Jarabo Jose R, Gómez Ana M, Calatayud Joaquín, Fraile Carlos A, Fernández Elena, Pajuelo Nuria, Embún Raul, Molins Laureano, Rivas Juan J, Hernando Florentino
Department of Thoracic Surgery, Hospital Clinico San Carlos, Madrid, Spain.
Department of Thoracic Surgery, Hospital Clinico San Carlos, Madrid, Spain.
Arch Bronconeumol (Engl Ed). 2018 Apr;54(4):189-197. doi: 10.1016/j.arbres.2017.10.003. Epub 2018 Jan 10.
Resection of both liver and lung metastases from colorectal carcinoma (CRC) is a standard of care in selected patients with oligometastatic disease. We present here the analysis of the subgroup of patients undergoing combined surgery from the Spanish Group of Surgery of Pulmonary Metastases (PM) from Colorectal Carcinoma (GECMP-CCR-SEPAR).
We analyze characteristics, survival and prognostic factors of patients undergoing combined resection from March-2008 to February-2010 and followed-up during at least 3 years, from the prospective multicenter Spanish Registry.
A total of 138 patients from a whole series of 543 cases from 32 thoracic surgery units underwent both procedures. Seventy-seven (43.8%) resected liver metastases were synchronic with colorectal tumor. Median disease specific survival (DSS) from first pulmonary metastasectomy was 48.9 months, being three and 5-year DSS 65.1% and 41.7%, respectively. From CRC-surgery median DSS was 97.2 months, with 3 and 5-year DSS rates of 96.7% and 77%, respectively. Five-year DSS from pulmonary metastasectomy was 41.7% for patients with combined resection and 52.4% for those without hepatic involvement (P=.04). Differences disappeared when considering DSS from colorectal surgery. Carcinoembrionary antigen (CEA) before lung surgery over 10mg/dl and bilateral PM were independent prognostic factors for survival (hazard ratio 2.4 and 2.5, respectively).
Patients with resection of PM of CRC with history of resected hepatic metastases presented significantly lower disease specific survival rates than those undergoing pulmonary metastasectomy alone. CEA before lung surgery and bilateral PM associated worse prognosis.
对于部分寡转移疾病患者，同时切除结直肠癌（CRC）的肝转移灶和肺转移灶是一种标准治疗方案。在此，我们展示了来自西班牙结直肠癌肺转移瘤手术组（GECMP - CCR - SEPAR）接受联合手术患者亚组的分析结果。
我们分析了2008年3月至2010年2月期间接受联合切除术且至少随访3年的患者的特征、生存情况及预后因素，这些数据来自前瞻性多中心西班牙登记处。
在来自32个胸外科单位的543例患者的整个系列中，共有138例患者接受了两种手术。77例（43.8%）切除的肝转移灶与结直肠癌肿瘤同时出现。首次肺转移瘤切除术后的疾病特异性生存（DSS）中位数为48.9个月，3年和5年DSS分别为65.1%和41.7%。从结直肠癌手术开始计算，DSS中位数为97.2个月，3年和5年DSS率分别为96.7%和77%。联合切除患者肺转移瘤切除术后的5年DSS为41.7%，无肝转移患者为52.4%（P = 0.04）。考虑结直肠癌手术的DSS时，差异消失。肺手术前癌胚抗原（CEA）超过10mg/dl和双侧肺转移瘤是生存的独立预后因素（风险比分别为2.4和2.5）。
有肝转移灶切除史的CRC肺转移瘤切除患者的疾病特异性生存率显著低于仅接受肺转移瘤切除术的患者。肺手术前CEA升高和双侧肺转移瘤与较差的预后相关。
