结直肠癌根治术后肺转移的危险因素分析

Analysis of risk factors for pulmonary metastasis after curative resection of colorectal cancer

目的了解结直肠癌根治术后单纯肺转移的危险因素，以提高高危患者随访的针对性和早诊率。方法回顾性分析2004年1月至2006年12月间在北京大学肿瘤医院行结直肠癌根治术的268例患者的临床病理及术后随访资料，其中16例（6．0％）患者术后出现单纯性肺转移。采用单因素和多因素分析筛选结直肠癌根治术后肺转移的高危因素。结果16例术后单纯肺转移患者中单侧肺转移10例，双侧肺转移6例；原发灶根治术后至诊断肺转移的中位时间为13．9月；81.3％（13／16）的肺转移患者是经胸部增强CT诊断。单因素分析显示：术前CEA水平、原发肿瘤部位、TNM分期及术后辅助化疗与术后肺转移有关（均P〈0．05）。多因素分析显示，原发肿瘤部位（P=0．003，OR=5．503，95％CI：1．794—16．884）和术前CEA水平（P=0．019，OR=4．319，95％CI：1．269—14．692）是结直肠癌根治术后肺转移的独立危险因素。结论直肠癌和术前CEA水平异常增高是结直肠癌根治术后肺转移的高危因素，对这部分患者术后要加强随访，常规行胸部增强CT检查。

Objective To explore the risk factors for pulmonary metastasis after curative resection of colorectal cancer in order to improve the effectiveness of follow-up and the rate of early diagnosis for the high-risk patients. Methods The clinicopathological and follow-up data of 268 patients with colorectal cancer undergoing radical resection from January 2004 to December 2006 in the Beijing Cancer Hospital were analyzed retrospectively. Patients were divided into study group including 16 （6.0%） patients who developed lung metastasis and control group without lung metastasis. The high-risk variables associated with lung metastasis were reviewed by univariate analysis and multivariate analysis. Results Lung metastasis developed in 16 patients, including 10 cases with unilateral lung metastasis and 6 with bilateral. The median duration from colorectal surgery to identification of lung metastasis was 13.9 months. The diagnosis rate of pulmonary metastasis by enhanced chest CT was 81.3% （13/16）. Univariate analysis identified the following associated with significant factors associated with pulmonary metastasis： primary tumor location （P=0.003）, adjuvant chemotherapy （P=0.034）, TNM stage （P=0.005） and preoperative serum carcinoembryonic antigen （CEA） level （P=0.001）. Multivariate analysis revealed that primary tumor location （rectum） and preoperative serum CEA level（ t〉5 μg/L）were independent risk factors for pulmonary metastasis（both P〈0.05）. Conclusions Primary tumor location and elevated preoperative CEA level are independent risk factors for pulmonary metastasis. Strict postoperative follow-up and routine chest enhanced CT examination is necessary for this particular patient population.