Outcomes and Prognostic Factors of Patients with Metastatic Colorectal Cancer Who Underwent Pulmonary Metastasectomy with Curative Intent: A Brazilian Experience

Gössling, Gustavo; Chedid, Marcio; Pereira, Fernando; Silva, Rafaela K. da; Andrade, Leonardo Bandeira de; Peruzzo, Nicolas da Costa; Saueressig, Mauricio Guidi; Schwartsmann, Gilberto; Parikh, Aparna R.

doi:10.1002/onco.13802

Cited by 11 publications

(10 citation statements)

References 44 publications

(49 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our study found a five-year OS of 33.2%, which is within the range of OS in such cases described in the literature (27%-68%) (5). Nevertheless, it is far from the 49.8% found by Gössling in Brazil (8) and even further from the 68.1% described by Okumura in Japan (9). Our OS was similar to that reported in the PulMiCC trial (NCT01106261), the only randomized controlled trial to date comparing pulmonary metastasectomy with systemic therapy, which reported a 38% five-year survival for metastasectomy and was stopped due to poor recruitment (10).…”

Section: Discussionsupporting

confidence: 72%

“…In our series, the five-year DFS was slightly below this range (21.6%) probably due to the factors described above. Nevertheless, it should be noted that the median DFS was 24.6 which was higher than the median DFS of 14 months (95% CI, 10.4-17.5) described by Gössling et al (8), in their study that included 58 patients who underwent pulmonary metastasectomy from CRC in Brazil.…”

Section: Discussioncontrasting

confidence: 58%

“…Gössling et al ( 8 ) reported that variables that showed significance with long-term relapse-free survival and OS were longer DFI, large lesion size, number of lesions, metachronous presentation, and CK20 expression in metastases. But it must be noted that laterality and adjuvant or perioperative chemotherapy did not have a statistical impact in their sample.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Lung Metastasectomy from Colorectal Cancer, 10-year Experience in a South American Cancer Center

et al. 2022

View full text Add to dashboard Cite

PurposeThis study aimed to describe the survival outcomes and factors associated with prognosis in patients undergoing pulmonary metastasectomy with colorectal cancer (CRC) in a cancer center in South America.Material and methodsA retrospective analysis of patients that underwent lung metastasectomy due to CRC at National Cancer Institute (INC), Colombia between 2007 and 2017 was performed and Kaplan-Meier survival analysis along with log-rank test and Cox regression multivariate analysis were completed.ResultsSeventy-five patients with colorectal adenocarcinoma were included in the study. Of them, 57.3% were women with a median age of 62 years [interquartile ranges (IQR): 18.5]. For 45.3% the adenocarcinoma was located in the rectum and 29.3% had stage IV at diagnosis. 56% had a history of controlled extrapulmonary metastasis and 20% of the cases had a history of the metastasis of the liver. The median follow-up was 36.8 months (IQR: 27.4). Three-year and five-year overall survival (OS) was 57.5% [95% confidence interval (CI), 47.0–70.4] and 33.2% (95% CI, 23.4–47.2), respectively. Patients with bilateral, more than one pulmonary metastasis, abnormal postmetastasectomy carcinoembryonic antigen (CEA), history of liver metastasis, and disease-free interval (DFI) ≤12 months had worse OS. Three-year and five-year disease-free survival (DFS) was 30.1% (95% CI, 20.8–43.6) and 21.6% (95% CI, 13.0–35.9), respectively. Bilateral, more than one pulmonary metastasis, and patients with stage IV at diagnosis had the worst DFS. Multivariate analysis in the Cox regression model showed that abnormal postmetastasectomy CEA [Hazard Ratio (HR):1.97, 95% CI, 1.01–3.86, p = 0.045] and DFI ≤ 12 months (HR: 3.08, 95% CI, 1.26–7.53, p = 0.014) were independent factors for worst OS.ConclusionsThe OS found falls within the wide range described in the world literature but interestingly it falls at the bottom end of this range. The factors associated with worst survival were identified as bilateral, more than one pulmonary metastasis, abnormal postmetastasectomy CEA, history of liver metastasis, and DFI ≤12 months.Contribution to the fieldPulmonary metastasectomy is the standard of care in patients with metastatic CRC. However, the literature supporting this conduct is based on retrospective studies and the only randomized controlled trial conducted to date was stopped due to poor recruitment. Limited information is available in South America about survival and factors associated with prognosis in patients with metastatic CRC. While this study is another series that adds to the many studies across the world that describe the use of pulmonary metastasectomy in CRC, it presents critical data as it is one of the few studies carried out in South America. As described in a wide range of world literature, OS found falls in patients that underwent lung metastasectomy due to CRC however; interestingly, in the South American population analyzed here it falls at the bottom end of this range. This may be explained by a large number of patients included with a history of extrapulmonary metastasis as well as may reflect inadequate patient access to reference cancer centers in Colombia. Factors associated with worst survival in our population were bilateral, more than one pulmonary metastasis, abnormal postmetastasectomy CEA, history of liver metastasis, and interval from diagnosis to development of pulmonary metastasis ≤12 months.

show abstract

Section: Discussionsupporting

confidence: 72%

Section: Discussioncontrasting

confidence: 58%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Lung Metastasectomy from Colorectal Cancer, 10-year Experience in a South American Cancer Center

et al. 2022

View full text Add to dashboard Cite

show abstract

“…At present, simultaneous surgical resection has become an optional treatment option for CRC patients with LM or PM. The lack of cytokeratin 20 expression in metastases is associated with poor overall survival for CRC PM patients ( 30 ). Isolated unilateral lung metastasis with normal CEA levels and no lymph node involvement is a positive prognostic factor for patients ( 31 , 32 ).…”

