Treatment and survival of patients with metachronous colorectal lung metastases

Abstract

Introduction The lungs are the second most common site for metachronous metastases in colorectal cancer. No treatment algorithm is established, and the role of adjuvant chemotherapy is unclear. This study aimed to map pulmonary recurrences in a modern multimodal treated population, and to evaluate survival depending on management. Methods Retrospective study based on the COLOFOL‐trial population of 2442 patients, radically resected for colorectal cancer stage II–III. All recurrences within 5 years were identified and medical records were scrutinized. Results Of 165 (6.8%) patients developing lung metastases as first recurrence, 89 (54%) were confined to the lungs. Potentially curative treatment was possible in 62 (37%) cases, of which 33 with surgery only and 29 with surgery and chemotherapy combined. The 5‐year overall survival (5‐year OS) for all lung recurrences was 28%. In patients treated with chemotherapy only the 5‐year OS was 7.5%, compared with 55% in patients treated with surgery, and 72% when surgery was combined with chemotherapy. Hazard ratio for mortality was 2.9 (95% confidence interval 1.40–6.10) for chemotherapy only compared to surgery. Conclusion A high proportion of metachronous lung metastases after colorectal surgery were possible to resect, yielding good survival. The combination of surgery and chemotherapy might be advantageous for survival.

Metachronous colorectal cancer metastasis: Who, what, when and what to do about it

“…[71][72][73] Survival is the poorest for those with multisite metachronous CRC metastases and those with technically unresectable disease. [1][2][3]74 Oncological resection is the most important factor in determining survival following metachronous CRC metastasis. 28 There does not appear to be a difference in survival for early compared with late recurrences, provided the disease can be resected.…”

“…The median survival time following metachronous CRC liver metastasis resection is 13–18 months 71–73 . Survival is the poorest for those with multisite metachronous CRC metastases and those with technically unresectable disease 1–3,74 . Oncological resection is the most important factor in determining survival following metachronous CRC metastasis 28 .…”

“…More than 70% of patients with metachronous metastasis from colorectal cancer (CRC) will die within 5 years. 1,2 Given that there are nearly two million new CRC cases diagnosed globally every year and 7%-23% of patients undergoing curative treatment develop metachronous metastasis, this is a substantial cause for clinical concern. [2][3][4][5][6][7][8][9] Following curative resection, patients undergo regular follow-up with the oncological goal of early detection of locoregional recurrence and metachronous lesions (Figure 1).…”

“…More than 70% of patients with metachronous metastasis from colorectal cancer (CRC) will die within 5 years 1,2 . Given that there are nearly two million new CRC cases diagnosed globally every year and 7%–23% of patients undergoing curative treatment develop metachronous metastasis, this is a substantial cause for clinical concern 2–9 …”

KRAS Inhibitors Are Potential Prophylaxis for Colorectal Cancer Metachronous Metastasis

“…Despite comprehensive treatments including surgery, neoadjuvant and adjuvant chemoradiotherapy were applied to patients according to guideline, up to 23% of patients still develop distant recurrence after curative treatment, known as metachronous metastasis [2]. Patients with metachronous metastasis often have a poor prognosis, with 5-year survival rate less than 30%, which is a severe challenge in the clinical practice of CRC [3,4]. Since the effectiveness of first-line chemotherapy in preventing metachronous metastasis of CRC is limited [5,6], there is an urgent need to identify a biomarker that can predict the risk of distant recurrence of CRC after curative surgery, and to provide interventions other than chemotherapy for high-risk patients.…”