结直肠癌肺转移患者的临床特点、转移灶表现、治疗方式及预后情况

Pulmonary metastases of colorectal carcinoma: Clinical characteristics, metastatic features, therapeutic methods and prognosis

目的:探讨结直肠癌肺转移患者的临床特点、转移灶表现、治疗方式及预后情况.方法:回顾120例结直肠癌肺转移患者的临床资料,对患者的临床参数、治疗方法和影响预后的相关因素进行分析.结果:结直肠癌肺转移患者6 mo、1、2、3和5年的累积生存率分别为78%、44%、26%、19%和16%,中位生存时间(overall survival,O S)为18 m o.有或无特异性肺部症状、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(均P>0.05).单因素分析发现结直肠癌原发部位(P=0.017)、脉管浸润(P=0.024)和T分期(P=0.008)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33和18 mo),但因例数较少,差异无统计学意义(P=0.128).153例接受结直肠癌根治术者中,术后两年内有82例患者出现肺转移,中位无病间期(diseasefree interval,DFI)为20 mo.中位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(均P<0.05),其中肿瘤浸润程度(T分期)是DFI的独立预测因子(P=0.019).结论:T分期是影响DFI的独立预测因子,表明侵袭能力强的肿瘤更易发生肺转移,在临床早期诊断时应关注肿瘤浸润程度对预后的影响.

AIM： To explore the clinical characteristics, metastatic features, therapeutic methods and prognosis in patients with pulmonary metastases .of colorectal carcinoma. METHODS： The clinical data of 120 patients with pulmonary metastases of colorectal cancer were retrospectively analyzed. The clinical parameters of the patients, treatment methods and the factors affecting prognosis were analyzed. RESULTS： In patients with pulmonary metastases of colorectal carcinoma, the 6-mo, 1-, 2-, 3-, and 5-year survival rates were 78%, 44%, 26%, 19% and 16%, respectively, with an overall median overall survival （OS） period of 18.0 mo. Pulmonary symptoms, sex, age, single or multiple pulmonary metastases, the presence or absence of liver metastases, mediastinal and/or hilar lymph node involvement were not signifi- cant prognostic factors of OS （P 〉 0.05）. Univar- iate analysis showed that factors significantly predicting a poor prognosis included primary tumor site （P = 0.017）, vessel invasion （P = 0.024） and high T stage （P= 0.008）. However, none of these were prognostic factors on multivariate analysis. There was a trend of better survival in patients submitted to metastasectomy com- pared with those submitted to chemotherapy alone, although there was no statistical dif- ference （median OS： 33.0 mo vs 18.0 mo, P = 0.128）. Among 153 patients who underwent radical colorectal resection, 82 had pulmonary metastases in two years after surgery, with a median disease free interval （DFI） of 20.0 mo. The factors that affected DFI included primary tumor site, morphotype, differentiation degree, T stage and N stage （P 〈 0.05）. T stage was an independent predictive factor of DFI （P = 0.019）. CONCLUSION： T stage is an independent predictor of DFI, showing that the tumor with strong ability of invasion tend to cause lung metastasis more commonly.