Section: Discussionmentioning

confidence: 99%

Prognostic Factors in Stage IV Colorectal Cancer Patients With Resection of Liver and/or Pulmonary Metastases: A Population-Based Cohort Study

et al. 2022

View full text Add to dashboard Cite

ImportanceCurrently, surgical resection of distant metastatic lesions has become the preferred treatment for select colorectal cancer (CRC) patients with liver metastasis (LM) and/or pulmonary metastasis (PM). Metastasectomy is the most common curative method. However, evidence of the factors affecting the prognosis of CRC patients after resection of LM and/or PM is still insufficient.ObjectiveTo explore the prognostic factors of CRC patients with LM and/or PM who have undergone resection of metastatic tumors and to provide reliable selection factors for surgical treatment in patients affected by LM and/or PM from CRC.MethodsThe SEER database was used to identify eligible CRC LM and/or PM patients who underwent resection of the primary tumor and distant metastases from January 1, 2010, to December 31, 2018. The Kaplan–Meier method was used to calculate survival, and comparisons were performed using the log-rank test for univariate analysis. A Cox proportional hazards regression model was used to identify prognostic factors for the multivariate analysis. The outcomes included overall survival (OS) and cancer-specific survival (CSS).ResultsA total of 3,003 eligible colorectal cancer patients with LM and/or PM were included in this study. The 3-year and 5-year OS rates were 53% and 33.6%, respectively, and the 3-year and 5-year CSS rates were 54.2% and 35.3%, respectively. In the adjusted multivariate analysis, age < 65 years (OS: p=0.002, CSS: p=0.002) was associated with better long-term outcomes, and primary tumors located on the left side of the colon (OS: p=0.004, CSS: p=0.006) or rectum (OS: p=0.004, CSS: p=0.006), T3 stage (OS: p<0.001, CSS: p<0.001), number of regional lymph nodes examined ≥ 12 (OS: p<0.001, CSS: p=0.001), and CRC LM (OS: p<0.001, CSS: p<0.001) were positive prognostic factors for survival after resection of metastatic tumors.ConclusionAge < 65 years is associated with better long-term outcomes in colorectal cancer patients with LM and/or PM, analogously to the left sided primary tumor, T3 stage, number of regional lymph nodes examined ≥ 12 and liver metastases.

show abstract

“…This also applies to the metastases of other primary tumours. These risk factors are equally effective in colorectal cancer metastasis surgery (liver metastases [283][284][285][286][287][288][289]; pulmonary metastases [290][291][292][293]). Thus, after clinical R0 resection of organ metastases, a large number of studies show that both the overall tumour burden (singular/multiple metastases, size or number of metastases) and growth rate dependent factors (synchronous/metachronous metastases, interval to onset) influence the outcome.…”

Section: Ispmrcc and Risk Factorsmentioning

confidence: 99%

Isolated Pancreatic Metastases of Renal Cell Carcinoma—Clinical Particularities and Seed and Soil Hypothesis

Sellner

Thalhammer

Klimpfinger

2023

Cancers

View full text Add to dashboard Cite

A meta-analysis of 1470 isolated pancreatic metastases of renal cell carcinoma revealed, that, in addition to the unusual exclusive occurrence of pancreatic metastases and the favourable treatment results, the isPMRCC is characterised by further peculiarities of the clinical course: The lack of prognostic significance of volume and growth rate dependent risk factors and the independence of treatment results from standard or local resections. As an explanation for all these peculiarities, according to today’s knowledge, a strong acting seed and soil mechanism can serve, which allows embolized tumour cells to grow to metastases only in the pancreas, and prevents them definitively or for years in all other organs. The good prognosis affects not only isolated PM, but also multi-organ metastases of the RCC, in which the additional occurrence of PM is also associated with a better prognosis. Genetic studies revealed specific changes in cases of PM of RCC: Lack of loss of 9p21.3 and 14q31.2, which are otherwise specific gene mutations at the onset of generalization, a low weight genome instability index, i.e., high genetic stability, and a low rate of PAB1 and a high rate of BPRM1 alterations, which signal a more favourable course. The cause of pancreatic organotropism in isPMRCC is still unclear, so only those factors that have been identified as promoting organotropism in other, more frequent tumour entities can be presented: Formation of the pre-metastatic niche, chemokine receptor–ligand mechanism, ability to metabolic adaptation, and immune surveillance.

show abstract

Outcomes and Prognostic Factors of Patients with Metastatic Colorectal Cancer Who Underwent Pulmonary Metastasectomy with Curative Intent: A Brazilian Experience

Cited by 11 publications

References 44 publications

Lung Metastasectomy from Colorectal Cancer, 10-year Experience in a South American Cancer Center

Lung Metastasectomy from Colorectal Cancer, 10-year Experience in a South American Cancer Center

Prognostic Factors in Stage IV Colorectal Cancer Patients With Resection of Liver and/or Pulmonary Metastases: A Population-Based Cohort Study

Isolated Pancreatic Metastases of Renal Cell Carcinoma—Clinical Particularities and Seed and Soil Hypothesis

Contact Info

Product

Resources

About