Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
Ann Thorac Surg. 2012 Dec;94(6):1796-800. doi: 10.1016/j.athoracsur.2012.04.049. Epub 2012 Jun 20.
The aim of this study was to clarify the clinical outcome and significance of mediastinal lymph node dissection (LND) during pulmonary resection of metastases from colorectal adenocarcinoma.
A retrospective chart review was performed. Between April 1985 and December 2009, 518 patients underwent 720 pulmonary metastasectomies for metastatic colorectal adenocarcinoma. Relevant factors were analyzed with the χ2 or Fisher exact test and the Mann-Whitney test. Survival and lymph node (LN) recurrence-free period after pulmonary metastasectomy were analyzed with Kaplan-Meier and Cox proportional hazards methods.
The overall 5-year and 10-year survival rate after pulmonary metastasectomy were 47.1% and 27.7%, respectively. The only significant prognostic factor for survival after pulmonary metastasectomy was mediastinal LN metastasis (p=0.047 in univariate and 0.0028 in multivariate analysis); 199 patients did not undergo LND, 279 patients underwent LND that were negative, and 40 patients underwent LND that contained 1 or more positive mediastinal LN for metastases. The sensitivity of positron emission tomographic scan for detecting mediastinal LN metastases was only 35%. Although long-term survivors were present, systematic LND was not a significant factor for prolonged survival (p=0.26) in the positive LND group.
Mediastinal LN metastases are a significant negative prognostic factor for survival after pulmonary metastasectomy for metastatic colorectal cancer. Computed tomography and positron emission tomography based imaging, as well as preoperative carcinoembryonic antigen levels have poor sensitivity for detecting malignant mediastinal LN in this setting. Systematic mediastinal LND should be performed for prognostic purposes during pulmonary metastasectomy for colorectal metastases.
本研究旨在阐明结直肠腺癌肺转移患者行肺切除术时纵隔淋巴结清扫（LND）的临床结果和意义。
对病历进行回顾性分析。1985 年 4 月至 2009 年 12 月期间，518 例患者共行 720 例肺转移切除术治疗结直肠腺癌转移。采用卡方检验或 Fisher 确切概率法和 Mann-Whitney 检验对相关因素进行分析。采用 Kaplan-Meier 和 Cox 比例风险方法分析肺转移切除术后生存和淋巴结（LN）无复发生存期。
肺转移切除术后 5 年和 10 年的总生存率分别为 47.1%和 27.7%。纵隔 LN 转移是肺转移切除术后生存的唯一显著预后因素（单因素分析中 p=0.047，多因素分析中 p=0.0028）；199 例患者未行 LND，279 例患者行 LND 且阴性，40 例患者行 LND 且纵隔 LN 有 1 个或更多阳性转移。正电子发射断层扫描（PET）扫描检测纵隔 LN 转移的敏感性仅为 35%。虽然存在长期存活者，但在阳性 LND 组，系统性 LND 不是延长生存时间的显著因素（p=0.26）。
纵隔 LN 转移是结直肠腺癌肺转移切除术后生存的显著负性预后因素。在这种情况下，CT 和 PET 基于影像学检查以及术前癌胚抗原水平检测恶性纵隔 LN 的敏感性较差。为了预后目的，在结直肠转移行肺转移切除时，应进行系统性纵隔 LND。
