Department of Surgery, Division of Surgical Oncology, Emory University, Atlanta, GA, USA.
J Am Coll Surg. 2010 Jan;210(1):31-8. doi: 10.1016/j.jamcollsurg.2009.09.032. Epub 2009 Nov 18.
CT imaging frequently detects subcentimeter pulmonary nodules (SPN) in patients undergoing resection of colorectal cancer liver metastases. Their clinical significance is unknown.
Patients were identified who underwent hepatic resection for colorectal cancer liver metastases between October 2004 and March 2006. The presence and imaging features of preoperative SPN were analyzed for their association with progression-free survival (PFS), disease-specific survival (DSS), and SPN progression.
One hundred sixty patients underwent liver resection and 68 (43%) had SPN identified preoperatively. Median number of nodules was 1 (75(th) percentile: </=2 nodules) and median size of the largest was 3 mm (25(th) to 75(th) percentile: 2 to 5 mm). SPN were unilateral in 77%, calcified in 19%, solid in 92%, and smooth in contour in 95% of patients. At median follow-up of 31 months for survivors, SPN were proven to be metastatic disease in 35% of patients (24 of 68), either by radiographic increase in size or number (n = 12) or histologic confirmation after resection (n = 12). Median PFS for the 160 patients was 16 months and 3-year DSS was 78%. There was a trend toward shorter median PFS in patients with preoperative SPN compared with patients with no SPN (12 versus 20 months; p = 0.242). There was no difference in 3-year DSS (70% versus 83%; p = 0.46). SPN progression after hepatic resection did not substantially affect 3-year DSS. Calcified nodules were less likely to progress compared with noncalcified nodules (8% versus 42%; p = 0.03).
SPN are common among patients undergoing resection of colorectal cancer liver metastases and approximately one-third of these will prove to be metastatic disease. Presence of limited preoperative SPN might be associated with shorter PFS after hepatectomy, but does not substantially impact 3-year DSS, and should not necessarily preclude resection of hepatic metastases.
在接受结直肠癌肝转移切除术的患者中，CT 成像经常检测到亚厘米级肺结节（SPN）。其临床意义尚不清楚。
本研究回顾性分析了 2004 年 10 月至 2006 年 3 月期间接受肝切除术治疗结直肠癌肝转移的患者。分析术前 SPN 的存在和影像学特征与无进展生存期（PFS）、疾病特异性生存期（DSS）和 SPN 进展的关系。
160 例患者接受了肝切除术，其中 68 例（43%）术前发现 SPN。结节的中位数为 1 个（第 75 百分位数：</=2 个结节），最大结节的中位数大小为 3 毫米（第 25 百分位数至第 75 百分位数：2 至 5 毫米）。SPN 在 77%的患者中为单侧，19%的患者为钙化，92%的患者为实性，95%的患者为轮廓光滑。在生存患者的中位随访 31 个月时，SPN 在 35%的患者（68 例中的 24 例）中被证实为转移性疾病，要么是通过影像学上的大小或数量增加（n=12），要么是通过切除后的组织学证实（n=12）。160 例患者的中位 PFS 为 16 个月，3 年 DSS 为 78%。与无 SPN 的患者相比，术前有 SPN 的患者的中位 PFS 有缩短的趋势（12 个月比 20 个月；p=0.242）。3 年 DSS 无差异（70%比 83%；p=0.46）。肝切除术后 SPN 的进展并没有显著影响 3 年 DSS。与非钙化结节相比，钙化结节进展的可能性较小（8%比 42%；p=0.03）。
SPN 在接受结直肠癌肝转移切除术的患者中很常见，其中约三分之一将被证实为转移性疾病。术前存在有限的 SPN 可能与肝切除术后 PFS 缩短有关，但不会对 3 年 DSS 产生实质性影响，也不应该理所当然地排除肝转移的切除。
