根治性手术后结直肠癌患者的胸部复发：发生率、危险因素以及胸部 CT 作为术后监测工具的价值。

Thoracic recurrence in patients with curatively-resected colorectal cancer: incidence, risk factors, and value of chest CT as a postoperative surveillance tool.

机构信息

Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.

Armed Forces Seoul Hospital, Seoul, Korea.

出版信息

Eur Radiol. 2019 Aug;29(8):4303-4314. doi: 10.1007/s00330-018-5712-8. Epub 2018 Oct 22.

DOI:10.1007/s00330-018-5712-8

PMID:30350166

Abstract

OBJECTIVE

To investigate the incidence of thoracic recurrence and the diagnostic value of chest CT for postoperative surveillance in curatively-resected colorectal cancer (CRC) patients.

METHODS

This retrospective study consisted of 648 CRC patients (M:F, 393:255; mean age, 66.2 years) treated with curative surgery between January 2010 and December 2012. The presence of CRC recurrence over follow-ups was analysed and recurrence-free survival and risk factors of recurrence were assessed using Kaplan-Meier analysis with log-rank test and Cox-regression analysis, respectively.

RESULTS

Over a median follow-up of 57 months, thoracic recurrence occurred in 8.0% (52/648) of patients with a median recurrence-free survival rate of 19.5 months. Among the 52 patients with thoracic recurrence, 18 (2.7%) had isolated thoracic recurrence, and only five (0.8%) were diagnosed through chest CT. Risk factors of overall thoracic recurrence included age, positive resection margin, presence of venous invasion, positive pathologic N-class, and presence of abdominal recurrence (odds ratio [OR] = 1.78, 19.691, 2.993, 2.502, and 31.137; p = 0.045, 0.004, 0.001, 0.005, and p < 0.001, respectively). As for isolated thoracic recurrence, serum carcinoembryonic antigen level ≥ 5 ng/mL during postoperative follow-up (OR = 9.112; p < 0.001) was demonstrated to be the only predictive factor. There were no thoracic recurrences in patients with CRC stages 0 and I.

CONCLUSION

In patients with curatively-resected CRCs, routine surveillance using chest CT may be of limited value, particularly in those with CRC stages 0 or I, as recurrence only detectable through chest CT was shown to be rare.

KEY POINTS

• Postoperative thoracic recurrence only detectable through chest CT was shown to be rare. • There were no thoracic recurrences in colorectal cancers stage 0 and I. • Postoperative surveillance chest CT is of limited value in patients with curatively resected colorectal cancers.

摘要

目的

研究根治性切除术后结直肠癌（CRC）患者的胸内复发率及胸部 CT 对术后监测的诊断价值。

方法

本回顾性研究纳入了 2010 年 1 月至 2012 年 12 月期间接受根治性手术治疗的 648 例 CRC 患者（男：女，393：255；平均年龄 66.2 岁）。通过分析随访期间 CRC 复发的情况，采用 Kaplan-Meier 分析结合对数秩检验评估无复发生存率，采用 Cox 回归分析评估复发的风险因素。

结果

在中位随访 57 个月期间，8.0%（52/648）的患者出现了胸内复发，无复发生存率为 19.5 个月。在 52 例胸内复发患者中，18 例（2.7%）为单纯性胸内复发，仅 5 例（0.8%）通过胸部 CT 诊断。总体胸内复发的风险因素包括年龄、切缘阳性、存在静脉侵犯、阳性病理 N 分级和腹部复发（比值比 [OR] = 1.78、19.691、2.993、2.502 和 31.137；p = 0.045、0.004、0.001、0.005 和 p < 0.001）。对于单纯性胸内复发，术后随访期间血清癌胚抗原水平≥5ng/mL（OR = 9.112；p < 0.001）是唯一的预测因素。CRC 0 期和 I 期患者无胸内复发。