结直肠癌单纯性肺转移90例患者预后相关因素分析

Prognostic factors related to simple lung metastases in 90 patients with primary colorectal cancer

目的:探讨结直肠癌单纯性肺转移患者的生存及预后相关因素。方法:回顾性分析90例结直肠癌单纯性肺转移患者的临床资料,其中34例接受肺转移R0手术切除,56例接受全身化疗。采用Kaplan-Meier法进行生存分析,log-rank检验进行预后的单因素分析,COX比例风险模型进行预后的多因素分析。结果:肺转移R0手术切除组和全身化疗组1、2和3年总生存率分别为97.1%、88.2%和74.9%以及82.1%、55.3%和31.4%(P<0.05),肺转移R0手术切除组1、2和3年无病生存率分别为64.7%、43.9%和33.8%。单因素分析结果显示,肺转移R0手术切除组患者是否伴有肺门或纵隔淋巴结转移(P=0.003)、肺转移肿瘤大小(P=0.007)和术前癌胚抗原水平(P=0.029)与肺转移R0手术切除后的3年总生存率相关;结直肠癌原发肿瘤伴有区域淋巴结转移(P=0.005)、肺转移肿瘤最大径≥4cm(P=0.006)和术前癌胚抗原水平≥5ng/mL(P=0.010)与肺转移R0手术切除患者的肿瘤复发有关;全身化疗组患者是否使用过包含所有3种细胞毒药物(氟尿嘧啶类、奥沙利铂和伊立替康()P=0.004)是影响3年总生存率的预后相关因素。多因素分析结果显示,肺转移肿瘤大小(P=0.032)是肺转移R0手术切除患者3年总生存率的独立预后因素,而结直肠癌原发肿瘤伴有区域淋巴结转移(P=0.030)和肺转移肿瘤最大径≥4cm(P=0.049)是肺转移R0手术切除患者肿瘤复发的独立预后因素。结论:结直肠癌单纯性肺转移患者行R0手术切除可明显提高生存率,尤其是肺转移肿瘤最大径<4cm的患者;全身化疗患者使用包括氟尿嘧啶类、奥沙利铂和伊立替康的3种细胞毒药物可明显延长总生存期。

Objective： To investigate the prognostic factors related to overall survival and prognosis of patients with simple lung metastases from primarycolorectal cancer. Methods： The clinical data from 90 patients with simple lung metastases from primary colorectal cancer were retrospectively reviewed. Of these 90 patients, 34 received R0 resection of lung metastases, and 56 received systemic chemotherapy. The survival analysis was performed by Kaplan-Meier method. The log-rank test was used for univariate analysis and the COX proportional hazards model for multivariate analysis of prognosis. Results： The 1-, 2- and 3-year cumulative survival rates between the patients receiving R0 resection of lung metastases and systemic chemotherapy were significantly different （97.1% vs 82.1%, P 〈 0.05; 88.2% vs 55.3%, P 〈 0.05; 74.9% vs 31.4%, P 〈 0.05）. The 1-, 2- and 3-year disease-free survival rates of patients receiving R0 resection of lung metastases were 64.7%, 43.9% and 33.8%, respectively. The univariate analysis revealed that in patients receiving R0 resection of lung metastases, the factors of hilar or mediastinal lymph node metastases （P = 0.003）, the maximum tumor size of pulmonary metastases （P = 0.007） and preoperative serum carcinoembryonic antigen level （P = 0.029） were significantly correlated with the 3-year overall survival, and the factors of lymph node metastases after curative resection of colorectal cancer （P = 0.005）, the maximum diameter of pulmonary metastases more than or equal to 4 cm （P = 0.006） and preoperative serum carcinoembryonic antigen level more than or equal to 5 ng/mL （P = 0.010） were significantly correlated with the recurrence after R0 resection of lung metastases, whilein patients receiving systemic chemotherapy, the factor of use of all three cytotoxic agents including fluorouracil, oxaliplatin and irinotecan （P = 0.004） was significantly correlated with the 3-year overall survival. The mulitivariate analysis revealed that in patients receiving R0 resection of lung metastases, the factor of maximum diameter of pulmonary metastases more than or equal to 4 cm （P = 0.032） was an independent prognostic factor related to the 3-year overall survival, while the factors of positive lymph node metastases after curative resection of the primary colorectal cancer （P = 0.030） and the maximum diameter of pulmonary metastases more than or equal to 4 cm （P = 0.049） were independent prognostic factors related to the recurrence after R0 resection of lung metastases. Conclusion： The overall survival of patients receiving R0 resection of lung metastases from primary colorectal cancer especially for the patients with the maximum diameter of pulmonary metastases less than 4 cm can be significantly improved. The overall survival of patients receiving systemic chemotherapy using all three cytotoxic agents including fluorouracil, oxaliplatin and irinotecan can also be significantly prolonged.