Cho Sukki, Song In Hag, Yang Hee Chul, Jheon Sanghoon
Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Gyeonggi, Korea.
Interact Cardiovasc Thorac Surg. 2013 Aug;17(2):303-7. doi: 10.1093/icvts/ivt164. Epub 2013 Apr 23.
This study was conducted to investigate the prognostic factors of pulmonary metastases, focusing on the time of detection of pulmonary metastases related to adjuvant chemotherapy in patients with colorectal cancer (CRC).
Between June 2003 and December 2010, 84 patients underwent pulmonary metastasectomy for pulmonary metastasis (PM) from CRC. The clinicopathological data of colorectal surgery and pulmonary metastasectomy were analysed retrospectively. Disease-free intervals (DFIs) were specifically classified into the following three groups related to adjuvant chemotherapy after colorectal operation: Group 1, metastasis detected at initial presentation; Group 2, metastasis detected during adjuvant chemotherapy; Group 3, metastasis detected after completion of chemotherapy. The prognostic influence of these variables on disease-free survival was analysed using the log-rank test for univariate analysis and the Cox proportional hazards model for multivariate analysis.
The median follow-up durations for patients after curative resection of CRC and pulmonary metastasectomy were 48.6 and 28.8 months, respectively. After pulmonary metastasectomy, recurrence was seen in 49 (58.3%) patients-pulmonary recurrence in 37 and extrathoracic recurrence in 12. Young age (<54 years old) at CRC operation, more than one PM, a DFIs of <12 months, detection synchronously or under adjuvant chemotherapy, and high CEA level before metastasectomy were worse prognostic factors by univariate analysis. From multivariate analysis, the number of pulmonary metastases (multiple metastases, HR=2.121, 95% confidence interval 1.081-4.159, P=0.029) and DFIs related with adjuvant chemotherapy (Group 1+2, HR=1.982, 95% confidence interval 1.083-3.631, P=0.027) were found to be independent predictors of disease-free survival.
Disease-free intervals in association with the time of adjuvant chemotherapy and number of metastases were independent poor prognostic factors for pulmonary metastases from colorectal cancer.
本研究旨在调查肺转移的预后因素，重点关注结直肠癌（CRC）患者中与辅助化疗相关的肺转移检测时间。
2003年6月至2010年12月期间，84例患者因CRC肺转移（PM）接受了肺转移瘤切除术。对结直肠手术和肺转移瘤切除术的临床病理数据进行回顾性分析。无病间期（DFIs）根据结直肠手术后辅助化疗的情况具体分为以下三组：第1组，初次就诊时发现转移；第2组，辅助化疗期间发现转移；第3组，化疗完成后发现转移。使用对数秩检验进行单因素分析，使用Cox比例风险模型进行多因素分析，分析这些变量对无病生存的预后影响。
CRC根治性切除和肺转移瘤切除术后患者的中位随访时间分别为48.6个月和28.8个月。肺转移瘤切除术后，49例（58.3%）患者出现复发——37例为肺复发，12例为胸外复发。单因素分析显示，CRC手术时年龄较轻（<54岁）、多个PM、DFIs<12个月、同步或在辅助化疗下检测到转移以及转移瘤切除术前CEA水平较高是较差的预后因素。多因素分析发现，肺转移灶数量（多发转移，HR=2.121，95%置信区间1.081-4.159，P=0.029）和与辅助化疗相关的DFIs（第1组+第2组，HR=1.982，95%置信区间1.083-3.631，P=0.027）是无病生存的独立预测因素。
与辅助化疗时间和转移灶数量相关的无病间期是结直肠癌肺转移的独立不良预后因素。
