Zink S, Kayser G, Gabius H J, Kayser K
Department of Pathology, Thoraxklinik, Heidelberg, Germany.
Eur J Cardiothorac Surg. 2001 Jun;19(6):908-13. doi: 10.1016/s1010-7940(01)00724-2.
Colon/rectum cancer often presents with intrapulmonary metastases. Surgical resection can be performed in a selected group of patients. In this study, the search for possible prognostic factors of patients with primary colon/rectum cancer and lung metastases was performed.
Medical records of 110 patients operated on pulmonary metastases of primary colon/rectum cancer were reviewed. The clinical parameters include age, sex, pTNM/UICC stage, grading, localization, surgical and adjuvant therapy of the primary cancer. The number, maximum diameter and total intra-thoracic resected tumor-mass ('load'), the pre-thoracotomy serum carcinoembryonic antigen (CEA) levels, localization of the metastases (uni- vs. bilateral), the presence of hilar/mediastinal tumor-infiltrated lymph nodes, the surgical procedure and performed therapy schemes of lung metastases were recorded.
The cumulated 5- and 10-year total survival after diagnosis of the primary carcinomas was estimated to 71 and 33.7%, respectively. After resection of the pulmonary metastases, the 3- and 5-year post-thoracotomy survival measured 57 and 32.6%, respectively. The median time interval between diagnosis of the primary cancer and thoracotomy (disease free interval (DFI)) was found to be 35 months. A non-negligible percentage of patients (15.4%) displayed limited tumor stages of the primary cancer (pT1/2, pN0). The median diameter of the largest metastasis measured 28 mm, and the median resected intrathoracic tumor-load was calculated to 11.4 cm(3). In only 8 patients hilar or mediastinal tumor-involved lymph nodes were found. A potentially curative resection of lung metastases was recorded in 96 patients. The overall survival was significantly correlated with the DFI and the number of intrapulmonary metastases. The DFI correlated significantly with the tumor load and the number of metastases; the post-thoracotomy survival with the number of metastases, tumor-load and pre-thoracotomy serum CEA level. Treatment, stage and grade of the primary cancer, occurrence of liver metastases and local recurrences, mode of treatment of metastases and postoperative residual stage had no significant correlation with either total nor post-thoracotomy survival.
Pulmonary metastases occur even in patients with limited tumor-stages of primary colon/rectum cancer. DFI is the major parameter to estimate the total survival of patients with lung metastases. The survival after thoracotomy depends on the number of metastases, the intrapulmonary tumor load and the presence of elevated serum CEA level prior to thoracotomy.
结肠癌/直肠癌常伴有肺内转移。部分患者可进行手术切除。本研究旨在探寻原发性结肠癌/直肠癌伴肺转移患者可能的预后因素。
回顾了110例接受原发性结肠癌/直肠癌肺转移手术患者的病历。临床参数包括年龄、性别、pTNM/UICC分期、分级、原发癌的部位、手术及辅助治疗情况。记录转移灶的数量、最大直径及胸腔内切除的肿瘤总量（“负荷”）、开胸术前血清癌胚抗原（CEA）水平、转移灶的部位（单侧 vs 双侧）、肺门/纵隔有无肿瘤浸润淋巴结、肺转移灶的手术方式及治疗方案。
原发性癌诊断后的累积5年和10年总生存率分别估计为71%和33.7%。肺转移灶切除术后，开胸术后3年和5年生存率分别为57%和32.6%。原发性癌诊断与开胸手术之间的中位时间间隔（无病间隔期（DFI））为35个月。相当比例的患者（15.4%）原发性癌处于肿瘤分期局限阶段（pT1/2，pN0）。最大转移灶的中位直径为28mm，胸腔内切除的肿瘤负荷中位数计算为11.4cm³。仅8例患者发现有肺门或纵隔肿瘤累及的淋巴结。96例患者实现了肺转移灶的潜在根治性切除。总生存率与DFI及肺内转移灶数量显著相关。DFI与肿瘤负荷及转移灶数量显著相关；开胸术后生存率与转移灶数量、肿瘤负荷及开胸术前血清CEA水平相关。原发性癌的治疗、分期和分级、肝转移及局部复发的发生情况、转移灶的治疗方式及术后残留分期与总生存率及开胸术后生存率均无显著相关性。
即使是原发性结肠癌/直肠癌处于肿瘤分期局限阶段的患者也会发生肺转移。DFI是评估肺转移患者总生存率的主要参数。开胸术后生存率取决于转移灶数量、肺内肿瘤负荷及开胸术前血清CEA水平升高情况。
