肝転移切除の既往のある大腸癌肺転移切除症例についての検討
大腸癌肝転移の治療方針としては切除可能であれば外科的切除が推奨されている．しかし肝転移切除後にさらに肺転移も発生した際の肺切除に対する手術適応指針として明確なものはない．当施設で行った肝転移切除の既往のある大腸癌肺転移切除30例について臨床病理学的因子および予後を解析し，肺転移巣切除の有用性を検討した．原発巣および肺転移巣切除後の5年生存率はそれぞれ67.5%と41.6%であった．臨床病理因子別による生存率の比較では，多発肺転移例が単発例よりも予後が悪い傾向にあった．肺転移巣切除後24例に肝や肺などに再転移が認められたが，さらに再転移巣切除が行われた群は非切除群に比べ有意に予後良好であった．大...
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| Published in | 日本呼吸器外科学会雑誌 Vol. 28; no. 6; pp. 694 - 700 |
|---|---|
| Main Authors | , , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
特定非営利活動法人 日本呼吸器外科学会
2014
|
| Subjects | |
| Online Access | Get full text |
| ISSN | 0919-0945 1881-4158 |
| DOI | 10.2995/jacsurg.28.694 |
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| Abstract | 大腸癌肝転移の治療方針としては切除可能であれば外科的切除が推奨されている．しかし肝転移切除後にさらに肺転移も発生した際の肺切除に対する手術適応指針として明確なものはない．当施設で行った肝転移切除の既往のある大腸癌肺転移切除30例について臨床病理学的因子および予後を解析し，肺転移巣切除の有用性を検討した．原発巣および肺転移巣切除後の5年生存率はそれぞれ67.5%と41.6%であった．臨床病理因子別による生存率の比較では，多発肺転移例が単発例よりも予後が悪い傾向にあった．肺転移巣切除後24例に肝や肺などに再転移が認められたが，さらに再転移巣切除が行われた群は非切除群に比べ有意に予後良好であった．大腸癌肺転移症例においては，肝転移切除の既往があっても肺転移切除は十分考慮されるべき治療法と考えられた．ただし予後不良傾向である多発肺転移例や高い再転移出現率への対応が今後の課題であると考えられた． |
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| AbstractList | 大腸癌肝転移の治療方針としては切除可能であれば外科的切除が推奨されている．しかし肝転移切除後にさらに肺転移も発生した際の肺切除に対する手術適応指針として明確なものはない．当施設で行った肝転移切除の既往のある大腸癌肺転移切除30例について臨床病理学的因子および予後を解析し，肺転移巣切除の有用性を検討した．原発巣および肺転移巣切除後の5年生存率はそれぞれ67.5%と41.6%であった．臨床病理因子別による生存率の比較では，多発肺転移例が単発例よりも予後が悪い傾向にあった．肺転移巣切除後24例に肝や肺などに再転移が認められたが，さらに再転移巣切除が行われた群は非切除群に比べ有意に予後良好であった．大腸癌肺転移症例においては，肝転移切除の既往があっても肺転移切除は十分考慮されるべき治療法と考えられた．ただし予後不良傾向である多発肺転移例や高い再転移出現率への対応が今後の課題であると考えられた． |
| Author | 永井, 秀雄 鈴木, 久史 朝戸, 裕二 中尾, 啓太 阿部, 秀樹 雨宮, 隆太 北原, 美由紀 清嶋, 護之 佐々木, 和人 川崎, 普司 吉見, 富洋 |
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| References | 19. Kopetz S, Chang GJ, Overman MJ, Eng C, Sargent DJ, Larson DW, et al. Improved survival in metastatic colorectal cancer is associated with adoption of hepatic resection and improved chemotherapy. J Clin Oncol 2009; 27: 3677-83. 5. Watanabe I, Arai T, Ono M, Sugito M, Kawashima K, Ito M, et al. Prognostic factors in resection of pulmonary metastasis from colorectal cancer. Br J Surg 2003; 90: 1436-40. 1. 大腸癌研究会編. 大腸癌治療ガイドライン, 医師用2010年版. 東京: 金原出版; 2010. 12. Ike H, Shimada H, Togo S, Yamaguchi S, Ichikawa Y, Tanaka K. Sequential resection of lung metastasis following partial hepatectomy for colorectal cancer. Br J Surg 2002; 89: 1164-8. 13. Regnard JF, Grunenwald D, Spaggiari L, Girard P, Elias D, Ducreux M, et al. Surgical treatment of hepatic and pulmonary metastases from colorectal cancers. Ann Thorac Surg 1998; 66: 214-9. 9. Miller G, Biernacki P, Kemeny NE, Gonen M, Downey R, Jarnagin WR, et al. Outcomes after resection of synchronous or metachronous hepatic and pulmonary colorectal metastases. J Am Coll Surg 2007; 205: 231-8. 14. Headrick JR, Miller DL, Nagorney DM, Allen MS, Deschamps C, Trastek VF, et al. Surgical treatment of hepatic and pulmonary metastases from colon cancer. Ann Thorac Surg 2001; 71: 975-80. 16. Lambert LA, Colacchio TA, Barth RJ Jr. Interval hepatic resection of colorectal metastases improves patient selection. Arch Surg 2000; 135: 473-80. 2. 田中 良太, 雨宮, 隆太, 朝戸, 裕二, 清嶋, 護之, 岡 大嗣, 池田 真美, 他. 大腸癌肝転移合併肺転移手術症例の検討. 日呼外会誌 2001; 15: 92-8. 