods Patient population From January 1991 to December 2007, according to our medical records, 41 patients had undergone complete * Corresponding author at: Department of Thoracic Surgery, Kyoto Uni- versity, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan. Tel.: þ81 75 751 3835; fax: þ81 75 751 4647. E-mail address: hdate@kuhp.kyoto-u.ac.jp (H. Date). 0748-7983/$ - see front matter Ó 2008 Published by Elsevier Ltd. doi:10.1016/j.ejso.2008.05.005 Available online at www.sciencedirect.com EJSO 35 (2009) 393e397 www.ejso.com