Ozdil Ali, Kececi Ozgur Gizem, Akpunar Esranur, Ergonul Ayse Gul, Gursoy Pinar, Nart Deniz, Akcam Tevfik Ilker, Turhan Kutsal, Cakan Alpaslan, Cagirici Ufuk
School of Medicine, Department of Thoracic Surgery, Ege University, Izmir, Turkey.
Acıbadem Kent Hospital, Thoracic Surgery Clinic, Izmir, Turkey.
Gen Thorac Cardiovasc Surg. 2025 Jul 21. doi: 10.1007/s11748-025-02185-4.
Pulmonary metastasectomy (PM) is a survival-enhancing treatment in the multimodal management of metastatic colorectal cancer (CRC). Given the high recurrence rates, we hypothesized that the adequacy of the surgical margin relative to nodule size might have prognostic value. This study aimed to analyze clinical characteristics and identify prognostic factors for disease-free survival (DFS) and overall survival (OS) in patients who underwent PM for CRC.
We retrospectively reviewed 105 patients who underwent PM for CRC metastases between January 2010 and December 2023. Survival outcomes were analyzed using Kaplan-Meier and Cox regression models. ROC analysis was used to determine the optimal cut-off value for the ratio of surgical margin (SM) to nodule size (NS).
The optimal cut-off value for SM/NS was 0.61 for DFS (sensitivity: 80.5%, specificity: 57%, (95% CI 0.67-0.86; p < 0.001) and 0.59 (95% CI 0.61-0.82; p < 0.001) with a sensitivity of 83.7% and specificity of 57.1% for OS. Univariate analysis showed that CEA level, disease-free interval (DFI), and NS were significantly associated with both DFS and OS. SM/NS was also significant for both outcomes (p < 0.001 and p = 0.001). Multivariate analysis confirmed that CEA, DFI, NS, and SM/NS were independent prognostic factors for DFS and OS (all p < 0.05).
SM/NS ratio may be a reliable prognostic factor in PM for CRC. A ratio of ≤ 0.6 was associated with poorer survival outcomes and could be a more consistent indicator than nodule size or margin width alone.
肺转移瘤切除术（PM）是转移性结直肠癌（CRC）多模式治疗中提高生存率的一种治疗方法。鉴于复发率较高，我们推测相对于结节大小的手术切缘充足性可能具有预后价值。本研究旨在分析接受CRC肺转移瘤切除术患者的临床特征，并确定无病生存期（DFS）和总生存期（OS）的预后因素。
我们回顾性分析了2010年1月至2023年12月期间接受CRC肺转移瘤切除术的105例患者。使用Kaplan-Meier和Cox回归模型分析生存结果。采用ROC分析确定手术切缘（SM）与结节大小（NS）比值的最佳临界值。
DFS的SM/NS最佳临界值为0.61（敏感性：80.5%，特异性：57%，95%CI 0.67 - 0.86；p < 0.001），OS的最佳临界值为0.59（95%CI 0.61 - 0.82；p < 0.001），敏感性为83.7%，特异性为57.1%。单因素分析显示，癌胚抗原（CEA）水平、无病间期（DFI）和NS与DFS和OS均显著相关。SM/NS对这两个结果也具有显著性（p < 0.001和p = 0.001）。多因素分析证实，CEA、DFI、NS和SM/NS是DFS和OS的独立预后因素（所有p < 0.05）。
SM/NS比值可能是CRC肺转移瘤切除术的可靠预后因素。≤0.6的比值与较差的生存结果相关，并且可能是比单独的结节大小或切缘宽度更一致的指标。
