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肝转移和肺肿瘤负荷在预测结直肠癌完全肺切除术后生存中的作用。

The role of hepatic metastases and pulmonary tumor burden in predicting survival after complete pulmonary resection for colorectal cancer.

机构信息

Medical Oncology Unit, Humanitas Cancer Center, Istituto Clinico Humanitas, IRCCS, Rozzano, Italy.

出版信息

J Thorac Cardiovasc Surg. 2013 Jan;145(1):97-103. doi: 10.1016/j.jtcvs.2012.07.097. Epub 2012 Aug 28.

Abstract

OBJECTIVE

Our objective was to investigate the role of clinicopathologic factors as predictors of outcome after complete pulmonary resection for metastatic colorectal cancer.

METHODS

Consecutive patients undergoing radical pulmonary resection for colorectal cancer at our institution were included in the study. Clinicopathologic variables including sex, age, site and stage of the primary tumor, disease-free interval, prior hepatic resection, timing of pulmonary metastases, preoperative chemotherapy, type of pulmonary resection, number, size, and location of pulmonary metastases, and thoracic lymph node involvement were retrospectively collected and investigated for prognostic significance. Survival curves were generated by the Kaplan-Meier technique and difference between factors were evaluated by the log-rank test.

RESULTS

A total of 127 patients undergoing pulmonary resection between 1997 and 2009 were included in the study. The median follow-up was 67.1 months. The median overall survival from the time of pulmonary resection was 48.9 months. The 5-year overall survival was 45.4%. Among all investigated prognostic variables, the number of pulmonary metastases (1 vs >1) was the most important factor affecting the outcome after pulmonary resection (5-year overall survival 55.4% vs 32.2%; hazard rate, 1.92; P = .006).

CONCLUSIONS

In this study, the presence of a single pulmonary metastasis was a favorable predictor of survival after complete pulmonary resection for metastatic colorectal cancer. All the other prognostic variables did not seem to affect survival and should not contraindicate such surgery in clinical practice. However, the study sample size does not allow us to draw any definitive conclusion, and further investigation of the role of these prognostic factors in larger series is warranted.

摘要

目的

本研究旨在探讨临床病理因素在预测结直肠癌肺转移完全切除术后结局中的作用。

方法

本研究纳入在我院行根治性肺切除术的结直肠癌患者。回顾性收集并分析了包括性别、年龄、原发肿瘤部位和分期、无病间期、既往肝切除术、肺转移的时间、术前化疗、肺切除术类型、肺转移的数量、大小和位置以及胸内淋巴结受累等临床病理变量,并探讨其对预后的意义。采用 Kaplan-Meier 法生成生存曲线,对数秩检验比较因素间差异。

结果

共纳入 1997 年至 2009 年间行肺切除术的 127 例患者。中位随访时间为 67.1 个月。从肺切除术时间起的中位总生存时间为 48.9 个月。5 年总生存率为 45.4%。在所有研究的预后变量中,肺转移灶数量(1 个 vs. >1 个)是影响肺切除术后结局的最重要因素(5 年总生存率分别为 55.4%和 32.2%;危险比,1.92;P=0.006)。

结论

在本研究中,单一肺转移灶是结直肠癌肺转移完全切除术后生存的有利预测因素。所有其他预后因素似乎并不影响生存,不应在临床实践中对此类手术产生禁忌。然而,本研究的样本量不允许我们得出任何明确的结论,需要进一步在更大的系列中研究这些预后因素的作用。

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