Cancer Res Treat.  2017 Jan;49(1):104-115. 10.4143/crt.2015.367.

Curative Resection for Metachronous Pulmonary Metastases from Colorectal Cancer: Analysis of Survival Rates and Prognostic Factors

• Ihn MH
• Kim DW
• Cho S
• Oh HK
• Jheon S
• Kim K
• Shin E
• Lee HS
• Chung JH
• Kang SB

• KMID: 2367508
• DOI: http://doi.org/10.4143/crt.2015.367

Abstract

PURPOSE
Prognostic factors in patients with pulmonary metastases (PM) from colorectal cancer (CRC) are still controversial. This study assessed oncologic outcomes and prognostic factors in patients with metachronous PM from CRC.
MATERIALS AND METHODS
Between June 2003 and December 2011, 122 patients with CRC underwent curative resection of PM detected at least 4 months after CRC resection. Clinico-pathological factors selected from the prospectively maintained database were analyzed retrospectively.
RESULTS
The median disease-free interval (DFI) between resection of the primary tumor and detection of PM was 22.0 months (range, 4 to 85 months). Solitary PM were detected in 77 patients (63.1%), with a median maximal tumor diameter of 12.0 mm (range, 2 to 70 mm). Of 52 patients who underwent mediastinal lymph node (LN) dissection, eight patients had LN involvement. Five-year overall survival and disease-free survival (DFS) rates after initial pulmonary metastasectomy were 66.4% and 50.9%, respectively. DFI, mediastinal LN involvement, and the number and distribution of PM were significantly prognostic factors for DFS. In multivariable analysis DFI ≥ 12 months, solitary lesion, and absence of mediastinal LN involvement were independently prognostic for DFS. Of the 122 patients, 48 patients (39.3%) developed recurrent PM a median 13.0 months after initial pulmonary metastasectomy. Recurrent DFI was independently prognostic of DFS in patients who underwent repeated pulmonary metastasectomy.
CONCLUSION
There is a potential survival benefit for patients with metachronous PM from CRC who undergo pulmonary metastasectomy, even those with recurrent PM. Pulmonary metastasectomy should be considered in selected patients, particularly those with longer DFI, solitary lesions, and absence of mediastinal LN involvement.

Keyword

Pulmonary metastasis; Colorectal neoplasms; Disease-free interval; Metastasectomy

MeSH Terms

Colorectal Neoplasms*
Disease-Free Survival
Humans
Lymph Nodes
Metastasectomy
Neoplasm Metastasis*
Prospective Studies
Retrospective Studies
Survival Rate*

Figure

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  Fig. 1. Five-year overall survival (A) and disease-free survival (B) in the high- and low-risk groups. a)High-risk group was defined as patients with disease-free interval (DFI) < 12 months, or multiple pulmonary metastases, or mediastinal lymph node (LN) involvement, b)Low-risk group was defined as patients with DFI ≥ 12 months, solitary lesions, and absence of mediastinal LN involvement.

Reference

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