Renaud Stéphane, Falcoz Pierre-Emmanuel, Olland Anne, Schaeffer Mickaël, Reeb Jérémie, Santelmo Nicola, Massard Gilbert
Department of Thoracic Surgery, Nouvel Hôpital Civil, 1, Strasbourg University Hospital, Strasbourg, France.
Department of Thoracic Surgery, Nouvel Hôpital Civil, 1, Strasbourg University Hospital, Strasbourg, France
Interact Cardiovasc Thorac Surg. 2015 Feb;20(2):215-21. doi: 10.1093/icvts/ivu364. Epub 2014 Oct 30.
Data on thoracic lymph node involvement (LNI) in lung metastasis of colorectal cancer (CRC) are conflicting, with a 5-year overall survival (OS) ranging from 6 to 40%. We aimed to evaluate whether there are subgroups of patients according to the lymph node ratio (LNR).
We retrospectively reviewed the data from 106 patients who underwent a thoracic procedure for CRC lung metastasis with pathologically proven thoracic LNI.
In the univariate analysis, the median OS was significantly poorer for a pN2 location of LNI (26 vs 16 months, P = 0.04), LNR ≥50% (30 vs 17 months, P = 0.005), high preoperative CEA (32 vs 16 months, P = 0.02), hepatic metastases (27 vs 11 months, P <0.0001) and disease-free survival < 24 months (32 vs 17 months, P = 0.05). When pN1 and pN2 patients were staged according to the LNR, the median OS was significantly better for an LNR <50% (27 vs 17 months for pN1, 32 vs 12 months for pN2, P = 0.01). In the multivariate analysis, a high preoperative CEA [hazard ratio (HR): 2.256 (1.051-4.841), P = 0.04], pN1 status [HR: 0.337 (0.162-0.7), P = 0.004] and the absence of hepatic metastases [HR: 0.395 (0.180-0.687), P = 0.02] remained significant prognostic factors. There was an upward trend for patients with LNR <50% [HR: 0.565 (0.296-1.082), P = 0.08]. Otherwise, low LNR was significantly associated with a decreased risk of loco-regional recurrence (HR: 0.36, 95% confidence intervals: 0.14-0.96, P = 0.04).
The LNR seems to be a more reliable prognostic factor than LNI for CRC lung metastasis. Prospective studies are necessary.
关于结直肠癌（CRC）肺转移中胸段淋巴结受累（LNI）的数据存在矛盾，5年总生存率（OS）在6%至40%之间。我们旨在评估是否存在根据淋巴结比率（LNR）划分的患者亚组。
我们回顾性分析了106例行胸段手术治疗CRC肺转移且经病理证实存在胸段LNI患者的数据。
在单因素分析中，LNI处于pN2位置（26个月对16个月，P = 0.04）、LNR≥50%（30个月对17个月，P = 0.005）、术前癌胚抗原（CEA）水平高（32个月对16个月，P = 0.02）、肝转移（27个月对11个月，P <0.0001）以及无病生存期<24个月（32个月对17个月，P = 0.05）时，中位OS显著较差。当根据LNR对pN1和pN2患者进行分期时，LNR<50%的患者中位OS显著更好（pN1患者为27个月对17个月，pN2患者为32个月对12个月，P = 0.01）。在多因素分析中，术前CEA水平高[风险比（HR）：2.256（1.051 - 4.841），P = 0.04]、pN1状态[HR：0.337（0.162 - 0.7），P = 0.004]以及无肝转移[HR：0.395（0.180 - 0.687），P = 0.02]仍然是显著的预后因素。LNR<50%的患者有上升趋势[HR：0.565（0.
