Department of General and Visceral Surgery, Friedrich-Alexander-University, Krankenhausstraße 12, 91054, Erlangen, Germany.
Langenbecks Arch Surg. 2024 Apr 12;409(1):121. doi: 10.1007/s00423-024-03311-1.
The optimal management of colorectal lung metastases (CRLM) is still controversial. The aim of this study was to compare surgical and non-surgical treatment for CRLM regarding the prognostic outcome.
This retrospective single-center cohort study included 418 patients, who were treated from January 2000 to December 2018 at a German University Hospital due to their colorectal carcinoma and had synchronous or metachronous lung metastases. Patients were stratified according the treatment of the CRLM into two groups: surgical resection of CRLM versus no surgical resection of CRLM. The survival from the time of diagnosis of lung metastasis was compared between the groups.
Two- and 5-year overall survival (OS) from the time of diagnosis of lung metastasis was 78.2% and 54.6%, respectively, in our cohort. Patients undergoing pulmonary metastasectomy showed a significantly better 2- and 5-year survival compared to patients with non-surgical treatment (2-year OS: 98.1% vs. 67.9%; 5-year OS: 81.2% vs. 28.8%; p < 0.001). Multivariate Cox regression revealed the surgical treatment (HR 4.51 (95% CI = 2.33-8.75, p < 0.001) and the absence of other metastases (HR 1.79 (95% CI = 1.05-3.04), p = 0.032) as independent prognostic factors in patients with CRLM.
Our data suggest that patients with CRLM, who qualify for surgery, benefit from surgical treatment. Randomized controlled trials are needed to confirm our findings.
The work has been retrospectively registrated at the German Clinical Trial Registry (DRKS00032938).
结直肠肺转移（CRLM）的最佳治疗方法仍存在争议。本研究旨在比较手术和非手术治疗 CRLM 的预后结果。
这是一项回顾性单中心队列研究，纳入了 2000 年 1 月至 2018 年 12 月在德国一所大学医院因结直肠癌接受治疗且存在同步或异时性肺转移的 418 例患者。根据 CRLM 的治疗方法，患者被分为两组：CRLM 切除术组和非 CRLM 切除术组。比较两组患者从肺转移诊断开始的生存情况。
本队列中，从肺转移诊断开始的 2 年和 5 年总生存率（OS）分别为 78.2%和 54.6%。与非手术治疗的患者相比，接受肺转移切除术的患者 2 年和 5 年的生存率显著提高（2 年 OS：98.1%比 67.9%；5 年 OS：81.2%比 28.8%；p<0.001）。多因素 Cox 回归分析显示，手术治疗（HR 4.51（95%CI=2.33-8.75，p<0.001）和无其他转移（HR 1.79（95%CI=1.05-3.04），p=0.032）是 CRLM 患者的独立预后因素。
我们的数据表明，有手术适应证的 CRLM 患者从手术治疗中获益。需要进行随机对照试验来证实我们的发现。
本工作已在德国临床试验注册中心（DRKS00032938）进行了回顾性注册。
