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대장암의 근치적 수술 후 발생한 폐전이

Pulmonary Metastases after Curative Resection in Patients with Colorectal Carcinomas

대한대장항문학회지 2003년 19권 5호 p.307 ~ 313
박인자 ( Park In-Ja ) - 울산대학교 의과대학 외과학교실

김희철 ( Kim Hee-Cheol ) - 울산대학교 의과대학 외과학교실
이강홍 ( Lee Kang-Hong ) - 울산대학교 의과대학 외과학교실
유창식 ( Yu Chang-Sik ) - 울산대학교 의과대학 외과학교실
김태원 ( Kim Tae-Won ) - 울산대학교 의과대학 내과학교실
장흥문 ( Jang Heung-Moon ) - 울산대학교 의과대학 내과학교실
김동관 ( Kim Dong-Kwan ) - 울산대학교 의과대학 서울아산병원 흉부외과
박승일 ( Park Seung-Il ) - 울산대학교 의과대학 서울아산병원 흉부외과
김진천 ( Kim Jin-Cheon ) - 울산대학교 의과대학 외과학교실


Purpose: Pulmonary metastases from colorectal carcinomas have been reported to occur in 10% of all patients who undergo a curative resection. A number of studies have reported aggressive treatments, including lung resection, for pulmonary metastases that appear to prolong the survival in selected cases. The aim of this study was to assess the clinical characteristics, and the prognostic factors of pulmonary metastases, as well as the outcomes after resection of the pulmonary metastases.

Methods: A retrospective study was performed on 104 patients who presented with primary pulmonary metastases without metastases in other organs after a curative resection for a colorectal carcinoma between January 1994 and December 2000 at Asan Medical Center. Pulmonary metastases were diagnosed by using serial changes in the chest X-ray and the CT. Univariate (log-rank) and multivariate (Cox’s model) analyses were employed to identify the prognostic factors.

Results: The mean interval between colorectal resection and pulmonary metastases (disease-free interval) was 22 (range: 4~64) months. Fifty-eight of 104 patients had pulmonary metastases originating from rectal cancer. More than half of the patients (55.7%) had bilateral multiple metastases. Fifty-six of 104 patients underwent chemotherapy, 28 conservative therapy, and 20 a pulmonary resection with the extent of the resection varying from a wedge resection of the metastatic nodule to a lobectomy. Prolonged survival was associated with serum CEA levels at the diagnosis of the metastases (P=0.02) and with the type of treatment (P<0.01).

Conclusion: The s-CEA level at the diagnosis of the pulmonary metastases appears to be a reliable predictor of survival in patients with pulmonary metastases from colorectal cancer. Resection of the pulmonary metastasis in colorectal cancer may significantly prolong survival. Thus, aggressive therapy, including surgery, should be considered for pulmonary metastatic tumors in selected groups.


종양전이;치료 성적;암태아성항원;결장직장종양;폐종양
Neoplasm metastasis;Treatment outcome;Carcinoembryonic antigen;Colorectal neoplasms;Lung neoplasms
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