Oncology Center of Hospital Sao Jose, Department of Surgery, University of Sao Paulo, LIM-62, Rua Martiniano de Carvalho, 965, Sao Paulo (SP) 01321-001, Brazil.
Int J Surg. 2013;11(3):244-8. doi: 10.1016/j.ijsu.2013.01.003. Epub 2013 Jan 19.
Despite the development of novel chemotherapy and biological agents, surgery is still an important option for patients with pulmonary metastases. Predictors of survival usually include disease-free interval, histology of the primary tumor, number of metastases and complete resection. The aim of this study was to report the outcomes of patients with pulmonary metastases from colorectal carcinoma submitted to surgical resection, and to identify prognostic factors that significantly affect overall survival.
We retrospectively analyzed 120 patients with previously treated colorectal carcinoma that had developed pulmonary metastases, admitted between 1990 and 2006. Overall survival was estimated using Kaplan-Meier analysis. The log-rank and Breslow tests were used to compare survival differences for each variable. Multivariate analyses to determine the independent prognostic factors for overall survival were performed using the Cox proportional hazard model as identified by the univariate analyses.
The median follow-up was 20.3 months (range: 3.27-134.2 months). The patients included in this study underwent a total of 165 thoracotomies (mean of 1.37 thoracotomies/patient). The median overall survival for all patients was 34.73 months, with an estimated 5-year survival rate of 24.39%. Multivariate analyses identified unilateral lesions, neoadjuvant chemotherapy at lung resection and complete resection as independent prognostic factors for overall survival.
These results indicate that prognostic factors identified in studies on pulmonary metastasectomy for all primary tumors should be interpreted carefully for patients with possibility of pulmonary metastasectomy from colorectal carcinoma.
尽管新型化疗和生物制剂不断发展，但手术仍然是肺转移患者的重要选择。生存预测因素通常包括无病间期、原发肿瘤的组织学、转移灶数量和完全切除。本研究旨在报告接受肺转移灶切除术的结直肠癌患者的结果，并确定显著影响总生存的预后因素。
我们回顾性分析了 1990 年至 2006 年间收治的 120 例经治疗的结直肠癌伴肺转移患者。采用 Kaplan-Meier 分析估计总生存情况。对数秩和 Breslow 检验用于比较每个变量的生存差异。采用 Cox 比例风险模型进行多变量分析，以确定单变量分析确定的总生存的独立预后因素。
中位随访时间为 20.3 个月（范围：3.27-134.2 个月）。本研究中的患者共接受了 165 次开胸手术（平均每位患者 1.37 次开胸手术）。所有患者的中位总生存时间为 34.73 个月，估计 5 年生存率为 24.39%。多变量分析确定单侧病变、肺切除术前新辅助化疗和完全切除是总生存的独立预后因素。
这些结果表明，对于有肺转移灶切除术可能的结直肠癌患者，应谨慎解释所有原发性肿瘤肺转移灶切除术研究中确定的预后因素。
