Study On The Clinical,Pathological Characteristics And Treatment Of Pulmonary Metastasis From Colorectal Cancer

Background and aim:Colorectal cancer is the most common malignant tumor of digestive system.Although multimodal treatment,including preoperative chemotherapy and total mesorectal and total mesocolon resection,has effectively reduced the local failure rate of colorectal cancer patients,it has not significantly improved the survival rate,because the high incidence of distant metastasis has not been solved..According to relevant studies,distant metastasis is still the main cause of death in patients with colorectal cancer.According to the stage of primary tumor,20%-70% of patients have liver metastasis and10%-20% of patients have pulmonary metastasis.At present,most of the research of tumor centers focus on the treatment of the liver metastasis of colorectal cancer and there is less research on the clinical,pathological characteristics and treatment methods on the pulmonary metastasis of colorectal cancer,which leads to the lack of professional,standardized and standardized treatment schemes for the pulmonary metastasis of colorectal cancer.Most of the recent studies are devoted to the study of traditional clinical and pathological prognostic indicators and the search for innovative markers,such as specific biological molecules of the pulmonary metastasis of colorectal cancer.However,this molecular spectrum analysis of the pulmonary metastasis of colorectal cancer is not complete.At present,only a few biomarkers have been explored,so it is difficult to grasp the occurrence and development of the pulmonary metastasis of colorectal cancer from the clinical perspective development and treatment.The treatment of colorectal cancer patients is a hundred flowers bloom and a hundred schools of thought contend.Although there is a lack of high-level evidence at present,when medical conditions permit,resection of the pulmonary metastasis of colorectal cancer has become one of the recognized treatment methods for specific patients,which may prolong the survival time of patients compared with conventional chemotherapy chemotherapy and targeted therapy.However,because the resection of pulmonary metastases will lead to corresponding complications,long postoperative recovery time and high risk,we must carefully select the appropriate patients to avoid the operation when the risk is greater than the benefit and this selection is very difficult.The purpose of this study is to summarize the relevant knowledge about pulmonary metastasis of colorectal cancer,focusing on its clinical,pathological characteristics and treatment methods.Methods:The basic data of patients with pulmonary metastasis of colorectal cancer treated in the First Affiliated Hospital of Naval Military Medical University from January 2012 to December 2018 were collected,mainly including age,gender,BMI,CEA,CA199,location of primary tumor(distance from tumor to dentate line),size of primary tumor,time of pulmonary metastasis,size of pulmonary metastasis,distribution of pulmonary metastasis,differentiation degree of primary tumor TNM stage,whether there are high-risk factors(vascular tumor thrombus,tumor budding,cancer nodule,nerve invasion),MMR status,KRAS gene status,NRAS gene status,BRAF gene status,PIK3 CA gene status,whether there is extrapulmonary metastasis,etc.R4.0.3 analysis software is used for data analysis and the difference test method is chi square test or Fisher exact test.Cox regression analysis is used for survival analysis,Kaplan Meier for survival curve analysis,and logistic regression analysis for multivariate analysis.This study mainly includes two parts.The first part mainly explores the clinical and pathological characteristics of the pulmonary metastasis of colorectal cancer.Through its clinicopathological data,we analyze the relevant clinicopathological factors that may affect the overall survival of patients,and discusse the independent risk factors related to the prognosis of the pulmonary metastasis of colorectal cancer.The second part mainly explores the differences in the treatment methods of the pulmonary metastasis of colorectal cancer.We analyze the treatment methods of the pulmonary metastasis of colorectal cancer.We analyze the clinicopathological factors that may affect the treatment methods of patients,further explore the treatment methods that may affect the overall survival and progress free survival of patients and discusse the relevant treatment methods for different modes of pulmonary metastasis.Results:In the first part,the clinicopathological data of patients were included in univariate analysis.It was found that the location of primary tumor,CEA,CA199,whether extrapulmonary metastasis occurred,the time of pulmonary metastasis,the size of pulmonary metastasis,the distribution of pulmonary metastasis,T stage and N stage had significant differences on the prognosis.The factors with P < 0.5 in univariate analysis were included in multivariate with Cox analysis.It was found that the location of the primary tumor,whether there was extrapulmonary metastasis,the time of pulmonary metastasis,the distribution of pulmonary metastasis and whether there was tumor thrombus in the vessel had significant differences in the prognosis of patients.In the second part,through univariate analysis of two different treatment methods and clinicopathological data,it was found that BMI,CEA,CA199,the size of pulmonary metastases,the time of pulmonary metastases,the distribution of pulmonary metastases,KRAS gene status,N stage and whether there are high-risk factors(tumor budding,nerve invasion and intravascular tumor thrombus)have an impact on patients’ choice of different treatment methods,The factors with P < 0.5 in univariate analysis were included in multivariate with logistic regression analysis.It was found that BMI,CA199 level and the time of pulmonary metastasis had an impact on the choice of treatment;Univariate analysis of three local lesion treatment methods and clinicopathological data showed that the location of the primary tumor,CA199,the presence of extrapulmonary metastasis,the size of pulmonary metastasis and the distribution of pulmonary metastasis were related to the choice of three different lesion treatment methods.The factors with P < 0.5 in univariate analysis were included in multivariate with logistic regression analysis.The distribution of pulmonary metastases,the presence of extrapulmonary metastases and the size of pulmonary metastases have an impact on the choice of three different destruction treatments.The multivariate analysis of PFS was continued in 345 patients.It was found that the presence of extrapulmonary metastasis,the distribution of pulmonary metastases,KRAS gene status and MMR status had an impact on PFS.Finally.According to the survival curve analysis of different treatment methods,it is found that the survival curve of different treatment methods is different and statistically significant.Conclusion:Through the retrospective analysis of the case data,it was found that the location of the primary tumor,whether there was extrapulmonary metastasis,the time of pulmonary metastasis,the distribution of pulmonary metastasis and whether there was tumor thrombus in the vessels were the independent risk factors for the prognosis of patients with the pulmonary metastasis of colorectal cancer.BMI,CA199 level and the time of pulmonary metastasis were independent influencing factors for patients to choose chemotherapy alone or local destruction treatment.CA199,the distribution of pulmonary metastases,the presence of extrapulmonary metastases and the size of pulmonary metastases are independent influencing factors for patients to choose stereotactic radiotherapy,interventional therapy and surgical resection.Further studies also found that the distribution of pulmonary metastases,the presence of extrapulmonary metastasis,MMR status and KRAS gene status were independent risk factors for PFS.Survival curve analysis found that PFS and OS of patients with local lesion treatment were better than those with simple chemotherapy.In patients with local lesion treatment,PFS and OS of patients with surgical treatment were better than interventional therapy and stereotactic radiotherapy.