Salah Samer, Ardissone Francesco, Gonzalez Michel, Gervaz Pascal, Riquet Marc, Watanabe Kazuhiro, Zabaleta Jon, Al-Rimawi Dalia, Toubasi Samar, Massad Ehab, Lisi Elena, Hamed Osama H
Medical Oncology Department, King Hussein Cancer Center, Amman, Jordan,
Ann Surg Oncol. 2015;22(6):1844-50. doi: 10.1245/s10434-014-4173-9. Epub 2014 Oct 18.
Data addressing the outcomes and patterns of recurrence after pulmonary metastasectomy (PM) in patients with colorectal cancer (CRC) and previously resected liver metastasis are limited.
We searched the PubMed database for studies assessing PM in CRC and gathered individual data for patients who had PM and a previous curative liver resection. The influence of potential factors on overall survival (OS) was analyzed through univariate and multivariate analysis.
Between 1983 and 2009, 146 patients from five studies underwent PM and had previous liver resection. The median interval from resection of liver metastasis until detection of lung metastasis and the median follow-up from PM were 23 and 48 months, respectively. Five-year OS and recurrence-free survival rates calculated from the date of PM were 54.4 and 29.3 %, respectively. Factors predicting inferior OS in univariate analysis included thoracic lymph node (LN) involvement and size of largest lung nodule ≥2 cm. Adjuvant chemotherapy and whether lung metastasis was detected synchronous or metachronous to liver metastasis had no influence on survival. In multivariate analysis, thoracic LN involvement emerged as the only independent factor (hazard ratio 4.86, 95 % confidence interval 1.56-15.14, p = 0.006).
PM offers a chance for long-term survival in selected patients with CRC and previously resected liver metastasis. Thoracic LN involvement predicted poor prognosis; therefore, significant efforts should be undertaken for adequate staging of the mediastinum before PM. In addition, adequate intraoperative LN sampling allows proper prognostic stratification and enrollment in novel adjuvant therapy trials.
关于结直肠癌（CRC）患者肺转移瘤切除术（PM）及先前已切除肝转移瘤后的复发结局和模式的数据有限。
我们在PubMed数据库中检索评估CRC患者PM的研究，并收集接受PM及先前根治性肝切除患者的个体数据。通过单因素和多因素分析潜在因素对总生存期（OS）的影响。
1983年至2009年期间，五项研究中的146例患者接受了PM且先前有肝切除。从肝转移瘤切除至肺转移瘤检测的中位间隔时间以及从PM开始的中位随访时间分别为23个月和48个月。从PM日期计算的5年OS率和无复发生存率分别为54.4%和29.3%。单因素分析中预测较差OS的因素包括胸段淋巴结（LN）受累和最大肺结节大小≥2 cm。辅助化疗以及肺转移瘤是与肝转移瘤同时还是异时被检测到对生存无影响。多因素分析中，胸段LN受累是唯一的独立因素（风险比4.86，95%置信区间1.56 - 15.14，p = 0.006）。
PM为部分CRC且先前已切除肝转移瘤的患者提供了长期生存的机会。胸段LN受累预示预后不良；因此，在PM前应大力进行纵隔的充分分期。此外，术中充分的LN采样可实现适当的预后分层并纳入新的辅助治疗试验。
