Department of Surgery, Chonnam National University, Gwangju, Korea.
Dis Colon Rectum. 2012 Apr;55(4):459-64. doi: 10.1097/DCR.0b013e318246b08d.
The prognostic factors after pulmonary resection in patients with colorectal pulmonary metastases remain controversial.
The study aimed to identify the predicting factors for oncological outcomes after curative resection in patients with colorectal cancer and pulmonary metastases.
This study is a retrospective review of prospectively collected data.
This study was conducted at a tertiary care hospital/referral center in South Korea.
Between January 2000 and June 2010, 105 patients who developed pulmonary metastases after curative resection for colorectal cancer were enrolled. Forty-eight patients underwent pulmonary resection, and the remaining 58 were given chemotherapy and/or best supportive care.
The primary outcomes measured were the predictive factors of survival and recurrence.
During the 35.9-month median follow-up period, 3- and 5-year overall survival rates were 54.6% and 30.4%. On multivariate analysis, absence of adjuvant chemotherapy after pulmonary metastases (p = 0.003), presence of extrapulmonary metastases (p = 0.001), elevated prelaparotomy serum CEA level (p = 0.015), and absence of pulmonary resection (p = 0.048) were independent prognostic factors for poor overall survival. In patients who underwent pulmonary resection, the 3-year pulmonary recurrence-free survival rate was 78.3%. On multivariate analysis, elevated prelaparotomy serum CEA level (p = 0.018) and disease-free interval ≤ 12 months (p = 0.008) were independent risk factors associated with pulmonary re-recurrence after pulmonary resection.
This study took place at a single institution and had a small sample size.
Although we admit, to some degree, the benefits of the selection mechanism, pulmonary metastasectomy from colorectal cancer may improve survival after curative resection of colorectal cancer. Adjuvant chemotherapy, extrapulmonary metastases, and prelaparotomy CEA value are independent prognostic factors for overall survival. Prelaparotomy serum CEA level may be an especially reliable predictor of both overall survival and recurrence-free survival after pulmonary metastasectomy in patients who undergo curative resection for colorectal cancer.
结直肠肺转移患者肺切除术后的预后因素仍存在争议。
本研究旨在确定结直肠癌伴肺转移患者根治性切除术后肿瘤学结局的预测因素。
这是一项回顾性分析前瞻性收集数据的研究。
这项研究在韩国的一家三级保健医院/转诊中心进行。
2000 年 1 月至 2010 年 6 月期间，105 例接受结直肠癌根治性切除术后发生肺转移的患者入组。48 例患者接受了肺切除术，其余 58 例患者接受了化疗和/或最佳支持治疗。
主要观察指标为生存和复发的预测因素。
在中位随访 35.9 个月期间，3 年和 5 年总生存率分别为 54.6%和 30.4%。多因素分析显示，肺转移后无辅助化疗（p=0.003）、存在肺外转移（p=0.001）、术前血清 CEA 水平升高（p=0.015）和未行肺切除术（p=0.048）是总生存不良的独立预后因素。在接受肺切除术的患者中，3 年无肺复发生存率为 78.3%。多因素分析显示，术前血清 CEA 水平升高（p=0.018）和无病间隔≤12 个月（p=0.008）是肺切除术后肺复发的独立危险因素。
本研究在单中心进行，样本量较小。
尽管我们在一定程度上承认选择机制的益处，但结直肠癌肺转移的肺切除术可能会改善结直肠癌根治性切除术后的生存。辅助化疗、肺外转移和术前 CEA 值是总生存的独立预后因素。术前血清 CEA 水平可能是结直肠癌根治性切除术后发生肺转移的患者总生存和无复发生存的一个特别可靠的预测因素。
