Chemotherapy for resected colorectal cancer pulmonary metastases: Utilization and outcomes in routine clinical practice

Adjuvant chemotherapy for isolated resectable colorectal lung metastasis: A retrospective study using inverse probability treatment weighting propensity analysis

BACKGROUND

The benefit of adjuvant chemotherapy (ACT) for patients with no evidence of disease after pulmonary metastasis resection (PM) from colorectal cancer (CRC) remains controversial.

AIM

To assess the efficacy of ACT in patients after PM resection for CRC.

METHODS

This study included 96 patients who underwent pulmonary metastasectomy for CRC at a single institution between April 2008 and July 2023. The primary endpoint was overall survival (OS); secondary endpoints included cancer-specific survival (CSS) and disease-free survival (DFS). An inverse probability of treatment-weighting (IPTW) analysis was conducted to address indication bias. Survival outcomes compared using Kaplan-Meier curves, log-rank test, Cox regression and confirmed by propensity score-matching (PSM).

RESULTS

With a median follow-up of 27.5 months (range, 18.3-50.4 months), the 5-year OS, CSS and DFS were 72.0%, 74.4% and 51.3%, respectively. ACT had no significant effect on OS after PM resection from CRC [original cohort: P = 0.08; IPTW: P = 0.15]. No differences were observed for CSS (P = 0.12) and DFS (P = 0.68) between the ACT and non-ACT groups. Multivariate analysis showed no association of ACT with better survival, while sublobar resection (HR = 0.45; 95%CI: 0.20-1.00, P = 0.049) and longer disease-free interval (HR = 0.45; 95%CI: 0.20-0.98, P = 0.044) were associated with improved survival.

CONCLUSION

ACT does not improve survival after PM resection for CRC. Further well-designed randomized controlled trials are needed to determine the optimal ACT regimen and duration.

Effect of perioperative chemotherapy on resection of isolated pulmonary metastases from colorectal cancer: A single center experience

BACKGROUND

Numerous studies have assessed surgical resection as a standard treatment option for patients with colorectal cancer (CRC) and resectable pulmonary metastases (PM). However, the role of perioperative chemotherapy after complete resection of isolated PM from patients with CRC patients remains controversial. We hypothesize that perioperative chemotherapy does not provide significant survival benefits for patients undergoing resection of PM from CRC.

AIM

To determine whether perioperative chemotherapy affects survival after radical resection of isolated PM from CRC.

METHODS

We retrospectively collected demographic, clinical, and pathologic data on patients who underwent radical surgery for isolated PM from CRC. Cancer-specific survival (CSS) and disease-free survival were calculated using Kaplan-Meier analysis. Inter-group differences were compared using the log-rank test. For multivariate analysis, Cox regression was utilized when indicated.

RESULTS

This study included 120 patients with a median age of 61.6 years. The 5-year CSS rate was 78.2%, with 36.7% experiencing recurrence. Surgical resection for isolated PM resulted in a 5-year CSS rate of 50.0% for second metastases. Perioperative chemotherapy (P = 0.079) did not enhance survival post-resection. Factors associated with improved survival included fewer metastatic lesions [hazard ratio (HR): 2.51, P = 0.045], longer disease-free intervals (HR: 0.35, P = 0.016), and wedge lung resections (HR: 0.42, P = 0.035). Multiple PM predicted higher recurrence risk (HR: 2.22, P = 0.022). The log-rank test showed no significant difference in CSS between single and repeated metastasectomy (P = 0.92).

CONCLUSION

Perioperative chemotherapy shows no survival benefit post-PM resection in CRC. Disease-free intervals and fewer metastatic lesions predict better survival. Repeated metastasectomy is warranted for eligible patients.

Peri-operative chemotherapy for resectable colorectal lung metastasis: a systematic review and meta-analysis

Purpose

Several studies have evaluated surgical resection of pulmonary metastases as a standard treatment option for colorectal cancer (CRC) patients with resectable pulmonary metastases. However, the role of peri-operative chemotherapy after complete resection of pulmonary metastases from CRC patients is still controversial. This systematic review and meta-analysis is aimed to investigate the clinical efficacy of peri-operative chemotherapy after resection of CRC pulmonary metastases.

Methods

PubMed, the Cochrane Library databases, and Embase were searched for studies evaluating the effect of peri-operative chemotherapy on the survival of patients with CRC after pulmonary metastasectomy. The hazard ratio (HR) was used for analyzing overall survival (OS) and progression-free survival (PFS)/recurrence-free survival (RFS)/disease-free survival (DFS).

