Girard P, Baldeyrou P, Grunenwald D
Service de Chirurgie thoracique, Institut mutualiste Montsouris, Centre médico-chirurgical de la Porte de Choisy, Paris.
Presse Med. 1995 Jun 17;24(22):1028-32.
Surgery has become a recognized therapeutic means in selected patients with isolated pulmonary metastases, with a 5-year survival rate of about 35%, but specific studies on the results and prognosis of surgery for pulmonary metastases from colorectal cancer remain relatively rare.
Between 1980 and 1991, 65 patients (34 men, 31 women, mean age 58.2 years) underwent 81 thoracic operations with curative intent (including 15 bilateral operations and 7 incomplete resections) for pulmonary metastases from colorectal cancer.
The 5- and 10-year probabilities of survival (Kaplan-Meier) after the first thoracic operation were 27% and 22% respectively. The site of the primary tumor (colon or rectum), the disease-free interval, previous resection(s) of hepatic metastases, and the size of pulmonary metastases were not found to the have a statistically significant influence on prognosis. On the other hand, the quality of resection (complete or incomplete) (p < 0.001), the number of resected pulmonary metastases (p = 0.016), and the preoperative carcino-embryonic antigen level (p < 0.001) were found to be highly significant prognostic factors.
Complete resection of pulmonary metastases from colorectal cancer seems to prolong survival in a significant number of patients, and the results from this study should help to select those who may benefit from this treatment.
手术已成为部分孤立性肺转移患者公认的治疗手段，其5年生存率约为35%，但关于结直肠癌肺转移手术结果及预后的具体研究仍然相对较少。
1980年至1991年间，65例患者（34例男性，31例女性，平均年龄58.2岁）因结直肠癌肺转移接受了81例有治愈意图的胸科手术（包括15例双侧手术和7例不完全切除）。
首次胸科手术后5年和10年的生存率（Kaplan-Meier法）分别为27%和22%。未发现原发肿瘤部位（结肠或直肠）、无病间期、既往肝转移灶切除情况以及肺转移灶大小对预后有统计学显著影响。另一方面，切除质量（完全或不完全）（p<0.001）、切除的肺转移灶数量（p=0.016）以及术前癌胚抗原水平（p<0.001）是高度显著的预后因素。
结直肠癌肺转移的完全切除似乎能显著延长许多患者的生存期，本研究结果应有助于筛选可能从该治疗中获益的患者。
