Onaitis Mark W, Petersen Rebecca P, Haney John C, Saltz Leonard, Park Bernard, Flores Raja, Rizk Nabil, Bains Manjit S, Dycoco Joseph, D'Amico Thomas A, Harpole David H, Kemeny Nancy, Rusch Valerie W, Downey Robert
Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
Ann Thorac Surg. 2009 Jun;87(6):1684-8. doi: 10.1016/j.athoracsur.2009.03.034.
This study was undertaken to review a large series of resections of colorectal pulmonary metastases in the era of modern chemotherapy.
A retrospective chart review of prospectively maintained thoracic surgery databases identified 378 patients who underwent pulmonary resection for colorectal cancer metastases with curative intent from 1998 to 2007.
The primary site of disease was rectum (52%), left colon (26%), right colon (16%), and unknown (6%). Before thoracic recurrence, 166 patients (44%) had previously undergone resection of extrathoracic metastases. Median disease-free interval (DFI) was 24 months from the time of the primary operation. The number of metastatic deposits resected was one in 60%, two in 20%, three in 10%, and four or more in 10%. Chemotherapy was administered to 87 patients (23%) before resection and to 169 patients (45%) after resection. Three-year recurrence-free survival was 28%, and 3-year overall survival was 78%. Multivariable analysis revealed age younger than 65 years, female sex, DFI less than 1 year, and number of metastases greater than three as independent predictors of recurrence. Of 44 patients with three or more lesions and less than 1 year DFI, none was cured by operation. By contrast, recurrence-free survival was 49% at 3 years for those with one lesion and DFI greater than 1 year.
Age younger than 65 years, female sex, DFI less than 1 year, and number of metastases greater than three predict recurrence. Medical management alone should be considered standard for patients who have both three or more pulmonary metastases and less than 1 year DFI.
本研究旨在回顾现代化疗时代大量结直肠癌肺转移瘤切除术的情况。
对前瞻性维护的胸外科数据库进行回顾性图表分析，确定了1998年至2007年期间378例因结直肠癌转移而接受肺切除术且目的为治愈的患者。
疾病的原发部位为直肠（52%）、左半结肠（26%）、右半结肠（16%），不明（6%）。在胸内复发之前，166例患者（44%）曾接受过胸外转移瘤切除术。从初次手术时起，无病间期（DFI）的中位数为24个月。切除的转移灶数量为1个的占60%，2个的占20%，3个的占10%，4个或更多的占10%。87例患者（23%）在切除术前接受了化疗，169例患者（45%）在切除术后接受了化疗。3年无复发生存率为28%，3年总生存率为78%。多变量分析显示，年龄小于65岁、女性、DFI小于1年以及转移灶数量大于3个是复发的独立预测因素。在44例有3个或更多病灶且DFI小于1年的患者中，无1例通过手术治愈。相比之下，对于有1个病灶且DFI大于1年的患者，3年无复发生存率为49%。
年龄小于65岁、女性、DFI小于1年以及转移灶数量大于3个可预测复发。对于有3个或更多肺转移灶且DFI小于1年的患者，单纯药物治疗应被视为标准治疗方法。
