Department of Digestive Oncology, University Hospital Ambroise Paré, University Versailles Saint Quentin, APHP, Boulogne, France.
Gut. 2010 Oct;59(10):1383-8. doi: 10.1136/gut.2010.211557. Epub 2010 Aug 23.
Epidemiological data on synchronous and metachronous lung metastases from colorectal cancer are scarce. The aim of this study was to determine trends in the incidence, treatment and survival in colorectal cancer with lung metastases in the general population.
All cases of lung metastases from colorectal cancer registered in the Burgundy digestive cancer registry between 1976 and 2005 were included. Trends in the incidence of synchronous colorectal cancer lung metastases were estimated. A Cox model was used to analyse the risk of developing a metachronous metastasis. Multivariate analyses were performed using a relative survival model with proportional hazard applied to the net survival by interval.
Overall, 11.0% of patients had synchronous lung metastases. The frequency of synchronous lung metastases significantly increased for both sexes over time, with a nearly threefold increase between the periods 1976-1985 and 1996-2005. The overall 5-year cumulative risk of developing metachronous lung metastases was 5.8%. It did not significantly vary with time. Compared to colon cancer, rectal cancers had a higher risk of developing synchronous (OR: 2.80 (1.65-4.76)) and metachronous (OR: 2.63 (1.69-4.08)) lung metastases. Overall, 4.1% of synchronous lung metastases and 14.3% of metachronous lung metastases were resected for cure. The 3-year relative survival was 11.3% for synchronous lung metastases and 13.8% for metachronous lung metastases. It was, respectively, 53.0% and 59.2% after resection for cure. In multivariate analysis, the relative risk of death for the 1996-2005 period was about one fifth of that for the 1976-1985 period.
The incidence of synchronous lung metastases increased over time, whereas the incidence of metachronous lung metastases remained stable. Lung metastases were more frequent in rectal cancer than in colon cancer. Unless surgical resection is possible, the prognosis for lung metastases remains very poor.
有关结直肠癌同步和异时性肺转移的流行病学数据很少。本研究旨在确定普通人群中结直肠癌合并肺转移的发病率、治疗和生存趋势。
本研究纳入了 1976 年至 2005 年勃艮第消化癌症登记处登记的所有结直肠癌肺转移病例。估计了同步结直肠癌肺转移的发病率趋势。采用 Cox 模型分析了发生异时性转移的风险。采用比例风险的相对生存模型对间隔净生存进行多变量分析。
总体而言，11.0%的患者有同步性肺转移。无论男性还是女性，随着时间的推移，同步性肺转移的频率均显著增加，在 1976-1985 年和 1996-2005 年期间增加了近两倍。总体 5 年发生异时性肺转移的累积风险为 5.8%。时间上没有显著变化。与结肠癌相比，直肠癌发生同步（OR：2.80（1.65-4.76））和异时性（OR：2.63（1.69-4.08））肺转移的风险更高。总体而言，4.1%的同步性肺转移和 14.3%的异时性肺转移被切除以治愈。同步性肺转移的 3 年相对生存率为 11.3%，异时性肺转移的 3 年相对生存率为 13.8%。根治性切除后，分别为 53.0%和 59.2%。多变量分析显示，1996-2005 期间的死亡相对风险约为 1976-1985 期间的五分之一。
同步性肺转移的发病率随时间增加，而异时性肺转移的发病率保持稳定。直肠癌患者的肺转移发生率高于结肠癌患者。除非可以进行手术切除，否则肺转移的预后仍然非常差。
