Ohtaki Yoichi, Shimizu Kimihiro, Nagashima Toshiteru, Nakazawa Seshiru, Obayashi Kai, Azuma Yoko, Iijima Misaki, Kosaka Takayuki, Yajima Toshiki, Ogawa Hiroomi, Tsutsumi Soichi, Arai Motohiro, Mogi Akira, Kuwano Hiroyuki
Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Maebashi, Gunma, Japan.
Division of Digestive Surgery, Integrative Center of General Surgery, Gunma University Hospital, Maebashi, Gunma, Japan.
World J Surg. 2018 Apr;42(4):1161-1170. doi: 10.1007/s00268-017-4243-9.
The lung is one of the most common organs of metastasis from colorectal cancer (CRC), and we have encountered lung cancer patients with a history of CRC. There have been few studies regarding methods used to discriminate between primary lung cancer (PLC) and pulmonary metastasis from CRC (PM-CRC) based only on preoperative findings. We retrospectively investigated predictive factors discriminating between these lesions in patients with a history of CRC.
Between 2006 and 2015, 117 patients with a history of CRC (44 patients with 47 PLC and 73 patients with 102 PM-CRC) underwent subsequent or concurrent resection of pulmonary lesions. We compared the clinical and radiological characteristics of 100 patients with solitary lesions (43 PLC and 57 PM-CRC). Using univariate and multivariate analyses, we examined predictive factors for discrimination of these two lesions.
All tumors with findings of ground-glass opacity (GGO) were PLC (n = 19). In a multivariate analysis of 81 radiologically solid tumors, two factors were found to be significant independent predictors of PLC: a history of stage I CRC and presence of pleural indentation. All tumors in 26 patients with either GGO or both a stage I CRC history and pleural indentation were PLC, while most tumors in patients without all three factors were PM-CRC (43/44; 97.7%).
The presence or absence of GGO, pathological CRC stage, and pleural indentation could be useful factors to distinguish between PLC and PM-CRC.
肺是结直肠癌（CRC）最常见的转移器官之一，我们遇到过有CRC病史的肺癌患者。关于仅根据术前检查结果来区分原发性肺癌（PLC）和CRC肺转移（PM-CRC）的方法，相关研究较少。我们回顾性调查了有CRC病史患者中区分这些病变的预测因素。
2006年至2015年期间，117例有CRC病史的患者（44例有47个PLC病灶，73例有102个PM-CRC病灶）接受了肺部病灶的后续或同期切除。我们比较了100例有孤立性病灶患者（43例PLC和57例PM-CRC）的临床和放射学特征。通过单因素和多因素分析，我们研究了区分这两种病变的预测因素。
所有有磨玻璃影（GGO）表现的肿瘤均为PLC（n = 19）。在对81个放射学实性肿瘤的多因素分析中，发现两个因素是PLC的显著独立预测因素：I期CRC病史和胸膜凹陷征。26例有GGO或有I期CRC病史及胸膜凹陷征的患者的所有肿瘤均为PLC，而没有这三个因素的患者中的大多数肿瘤为PM-CRC（43/44；97.7%）。
GGO的有无、CRC病理分期和胸膜凹陷征可能是区分PLC和PM-CRC的有用因素。
