Lung metastasectomy for postoperative colorectal cancer in patients with a history of hepatic metastasis. Gen Thorac Cardiovasc Surg. 2014;62:314-320. [PMID: 24505023 DOI: 10.1007/s11748-014-0376-z]

Outcomes and prognostic factors after pulmonary metastasectomy in patients with colorectal cancer with previously resected hepatic metastases

OBJECTIVES

Outcomes and prognostic factors remain obscure in patients with colorectal cancer after pulmonary metastasectomy who had previously received a curative hepatic metastasectomy.

METHODS

We collected data of 757 patients with pulmonary metastasis from colorectal cancer who underwent curative metastasectomy between 2004 and 2008 from 46 Japanese institutions, from which we extracted data on patients who previously received curative hepatic metastasectomy. Disease-free survival, overall survival, and prognostic factors were analyzed.

RESULTS

The subjects of this study were 160 patients, of whom 44% had primary rectal tumor, 73% had a single pulmonary metastasis, 11% had a bilateral pulmonary metastasis, and 39% had high (>5 ng/mL) serum carcinoembryonic antigen. Patients' median age was 66 years, and 58% were male. The median follow-up was 64 months. Five-year overall survival and disease-free survival were 65.2% (95% confidence interval, 56.8-72.5) and 33.5% (95% confidence interval, 26.1-41.0), respectively. In multivariable analyses, high prethoracotomy carcinoembryonic antigen level was an independent prognostic factor for overall survival (hazard ratio, 2.01; 95% confidence interval, 1.16-3.47) and disease-free survival (hazard ratio, 2.10; 95% confidence interval, 1.41-3.12). Five-year overall survival and disease-free survival of patients with normal prethoracotomy carcinoembryonic antigen level were 76.4% (95% confidence interval, 66.1-83.9) and 40.7% (95% confidence interval, 30.5-50.5), respectively.

CONCLUSIONS

After pulmonary metastasectomy, approximately two thirds of patients with colorectal cancer with a history of curative hepatic metastasectomy survived for 5 years-half of them disease-free. Our results indicate that patients with colorectal cancer with pulmonary metastasis and a history of curative hepatic metastasectomy may benefit from sequential pulmonary metastasectomy, especially if prethoracotomy serum carcinoembryonic antigen levels are within normal range.

Survival after pulmonary metastasectomy in colorectal cancer patients: does a history of resected liver metastases worsen the prognosis? A literature review

Objective

: To assess the impact of past liver metastases on the survival duration of patients who are undergoing surgery for lung metastases.

Methods

: We conducted a review of literature published from 2007 to 2014. The studies were identified by searching PubMed, MEDLINE, and Embase and were supplemented by a manual search of the references listed by the retrieved studies. The following search terms were used: lung metastasectomy, pulmonary metastasectomy, lung metastases, and lung metastasis. We selected retrospective and prospective studies published from 2007 to 2014 on patients with lung metastases from colorectal cancer and were undergoing surgery with curative intent. We excluded reviews, studies that focused on surgical techniques, patients who were treated non-surgically, analyses of specific subgroups of patients, and those that did not report follow-up of the patients undergoing surgery.

Results

: We identified 28 papers that assessed survival after lung metastases, 21 of which were mostly retrospective studies that identified previous liver metastases to explore their impact on patient survival. In more than half of the papers analyzed (63.2%), patients with a history of resected liver metastases had a lower survival rate than those who did not have such a history, and the difference was statistically significant in eight of these studies. However, data were presented differently, and authors reported mean survival time, survival rates, or hazard ratios.

Conclusions

: A history of liver metastases seems to be a negative prognostic factor, but the individual data need to undergo a meta-analysis.

The optimal starting point for survival time in pulmonary metastasectomy

AIM

Studies of metastatic lung cancer have used various starting points for calculating the survival period, including the time of primary tumor resection and the first and final pulmonary metastasectomy. This study examined differences in prognostic factors according to the starting point used to calculate survival time.

METHODS

We performed surgical resection of pulmonary metastases in 202 consecutive patients between 1999 and 2013. Of these, 146 (excluding overlapping cases) underwent pulmonary metastasectomy. We examined the survival period after resection in patients with pulmonary metastases (group M) and primary tumors (group P). The prognostic influence of variables on survival was analyzed.

RESULTS

The 5-year survival rate was 76.7% in group P and 62.0% in group M. The significant prognostic factors were the disease-free interval (>1 and >2 years) in group P, and maximum tumor diameter in group M. Interestingly, multivariate analysis showed that the significant prognostic factors (age and nodule diameter) were identical in both groups.

CONCLUSIONS

We believe that the potential confounding factors were counterbalanced by the effect of prognostic factors on multivariate analysis in patients undergoing pulmonary metastasectomy. If the survival period is defined as starting from the time of the primary tumor resection, this may resolve the variance in survival, because pulmonary metastasectomy is only one option among several available treatments.

Surgical resection of pulmonary metastases from colorectal cancer: Efficacy and prognostic factors

AIM: To assess the efficacy and prognostic factors for surgical resection of pulmonary metastases from colorectal cancer.

METHODS: Forty patients underwent surgical resection of pulmonary metastases from colorectal cancer at our hospital between May 1996 and March 2012. Data of follow-up till June 30, 2013 were obtained. The disease-free interval, progression-free survival and overall survival were used for survival analysis. Records of general information, operation mode and history were analyzed.

RESULTS: The median overall survival time was 36.5 (4.0-159.0) mo, and the 5-year survival rate was 37%. Location of primary tumor, chemotherapy, preoperative CEA level and tumor TNM stage were significantly related with the survival of patients after resection of pulmonary metastases (P = 0.012, 0.033, 0.007, 0.008). Multi-factor Cox regression model analysis showed that location of primary tumor and preoperative CEA level were independent risk factors for death (OR = 5.023, 4.332; P = 0.002, 0.017).

CONCLUSION: Pulmonary metastasectomy can significantly improve the survival of patients with pulmonary metastases of colorectal carcinoma, and the prognosis is related with location of primary tumor, chemotherapy, preoperative CEA level and tumor TNM stage, with location of primary tumor and preoperative CEA level being independent risk factors for mortality of patients.