4. Goya T, Miyazawa N, Kondo H, Tsuchiya R, Naruke T, Suemasu K. Surgical resection of pulmonary metastases from colorectal cancer. 10-year follow-up. Cancer 1989; 64: 1418-21. 3. Yoshimi F, Asato Y, Suzuki A, Kiyoshima M, Shioyama Y, Imura J, et al. Long-term survival after repeat resections of metastases in liver, lung, and stomach from sigmoid colon cancer: report of a case. Surg Today 2007; 37: 53-60. 15. Mineo TC, Ambrogi V, Tonini G, Bollero P, Roselli M, Mineo D, et al. Longterm results after resection of simultaneous and sequential lung and liver metastases from colorectal carcinoma. J Am Coll Surg 2003; 197: 386-91. 8. Iida T, Nomori H, Shiba M, Nakajima J, Okumura S, Horio H, et al. Prognostic factors after pulmonary metastasectomy for colorectal cancer and rationale for determining surgical indications: a retrospective analysis. Ann Surg 2013; 257: 1059-64. 11. Murata S, Moriya Y, Akasu T, Fujita S, Sugihara K. Resection of both hepatic and pulmonary metastases in patients with colorectal carcinoma. Cancer 1998; 83: 1086-93. 17. Goldberg RM, Sargent DJ, Morton RF, Fuchs CS, Ramanathan RK, Williamson SK, et al. Randomized controlled trial of reduced-dose bolus fluorouracil plus leucovorin and irinotecan or infused fluorouracil plus leucovorin and oxaliplatin in patients with previously untreated metastatic colorectal cancer: a North American Intergroup Trial. J Clin Oncol 2006; 24: 3347-53. 18. Saltz LB, Clarke S, Díaz-Rubio E, Scheithauer W, Figer A, Wong R, et al. Bevacizumab in combination with oxaliplatin-based chemotherapy as first-line therapy in metastatic colorectal cancer: a randomized phase III study. J Clin Oncol 2008; 26: 2013-9. 7. Blackmon SH, Stephens EH, Correa AM, Hofstetter W, Kim MP, Mehran RJ, et al. Predictors of recurrent pulmonary metastases and survival after pulmonary metastasectomy for colorectal cancer. Ann Thorac Surg 2012; 94: 1802-9. 6. Iizasa T, Suzuki M, Yoshida S, Motohashi S, Yasufuku K, Iyoda A, et al. Prediction of prognosis and surgical indications for pulmonary metastasectomy from colorectal cancer. Ann Thorac Surg 2006; 82: 254-60. 10. Kobayashi K, Kawamura M, Ishihara T. Surgical treatment for both pulmonary and hepatic metastases from colorectal cancer. J Thorac Cardiovasc Surg 1999; 118: 1090-6. |
| References_xml | – reference: 7. Blackmon SH, Stephens EH, Correa AM, Hofstetter W, Kim MP, Mehran RJ, et al. Predictors of recurrent pulmonary metastases and survival after pulmonary metastasectomy for colorectal cancer. Ann Thorac Surg 2012; 94: 1802-9. – reference: 18. Saltz LB, Clarke S, Díaz-Rubio E, Scheithauer W, Figer A, Wong R, et al. Bevacizumab in combination with oxaliplatin-based chemotherapy as first-line therapy in metastatic colorectal cancer: a randomized phase III study. J Clin Oncol 2008; 26: 2013-9. – reference: 12. Ike H, Shimada H, Togo S, Yamaguchi S, Ichikawa Y, Tanaka K. Sequential resection of lung metastasis following partial hepatectomy for colorectal cancer. Br J Surg 2002; 89: 1164-8. – reference: 11. Murata S, Moriya Y, Akasu T, Fujita S, Sugihara K. Resection of both hepatic and pulmonary metastases in patients with colorectal carcinoma. Cancer 1998; 83: 1086-93. – reference: 10. Kobayashi