根治性手术切除结直肠癌肺转移灶的临床疗效及预后影响因素分析

目的探讨根治性手术切除结直肠癌肺转移灶的临床疗效及预后影响因素。方法采用回顾性队列研究方法。收集2004年1月至2015年12月北京大学肿瘤医院收治的63例结直肠癌肺转移病人的临床病理资料;男35例,女28例;年龄为(57±12)岁。病人均行原发灶和结直肠癌肺转移灶根治性R 0切除术。观察指标:(1)诊断及治疗情况。(2)随访及生存情况。(3)预后影响因素分析。采用门诊和电话方式进行随访,了解病人术后生存情况,随访时间截至2018年12月。正态分布的计量资料以x±s表示,偏态分布的计量资料以M(范围)表示。计数资料以绝对数或百分比表示。采用Kaplan-Meier法计算生存率并绘制生存曲线,单因素分析采用Log-rank检验,多因素分析采用COX比例风险模型。结果(1)诊断及治疗情况:63例结直肠癌肺转移病人中,同时性肺转移6例,异时性肺转移57例。18例病人胸部X线片检查初始发现肺部可疑转移灶,经X线计算机体层摄影术(CT)检查进一步证实为肺转移灶,45例病人胸部CT检查初始发现肺转移灶。63例病人均行原发灶和肺转移灶根治性R 0切除术。22例病人行纵隔淋巴结清扫,其中2例各有1枚纵隔淋巴结转移。所有病人术后恢复良好,未出现严重并发症。63例病人中,57例接受>6个月以氟尿嘧啶类药物为主的术后辅助化疗及靶向治疗。(2)随访及生存情况:63例病人均获得术后随访,随访时间为8~143个月,中位随访时间为58个月。63例病人中,19例死亡,24例出现二次复发,5年复发率为38.1%(24/63),复发时间为18个月(3~58个月)。24例二次复发病人中,19例发生肺转移,3例发生脑转移,2例发生骨转移,2例发生肝转移。同1例病人可同时发生多处转移。24例二次复发病人中,5例行再次手术治疗,19例行化疗和放化疗。63例病人5年总体生存率为62.7%。(3)预后影响因素分析:单因素分析结果为原发灶部位、肺转移灶数目和肺转移灶切除术前癌胚抗原水平是影响结直肠癌肺转移病人预后的相关因素(χ²=4.162、7.175、6.725,P<0.05)。多因素分析结果显示:肺转移灶数目和肺转移灶切除术前癌胚抗原水平是结直肠癌肺转移病人预后的独立影响因素(风险比=2.725,2.778,95%可信区间为1.051~7.064、1.072~7.021,P<0.05)。结论根治性手术切除结直肠癌肺转移灶安全、可行。肺转移灶数目和肺转移灶切除术前癌胚抗原水平是结直肠癌肺转移病人预后的独立影响因素。

Clinical efficacy of radical resection for lung metastasis from colorectal cancer and prognostic factors analysis

Objective To explore the clinical efficacy of radical resection for lung metastasis from colorectal cancer and the prognostic factors.Methods The retrospective cohort study was conducted.The clinicopathological data of 63 colorectal cancer patients with lung metastasis who were admitted to Peking University Cancer Hospital from January 2004 to December 2015 were collected.There were 35 males and 28 females,aged(57±12)years.Patients underwent radical resection for primary lesion and lung metastasis from colorectal cancer.Observation indicators:(1)diagnosis and trement;(2)follow-up and survival;(3)prognostic factors analysis.Follow-up was conducte by outpatient examination and telephone interview to detect the survival of patients after operation up to December 2018.Measurement data with normal distribution were represented as Mean±SD,and measurement data with skewed distribution were represented as M(range).Count data were described as absolute numbers or percentages.The Kaplan-Meier method was used to calculate survival rates and draw survival curves.Log-rank test was used for univariate analysi COX proportional hazard model was used for multivariate anlysis.Results(1)Diagnosis and treatment:of 63 patients with lung metastasis from colorectal cancer,6 had synchronous lung metastasis and 57 had metachronous lung metastasis.Eighteen cases of suspected lung metastasis were initially detected by chest X-ray,and further confirmed by computed tomography(CT).Forty-five cases of suspected lung metastasis were initially detected by chest CT.All the 63 patients underwent radical resection for primary and metastatic lesions.Two of 22 cases undergoing mediastinal lymph nodes dissection were detected one positive lymph node,respectively.All patients recovered well after operation,without severe complications.There were 57 of 63 patients receiving more than 6 months of postoperative adjuvant chemotherapy and targeted therapy based on fluorouracils.(2)Follow-up and survival:63 patients were followed up for 8-143 months,with a median follow-up time of 58 months.During the follow-up,19 of 63 patients died,24 patients had secondary recurrence with a 5-year recurrence rate of 38.1%(24/63)and a recurrence interval of 18 months(range,3-58 months).Of 24 patients with secondary recurrence,19 had lung metastasis,3 had brain metastasis,2 had bone metastasis,2 had liver metastasis;some patients had multiple metastases.Of 24 patients with secondary recurrence,5 underwent reoperation and 19 underwent chemotherapy and radiochemotherapy.The 5-year overall survival rate of 63 patients was 62.7%.(3)Prognostic factors analysis:results of univariate analysis showed that location of primary lesion,the number of lung metastases and carcinoembryonic antigen(CEA)level before resection of lung metastasis were related factors for prognosis of patients with lung metastasis from colorectal cancer(χ²=4.162,7.175,6.725,P<0.05).Results of multivariate analysis showed that the number of lung metastases and CEA level before resection of lung metastasis were independent influencing factors for prognosis of patients with lung metastasis from colorectal cancer(hazard ratio=2.725,2.778,95%confidence interval as 1.051-7.064,1.072-7.021,P<0.05).Conclusions Radical resection for lung metastasis from colorectal cancer is safe and feasible.The number of lung metastases and CEA level before resection for lung metastasis are independent influencing factors for prognosis of patients with lung metastasis from colorectal cancer.