Long-term results and prognostic factors after resection of hepatic and pulmonary metastases of colorectal cancer
Long-term results and prognostic factors after resection of hepatic and pulmonary metastases of colorectal cancer
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DOI：
10.1007/s00384-012-1553-0
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发表时间：
2013-04-01
影响因子：
2.8
通讯作者：
Altendorf-Hofmann, Annelore
中科院分区：
文献类型：
--
作者：
Schuele, Silke;Dittmar, Yves;Altendorf-Hofmann, Annelore
切除结直肠肝或肺转移瘤是目前公认的治疗理念。然而，这两个器官的病变通常仍被认为是无法治愈的。自1995年以来，所有癌症患者都被记录在我们的前瞻性癌症登记处。收集并分析结直肠转移灶行肝肺切除术患者的资料。65名患者接受了肝和肺转移手术。在33例中，首次远处转移与原发肿瘤同时被诊断。其余患者，原发肿瘤和首次远处转移的中位时间间隔为18个月（5-69个月）。51例患者（79%）实现了完全切除，而同步疾病患者的可能性较小（p = 0.017）。阴性切缘（p = 0.002）、同步转移不累及肺部（p = 0.0003）和双器官单一转移（p = 0.036）与较好的预后相关。所有患者在原发肿瘤确诊后的5年和10年生存率分别为57%和15%，第一次转移灶切除后的5年和10年生存率分别为37%和14%，第二次转移灶切除后的5年和10年生存率分别为20%和15%。完全切除后，5年和10年生存率分别增加到61%和18%，43%和17%，25%和19%。长期存活者（千分之一- 10年）只有在完全切除两个转移瘤后才能观察到。可切除的结肠原发肝和肺转移患者，无论转移灶的数量或大小或无病间隔如何，应在多学科评估后考虑手术。清晰的切除边缘是最有力的预后参数。
Resection of colorectal liver or lung metastases is an established therapeutical concept at present. However, an affection of both these organs is frequently still regarded as incurable.All cancer patients are documented in our prospective cancer registry since 1995. Data of patients who underwent liver and lung resection for colorectal metastases were extracted and analysed.Sixty-five patients underwent surgery for liver and lung metastases. In 33 cases, the first distant metastasis was diagnosed synchronously to the primary tumour. For the remaining patients, median time interval between primary tumour and first distant metastasis was 18 months (5-69 months). Complete resection was achieved in 51 patients (79 %) and was less likely in patients with synchronous disease (p = 0.017). Negative margins (p = 0.002), the absence of pulmonary involvement in synchronous metastases (p = 0.0003) and single metastases in both organs (p = 0.036) were associated with a better prognosis. Five- and 10-year survival rates for all patients are 57 and 15 % from diagnosis of the primary tumour, 37 and 14 % from resection of the first metastasis and 20 and 15 % from resection of the second metastasis. After complete resection, 5- and 10-year survival rates increased to 61 and 18 %, 43 and 17 % as well as 25 and 19 %, respectively. Long-term survivors (a parts per thousand yen10 years) were seen only after complete resection of both metastases.Patients with resectable liver and lung metastases of the colorectal primary should be considered for surgery after multidisciplinary evaluation regardless of the number or size of the metastases or the disease-free intervals. Clear resection margins are the strongest prognostic parameter.