重复肺切除能否为结直肠癌复发性肺转移提供长期生存？一项日本多中心回顾性研究的结果

Does Repeated Lung Resection Provide Long-Term Survival for Recurrent Pulmonary Metastases of Colorectal Cancer? Results of a Retrospective Japanese Multicenter Study.

作者信息

Hishida Tomoyuki, Tsuboi Masahiro, Okumura Takehiro, Boku Narikazu, Ohde Yasuhisa, Sakao Yukinori, Yoshiya Katsuo, Hyodo Ichinosuke, Mori Keita, Kondo Haruhiko

机构信息

Department of Thoracic Surgery, National Cancer Center Hospital East, Chiba, Japan.

出版信息

Ann Thorac Surg. 2017 Feb;103(2):399-405. doi: 10.1016/j.athoracsur.2016.08.084. Epub 2016 Oct 25.

DOI:10.1016/j.athoracsur.2016.08.084

PMID:27793399

Abstract

BACKGROUND

The purpose of this study was to clarify the long-term survival outcomes after repeated lung resection (RLR) of pulmonary metastases from colorectal cancer (PM-CRC) using data from a Japanese nationwide investigation.

METHODS

Among 898 patients who underwent R0 resection of PM-CRC at 46 Japanese institutions between 2004 and 2008, we analyzed the data of 216 patients who experienced recurrence limited to the lung after initial resection of PM-CRC. Overall survival (OS) after RLR was analyzed, and prognostic factors were explored using a multivariate Cox analysis.

RESULTS

Of a total 216 patients, 132 (61%) received RLR, and their 5-year OS rate was 75.3%. Twenty-two patients underwent a second RLR, and 2 patients underwent a third RLR; a favorable survival outcome was observed even after a second RLR (5-year OS rate, 55.1%). The prognostic factors associated with worse survival after RLR were concomitant liver metastasis, which had been completely resected or ablated at the initial lung metastasectomy (hazard ratio [HR], 4.84; 95% confidence interval [CI], 1.48-14.8) and location of the primary tumor in the rectum (HR, 3.16; 95% CI, 1.17-9.35). Patients without these 2 poor prognostic factors (n = 58) showed a 5-year OS rate of 82.6% after RLR.

CONCLUSIONS

This nationwide database study showed that RLR for resectable lung-limited recurrence after PM-CRC resection could provide favorable survival, especially for patients with colon cancer without liver metastases at the initial PM-CRC resection.

摘要

背景

本研究旨在利用日本全国性调查数据，阐明结直肠癌肺转移（PM-CRC）患者重复肺切除（RLR）后的长期生存结果。

方法

在2004年至2008年间，日本46家机构对898例PM-CRC患者进行了R0切除，我们分析了其中216例在初次切除PM-CRC后复发局限于肺部患者的数据。分析了RLR后的总生存期（OS），并使用多因素Cox分析探索预后因素。

结果

在总共216例患者中，132例（61%）接受了RLR，其5年OS率为75.3%。22例患者接受了第二次RLR，2例患者接受了第三次RLR；即使在第二次RLR后也观察到了良好的生存结果（5年OS率为55.1%）。与RLR后生存较差相关的预后因素是初始肺转移瘤切除时已完全切除或消融的合并肝转移（风险比[HR]，4.84；95%置信区间[CI]，1.48-14.8）以及原发肿瘤位于直肠（HR，3.16；95%CI，1.17-9.35）。没有这两个不良预后因素的患者（n = 58）在RLR后的5年OS率为82.6%。