Efficacy of adjuvant chemotherapy after complete resection of pulmonary metastasis from colorectal cancer

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.

Mapping the metabolic responses to oxaliplatin-based chemotherapy with in vivo spatiotemporal metabolomics

Adjuvant chemotherapy improves the survival outlook for patients undergoing operations for lung metastases caused by colorectal cancer (CRC). However, a multidisciplinary approach that evaluates several factors related to patient and tumor characteristics is necessary for managing chemotherapy treatment in metastatic CRC patients with lung disease, as such factors dictate the timing and drug regimen, which may affect treatment response and prognosis. In this study, we explore the potential of spatial metabolomics for evaluating metabolic phenotypes and therapy outcomes during the local delivery of the anticancer drug, oxaliplatin, to the lung. 12 male Yorkshire pigs underwent a 3 h left lung in vivo lung perfusion (IVLP) with various doses of oxaliplatin (7.5, 10, 20, 40, and 80 mg/L), which were administered to the perfusion circuit reservoir as a bolus. Biocompatible solid-phase microextraction (SPME) microprobes were combined with global metabolite profiling to obtain spatiotemporal information about the activity of the drug, determine toxic doses that exceed therapeutic efficacy, and conduct a mechanistic exploration of associated lung injury. Mild and subclinical lung injury was observed at 40 mg/L of oxaliplatin, and significant compromise of the hemodynamic lung function was found at 80 mg/L. This result was associated with massive alterations in metabolic patterns of lung tissue and perfusate, resulting in a total of 139 discriminant compounds. Uncontrolled inflammatory response, abnormalities in energy metabolism, and mitochondrial dysfunction next to accelerated kynurenine and aldosterone production were recognized as distinct features of dysregulated metabolipidome. Spatial pharmacometabolomics may be a promising tool for identifying pathological responses to chemotherapy.

Radiomics in Lung Metastases: A Systematic Review

Due to the rich vascularization and lymphatic drainage of the pulmonary tissue, lung metastases (LM) are not uncommon in patients with cancer. Radiomics is an active research field aimed at the extraction of quantitative data from diagnostic images, which can serve as useful imaging biomarkers for a more effective, personalized patient care. Our purpose is to illustrate the current applications, strengths and weaknesses of radiomics for lesion characterization, treatment planning and prognostic assessment in patients with LM, based on a systematic review of the literature.