Welter Stefan, Jacobs Jan, Krbek Thomas, Poettgen Christoph, Stamatis Georgios
Department of Thoracic Surgery, Ruhrlandklinik Essen, Tüschener Weg 40, 45239 Essen, Germany.
Eur J Cardiothorac Surg. 2007 Feb;31(2):167-72. doi: 10.1016/j.ejcts.2006.11.004. Epub 2006 Dec 5.
The purpose of this study was to identify the prognostic impact of unexpected lymph node metastases in patients undergoing resection of pulmonary metastases from colorectal cancer and specify the influence of pulmonary and mediastinal nodal involvement according to the modified Narukes lymph node mapping [Mountain CF, Dresler CM. Regional lymph node classification for lung cancer. Chest 1997;111(6):1718-23.].
From January 1993 to December 2003, 175 patients were diagnosed and resected for pulmonary metastases of colorectal cancer. Follow up informations were collected for 169 patients and an analysis of prognostic factors was performed. Ninety-six men (56.8%) and 73 women (43.2%) with a median age of 62 (range 34-81) were identified, 28 (16.7%) patients were found to have lymph node metastases, five of them were identified during a recurrent procedure. Probability of survival was calculated according to the method of Kaplan-Meier. The prognostic influence of lymph node metastases on survival was analyzed with the log-rank test.
Median survival was 47.2 months after first metastasectomy. Ten patients with intrapulmonary nodal involvement had a median survival of 86 months whereas 12 patients with hilar and six patients with mediastinal lymph node metastases had a median survival of 24.5 and 34.7 months. The survival difference between pulmonary and hilar/mediastinal metastases was statistically significant (p=0.008/p=0.07). Five year survival with pulmonary, hilar, and mediastinal metastases was 78.5, 0, and 0%, respectively. Perioperative mortality was 0%.
Resection of pulmonary metastases secondary to colorectal cancer is safe and indicated in highly selected patients. Because tumor involvement of lymph nodes has a strong impact on survival; depending on their location, at least a lymph node sampling should always be performed. Adjuvant chemotherapy in case of proven lymph node metastases might be a good option to improve prognosis.
本研究旨在确定结直肠癌肺转移患者意外发生淋巴结转移的预后影响，并根据改良的 Naruke 淋巴结图谱[Mountain CF, Dresler CM. 肺癌区域淋巴结分类。胸部 1997;111(6):1718 - 23.]明确肺和纵隔淋巴结受累的影响。
1993 年 1 月至 2003 年 12 月，175 例患者被诊断为结直肠癌肺转移并接受了切除术。收集了 169 例患者的随访信息并进行了预后因素分析。确定了 96 名男性（56.8%）和 73 名女性（43.2%），中位年龄为 62 岁（范围 34 - 81 岁），28 例（16.7%）患者发现有淋巴结转移，其中 5 例是在复发手术过程中发现的。根据 Kaplan - Meier 方法计算生存概率。用对数秩检验分析淋巴结转移对生存的预后影响。
首次肺转移切除术后的中位生存期为 47.2 个月。10 例肺内淋巴结受累患者的中位生存期为 86 个月，而 12 例肺门淋巴结转移患者和 6 例纵隔淋巴结转移患者的中位生存期分别为 24.5 个月和 34.7 个月。肺转移与肺门/纵隔转移之间的生存差异具有统计学意义（p = 0.008/p = 0.07）。肺、肺门和纵隔转移的 5 年生存率分别为 78.5%、0%和 0%。围手术期死亡率为 0%。
结直肠癌继发肺转移的切除在经过严格筛选的患者中是安全且可行的。由于肿瘤累及淋巴结对生存有强烈影响；根据其位置，至少应始终进行淋巴结采样。对于已证实有淋巴结转移的患者，辅助化疗可能是改善预后的一个好选择。
