CAJ | 학술논문

目的探讨肺转移瘤的分布及外科治疗的手术指征、手术方式及影响预后的因素,为外科治疗方式的选择提供参考.方法收集1998年3月至2013年12月于中国医学科学院肿瘤医院外科手术治疗的肺转移瘤患者的临床资料,采用Kaplan-Meier曲线及Log-rank检验进行生存分析,并用Cox比例风险模型进行多因素分析.结果全组329例患者中,上皮组织来源的278例(包括结直肠癌、肾癌、乳腺癌等),肉瘤类来源的32例,生殖细胞来源的3例,恶性黑色素瘤3例,其他来源13例(包括淋巴瘤、子宫肌瘤等).全组1、3和5年总生存率分别为85.1％、50.9％和37.1％,中位生存期38个月.生存分析显示手术切除范围(P =0.004)、淋巴结清扫与否(P=0.017)和手术根治性(P＜0.01)等3个因素与患者预后显著相关,多因素分析则显示淋巴结清扫与否及手术根治性是影响患者预后的独立因素.结论对于原发恶性肿瘤已控制且无其他器官转移的肺转移瘤,手术应在达到根治的情况下尽量减小肺切除范围,术中不应常规清扫肺门纵隔淋巴结,而应结合术前影像学和术中探查淋巴结的情况来决定是否清扫,以提高患者的长期生存.
목적 탐토폐전이류적분포급외과치료적수술지정、수술방식급영향예후적인소,위외과치료방식적선택제공삼고.방법 수집1998년3월지2013년12월우중국의학과학원종류의원외과수술치료적폐전이류환자적림상자료,채용Kaplan-Meier곡선급Log-rank검험진행생존분석,병용Cox비례풍험모형진행다인소분석.결과 전조329례환자중,상피조직래원적278례(포괄결직장암、신암、유선암등),육류류래원적32례,생식세포래원적3례,악성흑색소류3례,기타래원13례(포괄림파류、자궁기류등).전조1、3화5년총생존솔분별위85.1％、50.9％화37.1％,중위생존기38개월.생존분석현시수술절제범위(P =0.004)、림파결청소여부(P=0.017)화수술근치성(P＜0.01)등3개인소여환자예후현저상관,다인소분석칙현시림파결청소여부급수술근치성시영향환자예후적독립인소.결론 대우원발악성종류이공제차무기타기관전이적폐전이류,수술응재체도근치적정황하진량감소폐절제범위,술중불응상규청소폐문종격림파결,이응결합술전영상학화술중탐사림파결적정황래결정시부청소,이제고환자적장기생존.
Objective To evaluate the distribution,diagnosis,indication and modus operandi of surgical treatment and prognostic factors for patients with lung metastatic tumors.Methods The clinical features were collected for 329 surgical patients with lung metastatic tumors during March 1998 and December 2013.Survival analysis was also performed by Log-rank test and Cox-regression analysis.Results The origins were epithelial tissue tumors (n =278),sarcomas (n =32),germ cell tumors (a =3),malignant melanoma (n =3) and miscellaneous tumors (n =13).Their 1,3 and 5-year survival rates were 85.1％,50.9％ and 37.1％ respectively with a median survival time of 38 months.Log-rank survival analysis showed that resection extent (P =0.004),lymph node dissection (P =0.017) and radical operation (P ＜0.01) were significantly associated with patient survival.And multi-variable Cox-regression analysis showed that lymph node dissection and radical operation were two independent prognostic factors.Conclusion For lung metastatic tumor patients with well-controlled primary malignancy and non-metastasis of other organs,radical resection should be performed with minimal resection extent.And routine systematic lymph node dissection is not recommended.The necessity of lymph node dissection should be determined by radiological evaluations and surgical explorations.