Takeda-Miyata Naoko, Konishi Eiichi, Tanaka Tadashi, Shimomura Masanori, Tsunezuka Hiroaki, Okada Satoru, Ishihara Shunta, Ishikawa Narumi, Inoue Masayoshi
Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan; Department of Pathology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Department of Pathology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Lung Cancer. 2020 Nov;149:61-67. doi: 10.1016/j.lungcan.2020.09.010. Epub 2020 Sep 20.
Surgical resection for pulmonary metastases from colorectal cancer could provide long-term survival in selected patients, and it is commonly performed in practice. However, surgical margin relapse sometimes occurs and is a problematic issue to resolve. Spread through air spaces (STAS) is one of the invasion forms in primary lung cancer and is associated with local recurrence and a poor prognosis. The aim of this study was to evaluate the prognostic significance of STAS for pulmonary metastases from colorectal cancer and to assess the predictability of STAS with preoperative clinical information.
A total of 96 pulmonary metastatic lesions from colorectal cancer in 37 patients who underwent metastasectomy at our institution from January 2008 to December 2013 were retrospectively analyzed.
STAS was identified in 41.6 % of the 96 lesions. Surgical margin relapse was found in 8 lesions (8.3 %) from 7 patients (18.9 %). The distance of STAS was identified as an independent risk factor for surgical margin relapse on multivariable analysis (p = 0.033). The patients with STAS showed significantly worse overall survival than those without (5-year overall survival rate: 30.3 % vs. 76.9 %; p = 0.002). On multivariable analysis, patients with STAS had a significantly higher risk of death than those without (p = 0.019). An elevated pre-metastasectomy serum carcinoembryonic antigen level was independently correlated with STAS on multivariable analysis (p = 0.049).
STAS was related to a poor prognosis and surgical margin relapse in pulmonary metastases from colorectal cancer.
对结直肠癌肺转移患者进行手术切除可使部分患者获得长期生存，这在临床实践中较为常见。然而，手术切缘复发时有发生，是一个亟待解决的问题。气腔播散（STAS）是原发性肺癌的侵袭形式之一，与局部复发和预后不良相关。本研究旨在评估STAS对结直肠癌肺转移的预后意义，并利用术前临床信息评估STAS的可预测性。
回顾性分析2008年1月至2013年12月在我院接受转移灶切除术的37例患者的96个结直肠癌肺转移病灶。
96个病灶中41.6%发现有STAS。7例患者（18.9%）的8个病灶（8.3%）出现手术切缘复发。多变量分析显示，STAS的距离是手术切缘复发的独立危险因素（p = 0.033）。有STAS的患者总生存期明显低于无STAS的患者（5年总生存率：30.3%对76.9%；p = 0.002）。多变量分析显示，有STAS的患者死亡风险明显高于无STAS的患者（p = 0.019）。多变量分析显示，转移灶切除术前血清癌胚抗原水平升高与STAS独立相关（p = 0.049）。
STAS与结直肠癌肺转移的预后不良和手术切缘复发相关。
