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Einfluss des primären Lymphknotenstatus kolorektaler Karzinome auf die Entwicklung von Lungenmetastasen und thorakalen Lymphknotenmetastasen

Influence of primary lymph node status of colorectal cancer on the development of pulmonary metastases and thoracic lymph node metastases

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Zusammenfassung

Hintergrund

Die Lunge ist das zweithäufigste Metastasierungsorgan bei Patienten mit einem kolorektalen Karzinom (CRC). Die lymphonodale Metastasierung des CRC stellt einen Prognosefaktor für das Überleben dar.

Fragestellung

In der vorliegenden Studie wurde untersucht, welchen Einfluss die lymphonodale Metastasierung des CRC auf die Lungenmetastasierung, insbesondere die thorakale Lymphknotenmetastasierung besitzt.

Material und Methoden

Retrospektive Analyse von 88 Patienten (n = 56 männlich) mit kurativer Resektion von Lungenmetastasen bei CRC. Primärer Endpunkt: Einfluss des Lymphknotenstatus des CRC auf Lungenmetastasen, sekundäre Endpunkte krankheitsfreies Überleben/Gesamtüberleben. Die statistische Auswertung erfolgte mit SPSS.

Ergebnisse

Bei 48 Patienten bestand ein positiver Lymphknotenstatus des CRC, bei 9 Patienten ein N+-Status der Lungenmetastasierung. Der Lymphknotenstatus des CRC beeinflusste signifikant das Auftreten synchroner Metastasen (p = 0,03), das krankheitsfreie Intervall bis zur Ausbildung metachroner Lungenmetastasen (p = 0,012) und das Gesamtüberleben der Patienten mit einem CRC (p = 0,048). Die 5‑JÜR für CRC-Patienten mit Lungenmetastasen betrug nach pulmonaler Metastasektomie 48,7 %. Der thorakale Lymphknotenbefall beeinflusste das Überleben ebenfalls signifikant (p = 0,001).

Schlussfolgerung

Die Suche nach Lungenmetastasen sollte in das Staging und das Follow-up aller Patienten mit CRC einbezogen werden, insbesondere bei einem positiven Lymphknotenstatus des CRC.

Abstract

Background

The lungs are the second most common organ site for metastases in patients with colorectal cancer (CRC). Lymph node metastasis of CRC represents a prognostic factor for survival.

Objective

The present study investigated the influence of CRC lymph node metastasis on lung metastasis, in particular thoracic lymph node metastasis.

Material and methods

A retrospective analysis of 88 patients (n = 56 male) with curative resection of lung metastases of CRC was performed. Primary endpoint: influence of lymph node status of CRC on lung metastases. Secondary endpoints: disease-free survival and overall survival. Statistical evaluation was carried out with SPSS.

Results

In 48 patients a positive lymph node status of CRC and in 9 patients an N+ status of lung metastases were determined. The lymph node status of the CRC significantly affected the incidence of synchronous metastases (p = 0.03), disease-free interval until formation of metachronous lung metastases (p = 0.012) and the overall survival of patients with CRC (p = 0.048). The 5‑year survival rate for CRC patients with lung metastases was 48.7% after pulmonary metastasectomy. Thoracic lymph node involvement also significantly affected survival (p = 0.001).

Conclusion

Screening for pulmonary metastases should be included in the staging and follow-up of all patients with CRC, especially in patients with a positive lymph node status of the CRC.

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Authors and Affiliations

  1. Abteilung für Thoraxchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland

    H.-S. Hofmann, C. Doblinger, T. Potzger, M. Ried & R. Neu

  2. Klinik für Thoraxchirurgie, Krankenhaus Barmherzige Brüder Regensburg, Prüfeninger Str. 86, 93049, Regensburg, Deutschland

    H.-S. Hofmann, T. Szöke & C. Grosser

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  1. H.-S. Hofmann
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  2. C. Doblinger
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  3. T. Szöke
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  4. C. Grosser
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  5. T. Potzger
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  6. M. Ried
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Correspondence to H.-S. Hofmann.

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Interessenkonflikt

H.-S. Hofmann, C. Doblinger, T. Szöke, C. Grosser, T. Potzger, M. Ried und R. Neu geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Hofmann, HS., Doblinger, C., Szöke, T. et al. Einfluss des primären Lymphknotenstatus kolorektaler Karzinome auf die Entwicklung von Lungenmetastasen und thorakalen Lymphknotenmetastasen. Chirurg 90, 403–410 (2019). https://doi.org/10.1007/s00104-018-0742-y

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