Xiang R S, Zhang Q, Lu S B, Yang W J, Kong D Y, Sun Y, Zhang H R, Fan J L, Feng L, Zhang H Z
Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
Zhonghua Yi Xue Za Zhi. 2025 Aug 5;105(29):2491-2499. doi: 10.3760/cma.j.cn112137-20250324-00724.
To analyze the relationship between primary tumor lymph node indicators and prognosis and clinical efficacy in colorectal cancer patients with lung metastases. A retrospective analysis was performed on the clinical data of 204 patients diagnosed with colorectal cancer accompanied by solitary pulmonary metastases at the Cancer Hospital, Chinese Academy of Medical Sciences between January 2010 and December 2020. The cohort comprised 121 male and 83 female, with a mean age of (58.6±9.1) years. Patient survival status was documented, and the follow-up continued until the patient's death or December 31, 2024. The influencing factors of overall survival (OS) in colorectal cancer patients with pulmonary metastases were analyzed using a multivariate Cox proportional hazards regression model. Survival curves were plotted using the Kaplan-Meier method, and the log-rank test was employed to evaluate the differences in OS among colorectal cancer patients with lung metastases who had primary colorectal tumors with different lymph node statuses. An efficacy analysis was also conducted for patients with pulmonary metastases who solely received medical treatment. A total of 204 patients were followed up for 48.0(34.1, 80.4) months. One patient was lost to follow-up, and 39.7% (81/204) patients had died. The median OS was 48.0 months (95%: 11.5-119.3 months), with a 5-year overall survival rate of 58.5%. Multivariate analysis showed that pathological lymph node stage (pN) (+) (=2.14, 95%: 1.17-3.92), number of negative lymph node (NLN)<13 (=1.97, 95%: 1.22-3.18), carcinoembryonic antigen (CEA) during lung metastasis≥10 μg/L (=2.25, 95%: 1.28-3.98), multiple lung metastases (=2.16, 95%: 1.08-4.31), and non-surgical resection of lung metastases (=2.28, 95%: 1.11-4.65) were risk factors affecting OS in patients with colorectal cancer lung metastasis. Kaplan-Meier survival curves showed that patients with colorectal cancer lung metastases had shorter OS when primary tumor pN (+), primary tumor logarithmic odds of positive lymph node (LODDS)≥-1.1, primary tumor lymph node ratio (LNR)≥0.02, primary tumor NLN<13, or primary tumor total number of lymph node (TLN)<16(all <0.05). Among the 204 patients, 72 with pulmonary metastases did not undergo surgical intervention and solely received medical treatment. Based on their prognosis, they were categorized into the partial response (PR) group (=32) and the stable disease (SD)+progressive disease (PD) group (=40). The results indicated that the PR group had significantly lower rates of pN(+), LODDS≥-1.1, LNR≥0.02, NLN<13, and TLN<16 compared to the SD+PD group (all <0.05). Patients with colorectal cancer lung metastases who have primary tumors with pN(+), LODDS≥-1.1, LNR≥0.02, NLN<13, or TLN<16, tend to have shorter OS and poorer treatment outcomes. It is recommended to adopt an intensified systemic therapy strategy to improve the efficacy of medical treatment and, if possible, create conditions for surgical intervention.
分析结直肠癌肺转移患者的原发肿瘤淋巴结指标与预后及临床疗效之间的关系。对2010年1月至2020年12月在中国医学科学院肿瘤医院确诊为结直肠癌伴孤立性肺转移的204例患者的临床资料进行回顾性分析。该队列包括121例男性和83例女性，平均年龄为(58.6±9.1)岁。记录患者的生存状态，随访持续至患者死亡或2024年12月31日。采用多因素Cox比例风险回归模型分析结直肠癌肺转移患者总生存(OS)的影响因素。采用Kaplan-Meier法绘制生存曲线，采用log-rank检验评估不同淋巴结状态的原发性结直肠癌伴肺转移的结直肠癌患者之间OS的差异。对仅接受药物治疗的肺转移患者也进行了疗效分析。共对204例患者进行了48.0(34.1,80.4)个月的随访。1例患者失访，39.7%(81/204)的患者死亡。中位OS为48.0个月(95%:11.5 - 119.3个月)，5年总生存率为58.5%。多因素分析显示，病理淋巴结分期(pN)(+) (=2.14,95%:1.17 - 3.92)、阴性淋巴结数量(NLN)<13(=1.97,95%:1.22 - 3.18)、肺转移时癌胚抗原(CEA)≥10μg/L(=2.25,95%:1.28 - 3.98)、多发肺转移(=2.16,95%:1.08 - 4.31)及肺转移非手术切除(=2.28,95%:1.11 - 4.65)是影响结直肠癌肺转移患者OS的危险因素。Kaplan-Meier生存曲线显示，原发性肿瘤pN(+)、原发性肿瘤阳性淋巴结对数优势比(LODDS)≥-1.1、原发性肿瘤淋巴结比率(LNR)≥0.02、原发性肿瘤NLN<13或原发性肿瘤淋巴结总数(TLN)<16的结直肠癌肺转移患者的OS较短(均<0.05)。在204例患者中，72例肺转移患者未接受手术干预，仅接受药物治疗。根据其预后，将他们分为部分缓解(PR)组(=32)和疾病稳定(SD)+疾病进展(PD)组(=40)。结果表明，与SD+PD组相比，PR组的pN(+)、LODDS≥-1.1、LNR≥0.02、NLN<13和TLN<16的发生率显著较低(均<0.05)。原发性肿瘤具有pN(+)、LODDS≥-1.1、LNR≥0.02、NLN<13或TLN<16的结直肠癌肺转移患者往往OS较短，治疗效果较差。建议采取强化全身治疗策略，以提高药物治疗的疗效，并尽可能为手术干预创造条件。
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