Prognostic Factors After Pulmonary Metastasectomy for Colorectal Cancer and Rationale for Determining Surgical Indications

Iida, Tomohiko; Nomori, Hiroaki; Shiba, Mitsutoshi; Nakajima, Jun; Okumura, Sakae; Horio, Hirotoshi; Matsuguma, Haruhisa; Ikeda, Norihiko; Yoshino, Ichiro; Ozeki, Yuichi; Takagi, Keigo; Goya, Tomoyuki; Kawamura, Masafumi; Hamada, Chikuma; Kobayashi, Koichi

doi:10.1097/sla.0b013e31826eda3b

Cited by 138 publications

(113 citation statements)

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“…In the study population, the number of liver metastases, the size of lung metastases, and the preoperative serum CEA levels were lower than in the medical population, which may have led to the favorable prognosis in the study population. Several series of lung resection have demonstrated factors predictive of survival in patients with colorectal lung metastases; 35,36 however, the factors vary widely among reports and no consensus is available to date regarding indications for lung resection. As suggested by our study, effective chemotherapy may further impact the prognosis of patients with colorectal lung metastases.…”

Section: Discussionmentioning

confidence: 98%

Is Complete Liver Resection Without Resection of Synchronous Lung Metastases Justified?

et al. 2014

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Section: Discussionmentioning

confidence: 98%

Is Complete Liver Resection Without Resection of Synchronous Lung Metastases Justified?

et al. 2014

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“…15,[21][22][23] The pre-thoracotomy CEA level was the most prognostic factor for survival in a multivariate analysis, and has been reviewed in other reports. 34,35) It has been reported that 70% of patients with recurrent or metastatic colorectal carcinoma are CEA-positive. 36) The indications for surgery should be considered carefully in these "high-risk" patients.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Factors for Survival after Resection of Pulmonary Metastases from Colorectal Carcinoma

Osoegawa

Kometani

Fukuyama

et al. 2016

ATCS

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IntroductionRecent advances in systemic chemotherapy have prolonged the survival in patients with metastatic colorectal carcinoma. [1][2][3] The combination of oxaliplatin, fluoropyrimidine and CPT-11, along with other newly developed molecular targeting agents like bevacizumab, cetuximab/ panitumumab and regorafenib has led to the median overall survival reaching approximately 2.5 years. [4][5][6][7][8][9][10][11][12] Nearly half of the patients with colorectal carcinoma experience distant metastases, mainly in the liver and lungs. 13) From the pathological view with regard to the cascade hypothesis, these two metastatic sites develop in discrete steps, which supports the idea that these hematogenous metastases are limited diseases. 14) Several retrospective studies have shown that patients with isolated pulmonary metastases from colorectal carcinoma benefit from resection. The published five-year survival rates after pulmonary Purpose: As chemotherapy has improved, the survival of patients with metastatic colorectal carcinoma has reached up to 2.5 years. Many of these patients experience pulmonary metastases; however, the prognosis after pulmonary metastasectomy is not satisfying. In this study, we analyzed the prognostic factors for survival in patients who underwent pulmonary metastasectomy. Methods: Eighty-seven patients with colorectal carcinoma received pulmonary metastasectomy. The pathological status of the primary tumor, outcome of the pulmonary metastasectomy, disease-free interval, perioperative carcinoembryonic antigen (CEA) level and history of liver metastases were assessed. Results: The five-year survival was 42.5% after pulmonary metastasectomy. A univariate analyses revealed that the CEA level (p = 0.043) and the number of pulmonary metastases (p = 0.047) were prognostic factors for survival. The CEA level was an independent prognostic factor in a multivariate analysis (relative risk = 2.01, p = 0.037). Among cases with elevated preoperative CEA levels, those whose CEA level normalized after metastasectomy had a better prognosis compared with those whose CEA level decreased but was still high, or whose level increased after metastasectomy (median survival time of 41.8 months compared with 28.1 or 15.7 months, respectively p = 0.021). Conclusion: The CEA level can be a predictive marker for the prognosis in patients with pulmonary metastases from colorectal carcinoma.

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“…Several authors have reported a worse prognosis after lung metastasectomy in patients with hilar/mediastinal lymph node metastasis [5, 18, 20, 21]. However, it still remains uncertain whether those patients benefit from lung metastasectomy along with lymph node dissection.…”

Section: Discussionmentioning

confidence: 99%

Survival after initial lung metastasectomy for metastatic colorectal cancer in the modern chemotherapeutic era

et al. 2017

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BackgroundA clear survival benefit has been reported for lung metastasectomy for colorectal cancer, and several clinicopathological prognostic factors have been proposed in the past. However, clinical advances, such as chemotherapy and radiographic imaging, should have improved patient outcome and may have altered prognosticators. This study aimed to assess patient survival and determine prognostic factors for survival and recurrence in patients who underwent initial lung metastasectomy for colorectal cancer in the modern clinical era.MethodsClinicopathological data and outcomes of 59 patients who underwent curative initial lung metastasectomy for colorectal cancer from 2004 to 2012 at a single institution in Japan were retrospectively investigated. Survival was estimated using the Kaplan - Meier method, and Cox proportional hazards regression models were used to estimate the prognostic impacts of each variable in univariate and multivariate analysis.ResultsThe 5-years overall and disease-free survival rates were 54.3 and 40.6%, respectively. A disease-free interval < 24 months after colorectal cancer resection (P = 0.004) and a serum carcinoembryonic antigen ≥ 5.0 ng/mL before initial lung metastasectomy (P = 0.015) were independent predictors for poor overall survival. Moreover, the disease-free interval after colorectal cancer resection < 24 months (P = 0.010) and a colorectal cancer with N2 stage disease (P = 0.018) were independently associated with poor disease-free survival. On the other hand, the number of lung metastasis was not identified as a poor prognostic factor for both overall and disease-free survival.ConclusionsOur findings demonstrated similar or slightly better overall survival, and substantially favorable disease-free survival as compared with past reports. Poor prognostic factors for overall survival appeared not to differ from those of past studies, although this modern series did not determine the number of lung metastasis as a poor prognostic factor, which should be investigated in future studies. Moreover, initial lung metastasectomy is not expected to be a curable treatment for patients with both a short disease-free survival after colorectal cancer resection and colorectal cancers with N2 stage disease.

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Prognostic Factors After Pulmonary Metastasectomy for Colorectal Cancer and Rationale for Determining Surgical Indications

Cited by 138 publications

References 18 publications

Is Complete Liver Resection Without Resection of Synchronous Lung Metastases Justified?

Is Complete Liver Resection Without Resection of Synchronous Lung Metastases Justified?

Prognostic Factors for Survival after Resection of Pulmonary Metastases from Colorectal Carcinoma

Survival after initial lung metastasectomy for metastatic colorectal cancer in the modern chemotherapeutic era

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