Baskent University Faculty of Medicine, Department of Thoracic Surgery - Ankara, Turkey.
Baskent University Faculty of Medicine, Department of Internal Medicine, Division of Medical Oncology - Ankara, Turkey.
Rev Assoc Med Bras (1992). 2021 Jul;67(7):1015-1020. doi: 10.1590/1806-9282.20210472.
Pulmonary metastasectomy for the treatment of metastatic colorectal cancer is essential, but high ranked evidence of survival benefit is lacking. Here, we aimed to examine the prognostic factors after pulmonary metastasectomy in patients with colorectal cancer.
This is a single-center, retrospective hospital-based observational case series study. We reviewed data for 607 patients with metastatic colorectal cancer (mCRC) who were treated and observed from 2012 to 2019. Of the 607 patients with mCRC, 87 were with solitary lung metastases. Of the 87 patients, 39 were not appropriate for metastasectomy, while 15 patients recognized as suitable candidates by the multidisciplinary thoracic tumor board rejected metastasectomy. Consequently, only 33 patients were included in the final analysis.
Rectum was detected as the primary site in 16 (48.5%) patients. Over 80% of patients had metachronous lung metastases, with a median of 29.0 months from initial diagnosis. Video-assisted thoracic surgery with wedge resection was performed in 20 (60.6%) patients. Over 90% of patients had solitary metastasis resected, with 97% of R0 resection. Median tumor size was 23.0 mm (min: 10; max: 90). Adjuvant treatment was given to 31 (93.9%) patients, while neoadjuvant treatment was given only to 8 (25%) patients. Of the 33 patients, there were 25 (75.7%) relapses. The most frequent site of relapse was lung in 15 (45.5%) patients. Interestingly, there were only 4 (12.2%) patients who had a relapse in the liver after lung metastasectomy. We found that median disease-free survival (DFS) and overall survival (OS) were 43.0 (13.0-73.0) and 55.0 (31.6-78.4) months, respectively.
Pulmonary metastasectomy was associated with significantly long-time survival rates in mCRC (43 months of DFS and 55 months of OS). The second relapse occurred in 25 (75.7%) patients, with isolated lung metastases in nearly half of the patients (45.5%). Therefore, lung metastases in mCRC were unique and a multidisciplinary team including a thoracic surgeon should manage these patients.
结直肠癌转移灶肺切除术是治疗转移性结直肠癌的关键，但缺乏生存获益的高等级证据。在此，我们旨在研究结直肠癌患者肺转移灶切除术后的预后因素。
这是一项单中心、回顾性基于医院的观察性病例系列研究。我们回顾了 2012 年至 2019 年期间治疗和观察的 607 例转移性结直肠癌（mCRC）患者的数据。在 607 例 mCRC 患者中，87 例为单发肺转移。在 87 例患者中，39 例不适合转移灶切除术，而多学科胸肿瘤委员会认为 15 例适合候选者拒绝了转移灶切除术。因此，只有 33 例患者被纳入最终分析。
16 例（48.5%）患者为直肠首发部位。超过 80%的患者为异时性肺转移，从初始诊断到发现转移的中位时间为 29.0 个月。20 例（60.6%）患者采用电视辅助胸腔镜楔形切除术。超过 90%的患者切除了单发转移灶，97%的患者达到了 R0 切除。中位肿瘤大小为 23.0 毫米（最小：10；最大：90）。31 例（93.9%）患者接受了辅助治疗，仅 8 例（25%）患者接受了新辅助治疗。在 33 例患者中，有 25 例（75.7%）复发。最常见的复发部位是肺，15 例（45.5%）患者发生肺转移。有趣的是，肺转移灶切除术后仅 4 例（12.2%）患者出现肝转移。我们发现中位无病生存（DFS）和总生存（OS）分别为 43.0（13.0-73.0）和 55.0（31.6-78.4）个月。
肺转移灶切除术与 mCRC 患者的长期生存率显著相关（DFS 为 43 个月，OS 为 55 个月）。25 例（75.7%）患者出现第二次复发，其中近一半（45.5%）患者为孤立性肺转移。因此，mCRC 中的肺转移具有独特性，包括胸外科医生在内的多学科团队应管理这些患者。
