直肠癌肺转移外科治疗的预后因素分析

目的探讨影响手术治疗直肠癌肺转移的预后因素。方法1973年9月到2007年9月，我院共诊断43例直肠癌肺转移患者并行45次肺转移瘤切除手术，其中男31例，女12例；年龄36～77岁（平均58岁）。随访资料包括：年龄、性别、pTNM分期、肺转移瘤数目及最大直径、术前血清癌胚抗原（carcinoembryonic antigen，CEA）水平、直肠癌原发灶切除至发现肺转移的时间即无瘤间隔时间（disease-free interval，DFI）、肺门及纵隔淋巴结转移、术中出血量、术后化疗等。用Kaplan Meier法统计生存率，Cox回归比例风险模型分析各可能因素对预后的影响。结果所有患者均被随访，随访时间1～103个月（中位数54个月）。术后因合并心脏并发症早期死亡1例（2．3％），患者中位生存期42．6个月，术后患者1年，3年，5年生存率分别为91．3％，56．4％和32．2％。DFI为0～144个月（中位数28．6个月），9例发生肺门或纵隔淋巴结转移。5年生存率CEA〈5ng／ml为42．6％，CEA≥5ng／ml为18．0％（P=0．009）；DFI≥3年患者5年生存率为53．3％，1年〈DFI〈3年患者为32．3％，DFI≤1年患者为15．1％（P=0．036）。术前血清CEA水平和DFI是影响患者预后的独立因素（P=0．013，0．016）。结论对直肠癌肺转移患者手术治疗是有效的，CEA〈5ng／ml和DFI≥3年的患者长期生存率较高。

Surgical Treatment for Pulmonary Metastases from Rectal Cancer:Factors Influencing Prognosis

Objective To investigate prognostic factors of surgery treatment for pulmonary metastasis from rectal cancer. Methods From September 1973 to September 2007,43 patients, 12 women and 31 men with mean age of 58 years （ranged 36 77 years） were diagnosed and performed 45 curative resections of pulmonary metastases from rectal cancer in this hospital. Follow-up informations were collected including： the clinical parameters include age, sex, pTNM/UICC stage, the number, maximum diameter of lung metastases, the preoperative serum careinoembryonic antigen（CEA） levels, the interval between resection of primary tumor and diagnosis of lung metastasis （disease-free interval （DFI）, the presence of hilar/mediastinal tumor-infiltrated lymph nodes, intraoperative blood loss and postoperative chemotherapy schemes. After lung metastasectomy, probability of survival was calculated according to the method of Kaplan-Meier. All factors that may have affected the survival were entered into Cox＇ s proportional hazards regression model to identify significant variables associated with survival. Results Fourty-three patients were selected fully follow-up cases, with mean period ranged from 1-103 months （median 54 months）. There was 1 early postoperative mortality from cardiac complications （2.3 %）. The probability of survival at 1, 3, and 5 years was 91.3%,56.4% and 32.2%, respectively, Median overall survival was 42.6 months. The DFI was found to be 28.6 months（ranged 0-114 months）. Hilar or mediastinal tumor-involved lymph nodes were found in 9 patients. Five-year survival was 42.6% for patients with CEA〈5ng/ml and 18.0% for those with CEA≥5ng/ml （P=0. 009）. Five-year survival rate was 53.3% for patients with DFI≥3 years, 32.3% for those with 1 year〈DFI〈3 years and 15.1% for those with DFI ≤ 1 year （P= 0. 0.36）. In the multivariate analysis, the overall survival was significantly correlated with the preoperative serum CEA level and DFI （P=0. 013,0. 016）,respectively. Conclusion Patie