食管癌术后肺转移瘤的外科治疗效果及预后影响因素分析

Clinical Outcomes and Risk Factor Analysis of Surgical Resection of Pulmonary Metastases after Esophagectomy

目的探讨食管癌术后肺转移瘤的外科治疗效果及其预后影响因素。方法回顾性分析1994年3月至2008年5月徐州市第一人民医院和河北大学附属医院收治的食管癌术后肺转移瘤患者15例的临床资料,男10例、女5例,年龄43~72（65.0±8.8）岁。手术方式为肺部分切除术、肺楔形切除术、肺段切除术及肺叶切除术。随访时间60个月,分析转移瘤数目及大小、原发瘤TNM分期及无瘤生存时间（DFI）对肺转移瘤患者术后生存率的影响。结果肺转移瘤患者术后12、24、60个月的生存率分别为80.0%、66.7%和6.7%,患者术后中位DFI为30个月,DFI≥24个月肺转移瘤患者的术后生存率明显高于DFI〈24个月者（χ2=5.144,P=0.023）。肺单发转移患者的术后生存率明显高于肺多发转移患者（χ2=3.990,P=0.046）。而肺转移瘤大小和原发瘤TNM分期对肺转移瘤患者术后生存率无明显影响（P〉0.05）。Cox比例风险模型分析DFI是影响肺转移瘤患者术后生存率的主要因素（P=0.026）。结论外科手术是治疗食管癌术后肺转移的手段之一,尤其在肺单发转移瘤和食管癌术后DFI〉24个月的患者手术切除效果可能更佳。

Objective To investigate clinical outcomes and prognostic factors of surgical resection of pulmonary metastases after esophagectomy. Methods Clinical data of 15 patients who underwent surgical resection of pulmonary metastases after esophagectomy from March 1994 to May 2008 were retrospectively analyzed. There were 10 males and 5 females with their age of 43-72 （65.0 ± 8.8 ）years. Surgical procedures included partial lung resection, pulmonary wedge resection, segmental resection and lobectomy. Follow-up duration was 60 months after surgical resection of pulmonary metastases. The influence of number and size of pulmonary metastases, TNM staging of primary esophageal cancer, and disease-free interval （ DFI ） after esophagectomy on postoperative survival rate after pulmonary metastasectomy was analyzed. Results Twelve, 24 and 60 months survival rates after pulmonary metastasectomy were 80.0%, 66.7% and 6.7%, respectively. Median DFI was 30 months. Survival rate after pulmonary metastasectomy of patients whose DFI was longer than 24 months was significantly longer than that of patients whose DFI was shorter than 24 months （22=5.144, P=-0.023 ）. Survival rate after pulmonary metastasectomy of patients with solitary pulmonary metastasis was significantly longer than that of patients with multiple pulmonary metastases （22=3.990, P=0.046）.The size of pulmonary metastases and TNM staging of primary esophageal cancer didn＇t have significant impact on survival rate after pulmonary metastasectomy （P 〉 0.05 ）. Cox proportional hazards model showed that DFI after esophagectomy was the main factor affecting survival rate after pulmonary metastasectomy （P=0.026）. Conclusion Surgical resection is a therapeutic strategy for the treatment of pulmonary metas- tases after esophagectomy, and may achieve good clinical outcomes for patients with solitary pulmonary metastasis and patients whose DFI is longer than 24 months.