The prognostic factors of chest wall metastasis resection

Objective: Limited data exist regarding the outcomes after resection of pure hematogenous chest wall (CW) metastases. Therefore, we reviewed our 17 years' experience to determine clinically relevant factors. Methods: A retrospective review of all patients who underwent CW metastasectomy (other than breast cancer) from October 1991 to August 2008 at a single institution was performed. Post-CW metastasectomy survival curves were estimated by the Kaplan-Meier method and compared using log-rank test. Factors predictive of improved survival were determined by univariable and multivariable Cox proportional hazard regression analysis. Results: A total of 90 CW metastasectomies were performed on 79 patients (33 females and 46 males). The median follow-up period was 25.6 months. Operative mortality was 1.1%. The 5-year survival was 40%. Significant factors after multivariable analysis were margin status, histology, and a history of heavy smoking (≥20 pack years). Microscopically positive margin (P= 0.01; hazard ratio (HR) 2.85; 95% confidence interval (CI) 1.28-6.35) and grossly positive margin (P< 0.01; HR 9.55; 95% CI 2.60-35.1) fared worse. Compared with carcinoma, sarcoma (P< 0.01; HR 3.9; 95% CI 1.7-9.2) and melanoma (P< 0.01; HR 6.4; 95% CI 1.7-24) had worse survival. A history of heavy smoking diminished survival (P< 0.01; HR 3.7; 95% CI 1.6-8.4). Conclusions: The resection of CW metastases in highly selected patients as a part of multimodality treatment has low risk and is associated with prolonged survival. The margin status and histology are significant factors in the survival after CW metastasectomy. In addition, heavy smoking history also has a significant negative impact on survival.