61例肺转移瘤的外科治疗与预后因素分析

Analysis of surgical treatment and prognostic factors in 61 cases of metastatic pulmonary tumor

目的分析多种原发组织来源肺转移瘤的诊断、手术方式、疗效及影响预后的相关因素。方法回顾性分析2007年1月至2017年1月大连医科大学附属第一医院胸外科接受肺转移瘤手术的61例患者的临床资料,其中结直肠癌肺转移瘤30例,肾癌肺转移瘤10例,软组织肉瘤肺转移瘤7例,乳腺癌肺转移瘤5例,子宫内膜癌肺转移瘤3例,肝细胞癌肺转移瘤2例,甲状腺癌肺转移瘤2例,骨巨细胞瘤肺转移瘤1例,涎腺源性肿瘤肺转移瘤1例。对患者的临床资料及生存随访资料进行统计学分析。结果 61例患者1年、3年、5年的生存率分别为88. 4%、35. 8%、15. 9%。无瘤间期(DFI)、原发肿瘤是否得到完整切除、转移瘤的切除性质、淋巴结移是否存在转移、术后是否接受辅助化疗是肺转移瘤术后影响生存率的因素。多因素分析发现DFI、淋巴结是否存在转移是影响生存率的独立因素。结论对于单发或局限的肺转移瘤,外科手术治疗是很有必要的。肺部转移瘤能否被完整切除、淋巴结是否有转移对病人的预后有重要影响,应综合分析,选取最佳手术方式及切除范围。

Objective To analyze and discuss the diagnosis,surgical approach,prognosis,and prognostic factors of pulmonary metastases from various tissue primaries.Methods A retrospective analysis was performed on 61 patients,who underwent surgical treatment of thoracic surgery from January 2007 to January 2017 at the first Affiliated Hospital of Dalian Medical University.The clinical data of the 61 patients were collected and postoperative pathology confirmed pulmonary metastasis.The source of pulmonary metastases was complex,including various tissues and organs.Among them,colorectal primary was most common(30 cases),followed by renal carcinoma(10 cases),soft tissue sarcoma(7 cases),breast cancer(5 cases),endometrial carcinoma(3 cases),hepatocellular carcinoma(2 cases),thyroid carcinoma(2 cases),giant cell tumor of bone(1 case),and salivary gland-derived tumor(1 case).SPSS23.0 software was used for statistical analysis.The single factor analysis of survival rate and prognosis adopted Kaplan-Meier method,the difference of survival rate between groups was tested by Log-rank method,and the Cox regression proportional risk model was analyzed by multi-factor,P≤0.05 was considered to be statistically significant.Results The survival rates of 1,3 and 5-year were 88.4%,35.8%and 15.9%,respectively.Single-factor analysis revealed that DFI(disease free interval),primary tumor resection,lymph node metastasis,and adjuvant chemotherapy were factors affecting survival rate.Multivariate analysis revealed that DFI and lymph node metastasis were independent factors affecting survival rate.Conclusion For single or limited pulmonary metastases,surgical treatment is necessary.Whether the pulmonary metastases can be completely removed and lymph node metastasis have important effects on the prognosis,and therefore should be analyzed synthetically to select the best surgical approach and the range of resection.