Tan Ker Kan, Lopes Gilberto de Lima, Sim Richard
Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
J Gastrointest Surg. 2009 Apr;13(4):642-8. doi: 10.1007/s11605-008-0757-7. Epub 2008 Dec 11.
It is commonly thought that colon cancer metastases to the lungs without involvement of the liver are rare.
We performed a retrospective review of all patients with colorectal cancer diagnosed between December 2003 and August 2007 in Singapore. Isolated lung metastases were determined as (1) Definite if there was confirmed histology or cytology of the lung lesion(s) in the absence of liver lesions on CT scan, and (2) Probable if there were only radiological evidence suggestive of lung metastases rather than lung primary also in the absence of liver lesions on CT scan.
There were 196 patients with rectal and 558 patients with colon cancer (369 left-sided and 189 right-sided). There were 13 definite isolated lung metastases, and the remaining 43 were probable. Twenty-three (12%) patients with rectal cancer and 33 (6%) patients with colon cancer had isolated lung metastases (OR 2.11, 95% CI 1.21-3.70). Patients with >or=pT3 lesions (OR 1.92, 95% CI 0.75-4.93) and >or=pN1 (OR 1.56, 95% CI 0.86- 2.83) were more likely to have isolated lung metastases.
The true incidence of isolated lung without liver metastases in colorectal cancer is likely to lie between 1.7% and 7.2%. While the incidence of isolated lung metastases is twice as common in patients with rectal cancer, it is still significant in patients with colon cancer. The absence of liver involvement should not preclude a search for lung metastases.
人们普遍认为，结肠癌转移至肺部而无肝脏受累的情况较为罕见。
我们对2003年12月至2007年8月期间在新加坡诊断为结直肠癌的所有患者进行了回顾性研究。孤立性肺转移的判定标准为：（1）确诊：CT扫描显示肺部病变有组织学或细胞学确诊证据且无肝脏病变；（2）疑似：CT扫描同样无肝脏病变，仅有影像学证据提示肺转移而非原发性肺癌。
共有196例直肠癌患者和558例结肠癌患者（369例左侧结肠癌和189例右侧结肠癌）。有13例确诊的孤立性肺转移，其余43例为疑似。23例（12%）直肠癌患者和33例（6%）结肠癌患者有孤立性肺转移（比值比2.11，95%可信区间1.21 - 3.70）。肿瘤浸润深度≥T3的患者（比值比1.92，95%可信区间0.75 - 4.93）和区域淋巴结转移≥N1的患者（比值比1.56，95%可信区间0.86 - 2.83）更易发生孤立性肺转移。
结直肠癌中无肝脏转移的孤立性肺转移的实际发生率可能在1.7%至7.2%之间。虽然孤立性肺转移在直肠癌患者中的发生率是结肠癌患者的两倍，但在结肠癌患者中仍较为显著。无肝脏受累不应排除对肺转移的排查。