Results

Eight studies were included in the final analysis. The outcome showed that peri-operative chemotherapy had a significant favourable effect on OS (HR 0.83, 95% CI 0.75–0.92, p < 0.05) and PFS/RFS/DFS (HR 0.67, 95% CI 0.53–0.86, p < 0.05) in patients who received pulmonary metastasectomy. Multivariate analysis also validated this result (OS: HR 0.56, 95% CI 0.36–0.86, p < 0.05; PFS/RFS/DFS: HR 0.64, 95% CI 0.46–0.87, p < 0.05). There was a significant benefit in peri-operative group on OS and PFS/RFS/DFS in studies with R0 resection of pulmonary metastases (OS: HR 0.72, 95% CI 0.53–0.97, p < 0.05; PFS/RFS/DFS: HR 0.72, 95% CI 0.54–0.95, p < 0.05) and metachronous pulmonary metastases (OS: HR 0.40, 95% CI 0.22–0.75, p < 0.05; PFS/RFS/DFS: HR 0.67, 95% CI 0.49–0.92, p < 0.05).

Conclusion

Our meta-analysis demonstrated a significant difference in favor of peri-operative chemotherapy in CRC patients who underwent resection of pulmonary metastases. More clinical data and studies are needed to validate the findings of our study.

Electronic supplementary material

The online version of this article (10.1007/s00432-020-03142-9) contains supplementary material, which is available to authorized users.

Does adjuvant chemotherapy improve the prognosis of patients after resection of pulmonary metastasis from colorectal cancer? A systematic review and meta-analysis

BACKGROUND

It remains controversial whether patients benefit from adjuvant chemotherapy (ACT) after resection of pulmonary metastasis (PM) from colorectal cancer (CRC). This meta-analysis was intended to evaluate the efficacy of ACT in patients after resection of PM from CRC.

METHODS

We systematically retrieved articles from PMC, PubMed, Cochrane Library, and Embase (up to March 5, 2019). Survival data, including overall survival (OS) and disease-free survival (DFS), were tested by hazard ratios (HRs) and 95% confidence intervals (CIs).

RESULTS

We included 18 cohort studies with a total of 3885 patients. The meta-analysis showed that ACT had no significant effect on OS (HR = 0.78; 95% CI = 0.60-1.03; P = 0.077) and DFS (HR = 0.91; 95% CI = 0.74-1.11; P = 0.339) in patients after resection of PM from CRC. There was no significant difference in OS (HR = 0.79; 95% CI = 0.42-1.50; P = 0.474) in patients after resection of PM from CRC treated with bevacizumab (BV). Subgroup analysis showed that ACT did not improve OS (HR = 0.86; 95% CI = 0.57-1.29; P = 0.461) in patients who had undergone previous resection of extra PM. ACT did not improve OS in patients who had positive hilar/mediastinal lymph node metastasis (HR = 0.80; 95% CI = 0.57-1.14; P = 0.22).

CONCLUSION

In conclusion, ACT does not provide survival benefits for patients after resection of PM from CRC. ACT and targeted agents (BV) are not suggested for these patients.

Adjuvant chemotherapy improves prognosis of resectable stage IV colorectal cancer: a comparative study using inverse probability of treatment weighting

BACKGROUND

Adjuvant chemotherapy (AC) is known to be beneficial for stage III colorectal cancer (CRC). In contrast, only a few studies have reported the survival benefits of AC for stage IV CRC after curative surgery.

METHODS

We identified 155 CRC patients with various organ metastases who underwent curative surgery in our hospital between 2003 and 2017. Clinicopathological parameters and postoperative AC were reviewed. Multivariate analyses were performed to identify prognostic factors. Moreover, the effects of AC on recurrence-free survival (RFS) and overall survival (OS) were analyzed using inverse probability of treatment weighting.

RESULTS

The cohort comprised 94 males and 61 females, with a mean age of 63 years. AC was administered to 57% of patients who underwent surgery between 2003 and 2010 and 76% between 2011 and 2017 (p = 0.015). AC was more likely administered to patients with a good performance status, high preoperative albumin level, regional node and peritoneal metastases, and no intraoperative blood transfusion. Multivariate analyses identified AC as a significant prognostic factors for RFS and OS [hazard ratio (HR): 1.86, p = 0.003, and 2.66, p = 0.002, respectively]. After adjusting for different backgrounds, 5-year RFS and OS rates were higher in patients receiving AC (27% and 67%) than in those without AC (14% and 46%, p < 0.0001 and p = 0.0005). Subgroup analyses showed that AC significantly improved RFS in node-negative patients (HR: 2.16, p = 0.029), and RFS and OS in node-positive patients (HR: 2.03, p < 0.0001, and 2.02, p = 0.001, respectively).

CONCLUSION

AC can be discussed with resectable stage IV CRC patients because of its significant survival-improving effects.