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...

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.