Prognostic Analysis of Colorectal Cancer Patients after Surgical Resection of Pulmonary Metastasis - Case Series from a Single Center

結直腸癌患者手術切除肺轉移後的預後分析－來自單一醫學中心的病例分析

劉真如(Zen-Zu Liu) ； 林春吉(Chun-Chi Lin) ； 林宏鑫(Hung-Hsin Lin) ； 藍苑慈(Yuan-Tzu Lan) ； 張世慶(Shih-Ching Chang) ； 王煥昇(Huann-Sheng Wang) ； 楊純豪(Shung-Haur Yang) ； 陳維熊(Wei-Shone Chen) ； 姜正愷(Jeng-Kae Jiang) ； 林資琛(Tzu-Chen Lin) ； 林楨國(Jen-Kou Lin)

《中華民國大腸直腸外科醫學會雜誌》 29卷4期 (2018/12) Pp. 187-196

https://doi.org/10.6312/SCRSTW.201812_29(4).10713

摘要

Purpose. Pulmonary metastasectomy had been widely performed for colorectal cancer with lung metastasis with favorable outcomes. However, there is currently no standard surgical indication for the procedure. This study aim to identify the patient groups who might benefit from pulmonary metastasectomy. Methods. We reviewed 42 patients who underwent curative resection of pulmonary metastasis from colorectal cancer between February 2002 and January 2015. The prognostic factor for overall survival was analyzed. Results. Twenty-four male and 18 female were included, and the median age at pulmonary resection was 66.7 years (range, 36-92 years). The median interval between colorectal and pulmonary resection was 2.3 years (range, 0 to 8.9 years), and the median follow-up period after pulmonary resection was 30.7 months (range, 2.1 to 102.3 months). The 3 year overall survival after pulmonary resection was 57.3%. Univariate analysis revealed that younger than 65 years, rectal cancer origin, initial pathological stage IV, multiple lung metastases, previously-treated liver metastasis, CEA and CA 19-9 level, positive resection margin and thoracic lymph node involvement were significant adverse indicators of disease-free survival. In multivariate analysis, previously-treated liver metastasis was the only significant independent prognosticator identified. Conclusions. The current study highlighted the importance of selection criteria for pulmonary metastasectomy from colorectal cancer. If the patient had history of previously-treated liver metastasis, aggressive treatment strategy should be considered.

關鍵字

Colorectal cancer ； Pulmonary metastasis ； Pulmonary metastasectomy ； Survival analysis

並列摘要

目的：大腸直腸癌之肺部轉移切除是被廣泛接受的術式，且成效良好。然而，目前尚未制定此術式之適應症。本研究將探討大腸直腸癌之肺部轉移切除術對哪些族群的病人較有益。方法：本研究收錄42名在2002年2月至2015年1月間接受大腸直腸癌之肺部轉移切除術的病人，並分析影響存活率的預後因子。結果：本研究收錄24名男病患及18名女病患，接受肺切除時的年齡中位數為66.7歲（範圍36-92歲）。大腸直腸癌切除術至肺切除術之間的時間間隔中位數為2.3年（範圍0-8.9年）。肺切除術後的追蹤期間中位數為30.7個月（範圍2.1-102.3個月），三年總存活率是57.3%。單變項分析結果顯示，年齡、原發腫瘤部位、初診斷期別、肺轉移腫瘤數、已切除之肝轉移、腫瘤指數、切除邊緣及肺淋巴結轉移為無病存活率之顯著不良預後因子。在多變項分析中，已切除之肝轉移為無病存活率之獨立預後因子。結論：本研究點出慎選病人進行大腸直腸癌之肺轉移切除術之重要性，若病人曾接受肝轉移之切除，需更積極的治療。

並列關鍵字

大腸直腸癌 ； 肺轉移 ； 肺轉移切除術 ； 存活率分析

參考文獻

Gonzalez M, Ris H, Krueger T, Gervaz P. Colorectal cancer and thoracic surgeons: close encounters of the third kind. Exp Rev Anticancer Ther. 2012;12:495-503.

Tan K, L LGJ, Sim R. How uncommon are isolated lung metastases in colorectal cancer? A review from database of 754 patients over 4 years. J Gastrointest Surg. 2009;13(4):642-648.

Penna C, Nordlinger B. Colorectal metastasis (liver and lung). The Surgical clinics of North America. 2002;82(5):1075–1090, x–xi.

Mitry E, Guiu B, Cosconea S, Jooste V, Faivre J, Bouvier A. Epidemiology, management and prognosis of colorectal cancer with lung metastases: a 30-year population-based study. Gut. 2010;59(10):1383-1388.

Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray TM. Cancer statistics 2008. Cancer J Clin. 2008;58(2):71-96.