Is Adjuvant Chemotherapy Worthwhile After Radical Resection for Single Lung Metastasis From Colorectal Cancer? A Multicentric Analysis Evaluating the Risk of Recurrence

Abstract

Background: Adjuvant chemotherapy after resection of colorectal cancer (CRC) lung metastases may reduce recurrences and improve survival. The choice of best candidates for adjuvant chemotherapy in this setting is controversial, especially when a single lung metastases (SLM) is resected. The aim of this study is to evaluate the risk of recurrence after radical resection for single lung metastasis from CRC. Patients and methods: Demographic, clinical, and pathological data were retrospectively collected for patients radically operated on for single pulmonary metastasis from CRC in 4 centers. Survival was computed by Kaplan-Meyer methods. Chi-square, log-rank test, and for multivariate analysis, Cox-regression and binary logistic regression were used when indicated. Results: The sample consisted of 344 patients, mean age 65 yrs. Overall 5 yrs survival was 61.9%. Recurrence occurred in 113 pts (32.8%). At univariate analysis, age > 70 ( p = 0.046) and tumor size > 2 cm ( p = 0.038) were predictive of the worst survival chance, while synchronous lung metastasis ( p = 0.039), previous resection of extrathoracic metastasis ( p = 0.017), uptake at FDG-PET scan ( p = 0.006) and short (<12 months) disease-free interval (DFI) prior to lung metastasectomy ( p = 0.048) were risk factors for recurrence. At multivariate analysis, only high CEA (>4 ng/mL) was associated with worst survival (HR: 4.3, p = 0.014), while prior abdominal surgery (HR: 3, p = 0.033), PET positivity (HR: 2.7, p = 0.041), and DFI > 12 months (HR: 0.14, p < 0.001) confirmed to predict recurrence of disease. Conclusions: Surgical resection of solitary lung metastases from CRC is associated with prolonged survival. High value of CEA, PET positivity, previous extrathoracic resected metastasis, and short (<12 months) DFI were found to be predictive of death or disease recurrence and might identify in this scenario patients at higher risk which could potential benefit of chemotherapy.

Anatomical Resection Improves Disease-Free Survival After Lung Metastasectomy of Colorectal Cancer

“…Second, the DFI was a prognostic factor in some previous studies. 5 , 26 In this study, we calculated the DFIs using three kinds of method to explore the influence of calculation method. As a result, none of the DFIs was identified as prognostic factor in multivariable analysis.…”

Role of surgical resection and its alternative local therapy for pulmonary metastasis of colorectal cancer

“…Regarding DFI, Yokoyama et al 37 identified short DFI (<24 mo) and N2 of the primary lesion as risk factors for recurrence after pulmonary resection, but not for survival. Other reports have similarly identified DFI as a risk of recurrence; however, a cutoff for DFI was reported as 36 mo by Davini et al, 31 while it was determined to be 12 mo by Rapicetta et al 32 It is a convincing theory that DFI is a predictor of prognosis, as shorter DFI are expected to be biologically more malignant. However, the cutoff period has not yet been established because there is a great deal of variability in the optimal period.…”

“…Table 1 shows the major recent reports investigating the long‐term survival of patients who underwent pulmonary resection and those who did not. 28 , 30 , 31 , 32 , 33 Although the 5‐y overall survival rate of pulmonary resection tends to be better in retrospective studies, the survival rate of nonsurgery is also worthy of comparison.…”

Lung metastases from colorectal cancer: a multidisciplinary approach and role of local treatment: a narrative review

“…Patients who were most likely to benefit most from systemic chemotherapy were those with high value of preoperative CEA, hypermetabolism on the PET CT scan, previous extra-thoracic resected metastasis, and short (<12 months) DFI, all of which were features associated with increased risks of disease recurrence (68).…”