Kamiyoshihara Mitsuhiro, Igai Hitoshi, Ibe Takashi, Kawatani Natsuko, Yoshikawa Ryohei
Department of General Thoracic Surgery, Maebashi Red Cross Hospital, Maebashi, Japan
Department of General Thoracic Surgery, Maebashi Red Cross Hospital, Maebashi, Japan.
Asian Cardiovasc Thorac Ann. 2016 Jul;24(6):568-73. doi: 10.1177/0218492316655235.
Studies of metastatic lung cancer have used various starting points for calculating the survival period, including the time of primary tumor resection and the first and final pulmonary metastasectomy. This study examined differences in prognostic factors according to the starting point used to calculate survival time.
We performed surgical resection of pulmonary metastases in 202 consecutive patients between 1999 and 2013. Of these, 146 (excluding overlapping cases) underwent pulmonary metastasectomy. We examined the survival period after resection in patients with pulmonary metastases (group M) and primary tumors (group P). The prognostic influence of variables on survival was analyzed.
The 5-year survival rate was 76.7% in group P and 62.0% in group M. The significant prognostic factors were the disease-free interval (>1 and >2 years) in group P, and maximum tumor diameter in group M. Interestingly, multivariate analysis showed that the significant prognostic factors (age and nodule diameter) were identical in both groups.
We believe that the potential confounding factors were counterbalanced by the effect of prognostic factors on multivariate analysis in patients undergoing pulmonary metastasectomy. If the survival period is defined as starting from the time of the primary tumor resection, this may resolve the variance in survival, because pulmonary metastasectomy is only one option among several available treatments.
转移性肺癌的研究采用了各种计算生存期的起始点，包括原发性肿瘤切除时间、首次和末次肺转移瘤切除术时间。本研究根据计算生存时间所采用的起始点，研究了预后因素的差异。
1999年至2013年间，我们对202例患者进行了肺转移瘤的手术切除。其中，146例（不包括重叠病例）接受了肺转移瘤切除术。我们研究了肺转移瘤患者（M组）和原发性肿瘤患者（P组）切除术后的生存期。分析了各变量对生存的预后影响。
P组的5年生存率为76.7%，M组为62.0%。P组的显著预后因素是无病间期（>1年和>2年），M组是最大肿瘤直径。有趣的是，多因素分析显示两组的显著预后因素（年龄和结节直径）相同。
我们认为，在接受肺转移瘤切除术的患者中，多因素分析中预后因素的作用抵消了潜在的混杂因素。如果将生存期定义为从原发性肿瘤切除时间开始，这可能会解决生存期的差异，因为肺转移瘤切除术只是几种可用治疗方法中的一种选择。
