Yokoyama Shintaro, Mitsuoka Masahiro, Kinugasa Tetsushi, Hashiguchi Toshihiro, Matsumoto Ryoichi, Murakami Daigo, Nishi Tatsuya, Yoshiyama Koichi, Kashihara Masaki, Takamori Shinzo, Akagi Yoshito
Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.
BMC Surg. 2017 May 10;17(1):54. doi: 10.1186/s12893-017-0252-8.
A clear survival benefit has been reported for lung metastasectomy for colorectal cancer, and several clinicopathological prognostic factors have been proposed in the past. However, clinical advances, such as chemotherapy and radiographic imaging, should have improved patient outcome and may have altered prognosticators. This study aimed to assess patient survival and determine prognostic factors for survival and recurrence in patients who underwent initial lung metastasectomy for colorectal cancer in the modern clinical era.
Clinicopathological data and outcomes of 59 patients who underwent curative initial lung metastasectomy for colorectal cancer from 2004 to 2012 at a single institution in Japan were retrospectively investigated. Survival was estimated using the Kaplan - Meier method, and Cox proportional hazards regression models were used to estimate the prognostic impacts of each variable in univariate and multivariate analysis.
The 5-years overall and disease-free survival rates were 54.3 and 40.6%, respectively. A disease-free interval < 24 months after colorectal cancer resection (P = 0.004) and a serum carcinoembryonic antigen ≥ 5.0 ng/mL before initial lung metastasectomy (P = 0.015) were independent predictors for poor overall survival. Moreover, the disease-free interval after colorectal cancer resection < 24 months (P = 0.010) and a colorectal cancer with N2 stage disease (P = 0.018) were independently associated with poor disease-free survival. On the other hand, the number of lung metastasis was not identified as a poor prognostic factor for both overall and disease-free survival.
Our findings demonstrated similar or slightly better overall survival, and substantially favorable disease-free survival as compared with past reports. Poor prognostic factors for overall survival appeared not to differ from those of past studies, although this modern series did not determine the number of lung metastasis as a poor prognostic factor, which should be investigated in future studies. Moreover, initial lung metastasectomy is not expected to be a curable treatment for patients with both a short disease-free survival after colorectal cancer resection and colorectal cancers with N2 stage disease.
已有报道称，结直肠癌肺转移瘤切除术具有明显的生存获益，过去也提出了一些临床病理预后因素。然而，化疗和影像学检查等临床进展应已改善了患者的预后，且可能改变了预后指标。本研究旨在评估现代临床时代接受初次结直肠癌肺转移瘤切除术患者的生存情况，并确定生存和复发的预后因素。
回顾性调查了2004年至2012年在日本一家机构接受初次根治性结直肠癌肺转移瘤切除术的59例患者的临床病理数据和预后情况。采用Kaplan-Meier法估计生存率，并使用Cox比例风险回归模型在单因素和多因素分析中估计各变量的预后影响。
5年总生存率和无病生存率分别为54.3%和40.6%。结直肠癌切除术后无病间期＜24个月（P = 0.004）以及初次肺转移瘤切除术前血清癌胚抗原≥5.0 ng/mL（P = 0.015）是总生存不良的独立预测因素。此外，结直肠癌切除术后无病间期＜24个月（P = 0.010）以及N2期结直肠癌（P = 0.018）与无病生存不良独立相关。另一方面，肺转移灶数量未被确定为总生存和无病生存的不良预后因素。
我们的研究结果显示，与既往报道相比，总生存率相似或略高，无病生存率则显著更优。总生存的不良预后因素似乎与既往研究无异，尽管本现代系列研究未将肺转移灶数量确定为不良预后因素，未来研究应对此进行探究。此外，对于结直肠癌切除术后无病生存期短且为N2期结直肠癌的患者，初次肺转移瘤切除术预计无法实现治愈。
