肺转移瘤切除术后辅助化疗对结直肠癌预后的影响。
Effect of adjuvant chemotherapy after pulmonary metastasectomy on the prognosis of colorectal cancer.
作者信息
Shiomi Kazu, Naito Masanori, Sato Takeo, Nakamura Takatoshi, Nakashima Hiroyasu, Naito Masahito, Mikubo Masashi, Matsui Yoshio, Watanabe Masahiko, Satoh Yukitoshi
机构信息
Department of Thoracic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Kanagawa 252-0374, Japan.
Department of Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Kanagawa 252-0374, Japan.
出版信息
Ann Med Surg (Lond). 2017 Jun 20;20:19-25. doi: 10.1016/j.amsu.2017.06.026. eCollection 2017 Aug.
BACKGROUND
Adjuvant chemotherapy after resection of colorectal cancer (CRC) lung metastases may reduce recurrences and improve survival. We investigated the effects of adjuvant chemotherapy after curative resection of lung CRC metastases on prognosis.
METHODS
We retrospectively reviewed records of our patients undergoing pulmonary metastasectomy from CRC between January 2000-March 2014. Data were analyzed with Kaplan-Meier survival analysis and Cox proportional hazards models.
RESULTS
One-hundred (56 men; median age, 66 years) of 128 consecutive patients who underwent complete resection for first lung colorectal metastases were analyzed. Postoperative 5-year rates of overall survival (OS) and relapse-free survival (RFS) were 76% and 41%, respectively. Adjuvant chemotherapy strongly affected RFS and OS by multivariable analysis compared to surgery alone (RFS: HR, 0.49; 95% CI, 0.27-0.88; = 0.016 and OS: HR, 0.35; 95% CI, 0.14-0.81; = 0.014). Similar effects of adjuvant chemotherapy occurred in subgroups respectively classified according to number of lung metastases and preoperative serum carcinoembryonic antigen (CEA) level.
CONCLUSIONS
Adjuvant chemotherapy after curative resection of lung metastases might strongly affect the prognosis of metastatic CRC patients. Even patients with single metastatic lesions and normal preoperative CEA level appeared to receive benefits from such chemotherapy. Narrowing of suitable candidates by predicting the effects of systemic chemotherapy and prospective randomized studies are needed.
背景
结直肠癌（CRC）肺转移瘤切除术后辅助化疗可能会减少复发并提高生存率。我们研究了CRC肺转移瘤根治性切除术后辅助化疗对预后的影响。
方法
我们回顾性分析了2000年1月至2014年3月期间接受CRC肺转移瘤切除术患者的记录。采用Kaplan-Meier生存分析和Cox比例风险模型进行数据分析。
结果
对128例连续接受首次肺结直肠癌转移瘤完全切除术的患者中的100例（56例男性；中位年龄66岁）进行了分析。术后5年总生存率（OS）和无复发生存率（RFS）分别为76%和41%。多变量分析显示，与单纯手术相比，辅助化疗对RFS和OS有显著影响（RFS：风险比[HR]，0.49；95%置信区间[CI]，0.27 - 0.88；P = 0.016；OS：HR，0.35；95% CI，0.14 - 0.81；P = 0.014）。在根据肺转移瘤数量和术前血清癌胚抗原（CEA）水平分别分类的亚组中，辅助化疗也有类似效果。
结论
肺转移瘤根治性切除术后辅助化疗可能会显著影响转移性CRC患者的预后。即使是单个转移病灶且术前CEA水平正常的患者似乎也能从这种化疗中获益。需要通过预测全身化疗的效果来缩小合适的候选人群范围，并开展前瞻性随机研究。
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