Long-term survival after surgery for pulmonary metastases from colorectal cancer: an observational cohort study

Abstract

Background: Evidence for pulmonary metastasectomy following colorectal cancer (CRC) is scarce. The aim of the study was to investigate long-term survival and identify prognostic factors to aid patient selection. Methods: We included all patients who underwent pulmonary resections for CRC metastases between January 01, 2004 and December 31, 2015 in a population-based cohort study. The primary outcome measure was all-cause mortality and was ascertained from Swedish national registers. The Kaplan-Meier estimator was used to calculate cumulative survival. We used Cox regression for estimation of hazard ratios (HR) and 95% confidence intervals (CI) for the association between patient characteristics and survival. During a median follow-up time of 3.2 years, 36% (66/184) patients died. Overall survival at 5 years was 60% (95% CI: 50-68%) and was significantly lower compared to an age-and gender-matched Swedish population. Carcinoembryonic antigen (CEA) level was identified as a prognostic factor for mortality in the age and sex-adjusted analysis (HR, 2.46; 95% CI: 1.15-5.26, P=0.020). Conclusions: We found a steady increase in the number of pulmonary metastasectomies after CRC during the study period. We identified prethoracotomy CEA level as a prognostic factor for long-term survival, which was consistent with prior reports. The 5-year overall survival rate in our study was 60%, which was high in comparison with prior reports. Although our results indicated that current patient selection criteria were reasonable, definitive evidence of efficacy is pending.

Local treatment combined with chemotherapy improves survival of patients with pulmonary metastases of colorectal cancer—a real-world retrospective study

“…Although the clinical factors analyzed in each study were different, the roles of some predictors had been confirmed in many studies [9][10][11][12], including: the distribution and size of lung metastases, the status of pulmonary lymph nodes, the CEA level of lung lesions before surgery, and the existence of liver metastases, etc. [10,11,[13][14][15][16][17]. Tomohiko et al retrospectively investigated 1030 patients who underwent resection of colorectal cancer with lung metastasis, they found that more than one lung metastases, maximum tumor diameter of 2 cm or more suggested that patients with CRC-PM a poor prognosis [18].…”

Colorectal cancer metastases to the lungs: outcomes of surgical treatment and prognostic factors

“…Al-Ameri и соавт. не сообщают о показателях ВБП [9]. В работах G. Meimarakis и соавт., M. G. Zampino и соавт., S. Renaud и соавт.…”

“…Показатели 5-летней выживаемости без лечения у пациентов данной группы весьма низки (не более 5 %) [7,8]. Только хирургическое лечение с полным удалением всех проявлений заболевания дает значимый шанс на долгосрочную выживаемость: 5-летняя общая выживаемость (ОВ) пациентов после удаления метастазов в легких может достигать 56 %, 5-летняя безрецидивная выживаемость -67,2 % [9][10][11][12]. В клиническую практику внедряются новые технологии, так, появилась возможность локального воздействия на метастатические очаги стереотаксической лучевой терапией, также начал шире применяться торакоскопический доступ для хирургического удаления солитарных метастазов.…”

Surgery for pulmonary metastases from colorectal cancer: survival and prognostic factors

“…In the case of metastatic disease in the liver, improved survival has been attributed to hepatic metastasectomy and improved chemotherapy (26). These optimistic results in patients with hepatic metastases have likely contributed toward more aggressive surgical treatment of pulmonary metastases, leading to growing numbers of pulmonary metastasectomy procedures (7,27). It has been speculated that some of the survival benefit might be attributable to other factors including selection bias, lead-time bias and staging migration (2).…”

“…Randomized controlled trials has yet to publish results to help inform and guide clinical practice, and high-quality evidence supporting surgery is lacking (2), but retrospective studies could help to identify prognostic factors that can aid in the selection of patients likely to benefit from surgery. Prognostic factors suggested by prior studies include staging of primary tumor, number and laterality of metastases, disease-free interval (DFI), thoracic lymph node status, previous metastatic disease in the liver, carbohydrate antigen 19-9, prethoracotomy carcinoembryonic antigen (CEA), K-RAS gene status and location of the primary tumor (3)(4)(5)(6)(7)(8)(9). However,…”