Al-Ameri Mamdoh, Persson Michael, Bergman Per, Franco-Cereceda Anders, Sartipy Ulrik
Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden.
Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
J Thorac Dis. 2018 Jun;10(6):3372-3380. doi: 10.21037/jtd.2018.05.120.
This study aimed to describe overall survival following pulmonary metastasectomy for colorectal cancer (CRC) in Sweden, and to assess the discrimination of a recently proposed risk prediction model.
Individual-level data of 756 patients who underwent resection of pulmonary metastases from CRC between 2009 and 2015 were obtained from ThoR, a Swedish national quality register for thoracic surgery. We classified patients into three risk categories according to the number of preoperative risk factors [age, disease-free interval (DFI), presence of extrathoracic lesions, number of pulmonary metastases] established in a prior study. We estimated the hazard ratios (HRs) and 95% confidence interval (CI) by Cox regression and the restricted mean survival time difference as group contrast measures.
During a median follow-up time of 2.9 years, 35% (268/756) patients died. At 5 years, overall survival was 56% (95% CI: 51-60%). In a Cox regression model with risk category as the only independent variable, the HR for all-cause mortality was 1.94 (95% CI: 1.38-2.72, P<0.001) and 4.35 (95% CI: 2.49-7.62, P<0.001) in the moderate- (n=558) and high-risk categories (n=32), respectively, versus the low-risk category (n=166). At 5 years, the differences in restricted mean survival time were 6 months (P<0.001) and 1.5 years (P<0.001) in the moderate- and high-risk categories, respectively, versus the low-risk category.
Five-year survival after surgery for pulmonary metastases from CRC in Sweden was similar or higher compared with contemporary reports. A prognostic model, initially developed in Japanese patients, had excellent discrimination in an external validation cohort of Swedish patients.
本研究旨在描述瑞典结直肠癌（CRC）肺转移瘤切除术后的总生存率，并评估最近提出的风险预测模型的判别能力。
从瑞典国家胸外科质量登记处ThoR获取了2009年至2015年间756例行CRC肺转移瘤切除术患者的个体水平数据。我们根据先前研究确定的术前风险因素数量[年龄、无病间期（DFI）、胸外病变的存在、肺转移瘤数量]将患者分为三个风险类别。我们通过Cox回归估计风险比（HRs）和95%置信区间（CI），并将受限平均生存时间差作为组间对比指标。
在中位随访时间2.9年期间，35%（268/756）的患者死亡。5年时，总生存率为56%（95%CI：51 - 60%）。在以风险类别作为唯一自变量的Cox回归模型中，中风险组（n = 558）和高风险组（n = 32）的全因死亡率HR分别为1.94（95%CI：1.38 - 2.72，P < 0.001）和4.35（95%CI：2.49 - 7.62，P < 0.001），与低风险组（n = 166）相比。5年时，中风险组和高风险组与低风险组相比，受限平均生存时间的差异分别为6个月（P < 0.001）和1.5年（P < 0.001）。
瑞典CRC肺转移瘤手术后的5年生存率与当代报告相比相似或更高。最初在日本患者中开发的一种预后模型，在瑞典患者的外部验证队列中具有出色的判别能力。
