Background/Objectives: Patients with single metastases from colorectal cancer constitute a subgroup with an excellent 5-year OS of 55–70% and with a real chance for cure. In this situation, local margin recurrence in the lung may impair the prognosis and thus is the main outcome target of surgery. Methods: A retrospective multicenter analysis of patients with single metastases from colorectal cancers was performed. Four German Thoracic Surgery units contributed data from their prospective metastasectomy databases. Statistical analysis was focused on tumor recurrence and risk factors for local margin recurrence. Results: 166 patients from four centers could be further analyzed. For later comparison, 93 (56%) anatomic resections and 73 (44%) non-anatomic resections were pooled. Tumor recurrence was detected: at any site 87/161 (54%), within the lung 62/161 (38.5%) at intrapulmonary margins 25/145 (17.2%) and in intrathoracic lymph nodes 14/138 (10.1%). Intrapulmonary local margin recurrence was more often found in non-anatomic (25.4%) versus anatomic (11.6%) resections (p= 0.052). After propensity score matching (PSM), local margin recurrence was significantly more frequent after non-anatomic resection of intermediate and peripherally located metastases (p= 0.042). Furthermore, local margin recurrence was associated with small safety margins (p< 0.001), small number of lymph nodes removed (p< 0.001) and with intrathoracic lymph node recurrence (p= 0.001). The 5- and 10-year OS of the whole group was 70% and 47% with a median survival of 9.0 years. The 5- and 10-year RFS of the whole group was 59% and 43% with a median of 7.3 years. Conclusions: This study demonstrates that anatomical resection of single CRC lung metastases is superior to non-anatomic resection with respect to local radicality and local intrapulmonary margin recurrence, but there was no difference in OS and RFS.
背景/目的：结直肠癌单发肺转移患者是一个预后良好的亚组，其5年总生存率可达55-70%，且有治愈可能。在此情况下，肺切除边缘局部复发可能影响预后，因此成为手术的主要关注目标。方法：本研究对结直肠癌单发肺转移患者进行回顾性多中心分析。数据来源于德国四家胸外科中心的前瞻性转移瘤切除数据库。统计分析聚焦于肿瘤复发情况及切缘局部复发的危险因素。结果：共纳入四家中心的166例患者进行分析。为便于后续比较，将93例（56%）解剖性切除与73例（44%）非解剖性切除病例合并分析。肿瘤复发情况如下：任意部位复发87/161例（54%），肺内复发62/161例（38.5%），肺内切缘局部复发25/145例（17.2%），胸腔内淋巴结复发14/138例（10.1%）。非解剖性切除的肺内切缘局部复发率（25.4%）高于解剖性切除（11.6%）（p=0.052）。经倾向评分匹配后，对于位于肺中段及周边的转移灶，非解剖性切除的局部切缘复发率显著更高（p=0.042）。此外，切缘局部复发与较小安全切缘（p<0.001）、淋巴结清扫数量较少（p<0.001）及胸腔内淋巴结复发（p=0.001）相关。全组患者5年及10年总生存率分别为70%和47%，中位生存期9.0年；5年及10年无复发生存率分别为59%和43%，中位无复发生存期7.3年。结论：本研究表明，对于结直肠癌单发肺转移灶，解剖性切除在局部根治性和肺内切缘复发控制方面优于非解剖性切除，但两组在总生存率和无复发生存率方面无显著差异。
肿瘤(癌症)患者之家