Department of Thoracic Surgery, Kimitsu Central Hospital, Chiba, Japan.
Ann Surg. 2013 Jun;257(6):1059-64. doi: 10.1097/SLA.0b013e31826eda3b.
We aimed to identify prognostic factors after pulmonary metastasectomy for colorectal cancer and propose the clinical application of them. Furthermore, we endeavored to provide a rationale for pulmonary metastasesectomy.
Several prognostic factors have been proposed, but clinical application of them remains unclear. Moreover, there is no theoretical evidence that pulmonary metastasectomy is indicated for colorectal cancer.
We retrospectively analyzed 1030 patients who underwent pulmonary metastasectomy for colorectal cancer from 1990 to 2008. Prognostic factors were identified and the relationship of recurrent sites after pulmonary resection to pulmonary tumor size was assessed.
Overall 5-year survival was 53.5%. Median survival time was 69.5 months. Univariate analysis showed tumor number (P < 0.0001), tumor size (P < 0.0001), prethoracotomy serum carcinoembryonic antigen (CEA) level (P < 0.0001), lymph node involvement (P < 0.0001), and completeness of resection (P < 0.0001) to significantly influence survival. In multivariate analysis, all remained independent predictors of outcome. In patients whose recurrent sites extended downstream from the lung via hematogenous colorectal cancer spread, pulmonary tumor size was significantly larger than in those with recurrent sites confined to the lung and regions upstream from the lung.
We should utilize these prognostic factors to detect patients who might benefit from surgery. Therefore, we should periodically follow up advanced colorectal cancer patients by chest computed tomography to detect small pulmonary metastases before serum CEA elevation. Metastases to the lung or organs upstream from the lung are regarded as semi-local for colorectal cancer. This concept provides a rationale for validating surgical indications for pulmonary metastases from colorectal cancer.
我们旨在确定结直肠癌肺转移瘤切除术的预后因素，并提出其临床应用。此外，我们还致力于为肺转移瘤切除术提供理论依据。
已经提出了一些预后因素，但它们的临床应用仍不清楚。此外，没有理论证据表明肺转移瘤切除术对结直肠癌是指征。
我们回顾性分析了 1990 年至 2008 年间接受肺转移瘤切除术的 1030 例结直肠癌患者。确定了预后因素，并评估了肺切除术后复发部位与肺肿瘤大小的关系。
总体 5 年生存率为 53.5%。中位生存时间为 69.5 个月。单因素分析显示肿瘤数量（P < 0.0001）、肿瘤大小（P < 0.0001）、术前血清癌胚抗原（CEA）水平（P < 0.0001）、淋巴结受累（P < 0.0001）和切除的完整性（P < 0.0001）显著影响生存。多因素分析中，所有因素均为独立预后因素。在通过血行播散转移至肺的复发部位延伸至肺下游的患者中，肺肿瘤大小明显大于复发部位局限于肺和肺上游区域的患者。
我们应该利用这些预后因素来发现可能从手术中获益的患者。因此，我们应该定期通过胸部计算机断层扫描对晚期结直肠癌患者进行随访，以在血清 CEA 升高之前检测到小的肺转移灶。肺或肺上游器官的转移被认为是结直肠癌的半局部转移。这一概念为验证结直肠癌肺转移瘤切除术的手术适应证提供了理论依据。
