Vogelsang H, Haas S, Hierholzer C, Berger U, Siewert J R, Präuer H
Department of Surgery, Technische Universität München, Klinikum rechts der Isar, Ismaninger Strasse 22, 81675 Munich, Germany.
Br J Surg. 2004 Aug;91(8):1066-71. doi: 10.1002/bjs.4602.
Selection of patients for resection of lung metastases from colorectal cancer is problematic. The aim of this study was to evaluate clinically relevant prognostic factors and to define a subgroup of patients who would most benefit from such surgery.
Seventy-five patients (median age 58 (range 33-82) years) with pulmonary metastases from colorectal cancer underwent 104 R0 lung resections. Median follow-up was 33 (range 4-116) months. Patients who had no evidence of recurrent extrathoracic disease, no more than three metastases on either side, lobectomy as the maximal surgical procedure, and adequate cardiorespiratory function were eligible for surgery. Univariate and multivariate Cox regression, and classification and regression tree subgroup analyses were performed.
Overall median survival was 33 months, with 3- and 5-year survival rates of 47 and 27 per cent respectively. Size of metastases (relative risk (RR) 2.6) and extent of resection (RR 0.4) were identified as independent prognostic factors. Primary tumour stage was significant in univariate analysis. Subgroup analysis defined two statistically relevant prognostic groups: patients with a maximum metastasis size of 3.75 cm or less with a disease-free interval of more than 10 months and patients with larger metastases and a shorter disease-free interval. Median survival and 5-year survival were 45 months and 39 per cent in the former group, and 24 months and less than 11 per cent in the latter.
Subgroup analysis provided criteria for the selection of patients for R0 resection of lung metastases from colorectal cancer and differentiated between those at high or low risk of early tumour progression; the latter patients would benefit most from surgery.
选择结直肠癌肺转移患者进行切除术存在问题。本研究的目的是评估临床相关的预后因素，并确定最能从这种手术中获益的患者亚组。
75例（中位年龄58岁（范围33 - 82岁））结直肠癌肺转移患者接受了104次R0肺切除术。中位随访时间为33个月（范围4 - 116个月）。没有胸外疾病复发证据、两侧转移灶不超过3个、最大手术方式为肺叶切除术且心肺功能良好的患者符合手术条件。进行了单因素和多因素Cox回归分析以及分类和回归树亚组分析。
总体中位生存期为33个月，3年和5年生存率分别为47%和27%。转移灶大小（相对危险度（RR）2.6）和切除范围（RR 0.4）被确定为独立的预后因素。原发肿瘤分期在单因素分析中具有显著性。亚组分析确定了两个具有统计学意义的预后组：转移灶最大直径3.75 cm或更小且无病间期超过10个月的患者，以及转移灶较大且无病间期较短的患者。前一组的中位生存期和5年生存率分别为45个月和39%，后一组分别为24个月和不到11%。
亚组分析为选择结直肠癌肺转移患者进行R0切除提供了标准，并区分了早期肿瘤进展高风险或低风险的患者；后者从手术中获益最大。
