Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Tex.
Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Tex.
J Thorac Cardiovasc Surg. 2019 Apr;157(4):1648-1655. doi: 10.1016/j.jtcvs.2018.10.156. Epub 2018 Nov 26.
During resection of pulmonary metastases, the need to spare lung parenchyma is often weighed against the increased risk of local recurrence if an inadequate surgical margin is obtained. We sought to identify risk factors for local recurrence after wedge resection of pulmonary metastases of a colorectal origin.
A retrospective study of patients who underwent a wedge resection for colorectal pulmonary metastases from 2006 to 2016 was performed. Cox regression with robust variance was used to estimate the risk of local recurrence per nodule treated.
We identified 335 patients who underwent 679 wedge resections. The 2-year local recurrence risk for each nodule was 11.8% (95% confidence interval, 8.9%-14.6%), and the 5-year risk was 20.6% (95% confidence interval, 16.2%-24.8%). Longer margin length decreased the risk of local recurrence (hazard ratio, 0.434 per additional cm of length; P = .015), whereas larger tumor size increased this risk (hazard ratio, 1.520 per additional cm of size; P = .012). However, other factors tested, including tumor grade, KRAS mutation status, and response to induction chemotherapy, did not affect recurrence risk. A pathologic margin length of at least half the tumor size was estimated to result in a local recurrence rate <11%.
Among surgically resected colorectal pulmonary metastases, technical factors related to margin length and tumor size were associated with the risk of local recurrence, whereas tumor grade and KRAS status were not. However, the increased risk of local recurrence with larger tumors was diminished with a sufficient margin length.
在切除肺转移瘤时，往往需要权衡保留肺实质与获得不足切缘时局部复发风险增加之间的关系。本研究旨在确定结直肠来源肺转移瘤楔形切除术后局部复发的危险因素。
对 2006 年至 2016 年间接受楔形切除术治疗结直肠肺转移瘤的患者进行回顾性研究。采用稳健方差 Cox 回归估计每个结节的局部复发风险。
共纳入 335 例患者，共接受 679 例楔形切除术。每个结节的 2 年局部复发风险为 11.8%（95%置信区间，8.9%-14.6%），5 年复发风险为 20.6%（95%置信区间，16.2%-24.8%）。切缘长度越长，局部复发风险越低（风险比，每增加 1cm 长度降低 0.434；P=0.015），而肿瘤越大，复发风险越高（风险比，每增加 1cm 肿瘤大小增加 1.520；P=0.012）。然而，其他测试的因素，包括肿瘤分级、KRAS 突变状态和诱导化疗反应，并未影响复发风险。预计病理切缘长度至少达到肿瘤大小的一半可使局部复发率<11%。
在接受手术切除的结直肠肺转移瘤中，与切缘长度和肿瘤大小相关的技术因素与局部复发风险相关，而肿瘤分级和 KRAS 状态则不相关。然而，较大肿瘤的局部复发风险随着切缘长度的增加而降低。
