结直肠癌肺转移患者的临床回顾性分析

Retrospective analysis of patients with pulmonary metastases from colorectal carcinoma

目的了解结直肠癌肺转移患者的生存时间（OS）和结直肠癌根治术后发生肺转移的时间间隔并寻找相关影响因素。方法对206例结直肠癌肺转移患者的各项临床参数、治疗方法、无转移间隔时间（DFI）和OS进行分析。结果结直肠癌肺转移患者6个月、1年、2年、3年和5年的累积生存率分别为79％、46％、25％、20％和18％，中位OS为16个月。有或无特异性肺部及相关症状、性别、年龄、伴或不伴肝转移、肺转移灶单发或多发、是否存在纵隔和（或）肺门淋巴结转移均与OS无关（P值均〉0．05）。单因素分析发现结直肠癌原发部位（P=0．020）、脉管浸润（P=0．022）和T分期（P=0．009）是影响肺转移患者中位OS的因素，但多因素分析未发现独立预后因子。接受肺转移灶切除术者相比单纯化学治疗者中位OS更长（分别为34和16个月），但因例数较少，差异尚无统计学意义（P=0．125）。160例接受结直肠癌根治术者中，术后第1年和第2年各有48例患者出现肺转移，中位DFI为20个月。DFI与结直肠癌原发部位、形态类型、分化程度、T分期和N分期相关（P值均〈0．05），其中T分期是DFI的独立预测因子（P=0．023）。结论结直肠癌肺转移多发生在结直肠癌根治术后2年内，DFI、临床特征、病理特征和分期均不是独立的生存预后指标，但T分期是影响DFI的独立预测因子。

Objective To evaluate the overall survival （OS） of patients with pulmonary metastases from colorectal carcinoma and the disease free interval （DFI） between radical resection and pulmonary metastases so as to find the factors that affect the surveillance and treatment option. Methods Clinical data from 206 patients with pulmonary metastases from colorectal carcinoma, including clinical parameters, therapeutic methods, DFI and OS, were retrospectively analyzed. Results In patients with pulmonary metastases from eolorectal carcinoma, 6-month, 1 , 2-, 3- and 5-year survival rates were 7 9 % , 4 6 % , 2 5 % , 2 0 % and 18 % , respectively, with overall median OS of 16. 0 months. Pulmonary symptom, sex, age, single or multiple pulmonary metastases, the presence or absence of liver metastases, mediastinal and （or） hilar lymph node involvement had not been found to be significant prognostic factors of OS （P〉0.05）. Univariate analysis showed that factors significantly predicted a poor prognosis included primary tumor sites （P=0.02）, vessel invasion （P=0.022） and highTstage （P=0.009）. However, none of these was the prognostic factor on multivariate analysis. There was a trend of better survival in patients submitted to metastasectomy compared with those submitted to chemotherapy alone, however, no statistical significant was found （median OS ： 34. 0 months vs. 16.0 months, P=0. 125）. Among 160 patients underwent radical coloreetal resection, 48 patients had pulmonary metastasese both in the first and second year after surgery with median DFI of 20.0 months. The factors that affected DFI included primary tumor site, pathological morphology, differeneiation, T stage and regional lymph node stage （P〈0.05）. T stage was the independent predictive factor of DFI （P= 0.023）. Conclusions Pulmonary metastases mostly occurred within two years after primary colorectal resection. Neither DFI nor other clinical and pathological parameters predict prognosis. The T stage is the independent influencing factor of DFI.