K, Kawamura M, Ishihara T. Surgical treatment for both pulmonary and hepatic metastases from colorectal cancer. J Thorac Cardiovasc Surg 1999; 118: 1090-6. – reference: 15. Mineo TC, Ambrogi V, Tonini G, Bollero P, Roselli M, Mineo D, et al. Longterm results after resection of simultaneous and sequential lung and liver metastases from colorectal carcinoma. J Am Coll Surg 2003; 197: 386-91. – reference: 9. Miller G, Biernacki P, Kemeny NE, Gonen M, Downey R, Jarnagin WR, et al. Outcomes after resection of synchronous or metachronous hepatic and pulmonary colorectal metastases. J Am Coll Surg 2007; 205: 231-8. – reference: 16. Lambert LA, Colacchio TA, Barth RJ Jr. Interval hepatic resection of colorectal metastases improves patient selection. Arch Surg 2000; 135: 473-80. – reference: 6. Iizasa T, Suzuki M, Yoshida S, Motohashi S, Yasufuku K, Iyoda A, et al. Prediction of prognosis and surgical indications for pulmonary metastasectomy from colorectal cancer. Ann Thorac Surg 2006; 82: 254-60. – reference: 19. Kopetz S, Chang GJ, Overman MJ, Eng C, Sargent DJ, Larson DW, et al. Improved survival in metastatic colorectal cancer is associated with adoption of hepatic resection and improved chemotherapy. J Clin Oncol 2009; 27: 3677-83. – reference: 13. Regnard JF, Grunenwald D, Spaggiari L, Girard P, Elias D, Ducreux M, et al. Surgical treatment of hepatic and pulmonary metastases from colorectal cancers. Ann Thorac Surg 1998; 66: 214-9. – reference: 2. 田中 良太, 雨宮, 隆太, 朝戸, 裕二, 清嶋, 護之, 岡 大嗣, 池田 真美, 他. 大腸癌肝転移合併肺転移手術症例の検討. 日呼外会誌 2001; 15: 92-8. – reference: 3. Yoshimi F, Asato Y, Suzuki A, Kiyoshima M, Shioyama Y, Imura J, et al. Long-term survival after repeat resections of metastases in liver, lung, and stomach from sigmoid colon cancer: report of a case. Surg Today 2007; 37: 53-60. – reference: 1. 大腸癌研究会編. 大腸癌治療ガイドライン, 医師用2010年版. 東京: 金原出版; 2010. – reference: 14. Headrick JR, Miller DL, Nagorney DM, Allen MS, Deschamps C, Trastek VF, et al. Surgical treatment of hepatic and pulmonary metastases from colon cancer. Ann Thorac Surg 2001; 71: 975-80. – reference: 4. Goya T, Miyazawa N, Kondo H, Tsuchiya R, Naruke T, Suemasu K. Surgical resection of pulmonary metastases from colorectal cancer. 10-year follow-up. Cancer 1989; 64: 1418-21. – reference: 5. Watanabe I, Arai T, Ono M, Sugito M, Kawashima K, Ito M, et al. Prognostic factors in resection of pulmonary metastasis from colorectal cancer. Br J Surg 2003; 90: 1436-40. – reference: 8. Iida T, Nomori H, Shiba M, Nakajima J, Okumura S, Horio H, et al. Prognostic factors after pulmonary metastasectomy for colorectal cancer and rationale for determining surgical indications: a retrospective analysis. Ann Surg 2013; 257: 1059-64. – reference: 17. Goldberg RM, Sargent DJ, Morton RF, Fuchs CS, Ramanathan RK, Williamson SK, et al. Randomized controlled trial of reduced-dose bolus fluorouracil plus leucovorin and irinotecan or infused fluorouracil plus leucovorin and oxaliplatin in patients with previously untreated metastatic colorectal cancer: a North American Intergroup Trial. J Clin Oncol 2006; 24: 3347-53. |
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| Title | 肝転移切除の既往のある大腸癌肺転移切除症例についての検討 |
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