Cho Jong Ho, Kim Seok, Namgung Mi, Choi Yong Soo, Kim Hong Kwan, Zo Jae Ill, Shim Young Mog, Kim Jhingook
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Ilwon-dong, Gangnam-gu, Seoul, 135-710, South Korea.
World J Surg Oncol. 2015 Jul 25;13:222. doi: 10.1186/s12957-015-0621-7.
The presence of multiple metastatic pulmonary nodules is a predictor of poor survival after pulmonary metastasectomy. However, there is a paucity of data addressing the exact number of pulmonary metastases over which prognosis becomes grave. The aim of our study is to investigate the prognosis of pulmonary metastasectomy from colorectal cancer (CRC) depending on the number of pulmonary metastases.
Patients who had undergone pulmonary metastasectomy for CRC between November 1994 and December 2013 were included. Survival and recurrence patterns were analyzed with regard to the number of pulmonary metastases. Patients were divided into three groups depending on the number of pulmonary metastases that were detected by the final pathologic report: group I--single metastasis; group II--2-3 metastases; and group III--4+ metastases.
A total of 615 patients who had undergone pulmonary metastasectomy from colorectal cancer were included. The median follow-up period was 31 months (range 2-211 months). The median disease-free interval (DFI) from the time of the primary operation for colorectal cancer was 20 months (range 0-209 months). There were 414 patients in group I (single metastasis), 159 in group II (2-3 metastases), and 42 in group III (4+ metastases). The overall 5-year survival rate was 64.2%. The 5-year survival rates in groups I, II, and III were 70.0, 56.2, and 33.7%, respectively (group I vs. II, p<0.001; group II vs. III, p=0.012). The 5-year recurrence-free rates were 39.5, 30.6, and 8.5% in groups I, II, and III, respectively (group I vs. II, p<0.001; group II vs. III, p=0.056). Multivariable analysis revealed that age, multiple pulmonary nodules, thoracic lymph node metastasis, and adjuvant chemotherapy are independent predictors of survival.
The overall survival and recurrence after pulmonary metastasectomy for CRC is dependent on the number of metastases. Surgical treatment can be offered to patients with three or fewer pulmonary metastases. However, more meticulous patient selection is required to decide whether a surgical approach is feasible in patients with four or more pulmonary metastases.
多发性转移性肺结节的存在是肺转移瘤切除术后生存率低的一个预测因素。然而，关于肺转移瘤的确切数量与预后变差之间关系的数据却很匮乏。我们研究的目的是根据肺转移瘤的数量来调查结直肠癌（CRC）肺转移瘤切除术后的预后情况。
纳入1994年11月至2013年12月期间因CRC接受肺转移瘤切除术的患者。根据肺转移瘤的数量分析生存和复发模式。根据最终病理报告检测到的肺转移瘤数量将患者分为三组：I组——单个转移瘤；II组——2至3个转移瘤；III组——4个及以上转移瘤。
总共纳入615例因结直肠癌接受肺转移瘤切除术的患者。中位随访期为31个月（范围2至211个月）。从结直肠癌初次手术时起的中位无病间期（DFI）为20个月（范围0至209个月）。I组（单个转移瘤）有414例患者，II组（2至3个转移瘤）有159例，III组（4个及以上转移瘤）有42例。总体5年生存率为64.2%。I、II和III组的5年生存率分别为70.0%、56.2%和33.7%（I组与II组比较，p<0.001；II组与III组比较，p = 0.012）。I、II和III组的5年无复发生存率分别为39.5%、30.6%和8.5%（I组与II组比较，p<0.001；II组与III组比较，p = 0.056）。多变量分析显示，年龄、多个肺结节、胸段淋巴结转移和辅助化疗是生存的独立预测因素。
CRC肺转移瘤切除术后的总体生存和复发取决于转移瘤的数量。对于肺转移瘤为三个或更少的患者可以提供手术治疗。然而，对于有四个或更多肺转移瘤的患者，需要更细致地选择患者来决定手术方法是否可行。
