Prognostic Factors for Survival after Resection of Pulmonary Metastases from Colorectal Carcinoma

Abstract

IntroductionRecent advances in systemic chemotherapy have prolonged the survival in patients with metastatic colorectal carcinoma. [1][2][3] The combination of oxaliplatin, fluoropyrimidine and CPT-11, along with other newly developed molecular targeting agents like bevacizumab, cetuximab/ panitumumab and regorafenib has led to the median overall survival reaching approximately 2.5 years. [4][5][6][7][8][9][10][11][12] Nearly half of the patients with colorectal carcinoma experience distant metastases, mainly in the liver and lungs. 13) From the pathological view with regard to the cascade hypothesis, these two metastatic sites develop in discrete steps, which supports the idea that these hematogenous metastases are limited diseases. 14) Several retrospective studies have shown that patients with isolated pulmonary metastases from colorectal carcinoma benefit from resection. The published five-year survival rates after pulmonary Purpose: As chemotherapy has improved, the survival of patients with metastatic colorectal carcinoma has reached up to 2.5 years. Many of these patients experience pulmonary metastases; however, the prognosis after pulmonary metastasectomy is not satisfying. In this study, we analyzed the prognostic factors for survival in patients who underwent pulmonary metastasectomy. Methods: Eighty-seven patients with colorectal carcinoma received pulmonary metastasectomy. The pathological status of the primary tumor, outcome of the pulmonary metastasectomy, disease-free interval, perioperative carcinoembryonic antigen (CEA) level and history of liver metastases were assessed. Results: The five-year survival was 42.5% after pulmonary metastasectomy. A univariate analyses revealed that the CEA level (p = 0.043) and the number of pulmonary metastases (p = 0.047) were prognostic factors for survival. The CEA level was an independent prognostic factor in a multivariate analysis (relative risk = 2.01, p = 0.037). Among cases with elevated preoperative CEA levels, those whose CEA level normalized after metastasectomy had a better prognosis compared with those whose CEA level decreased but was still high, or whose level increased after metastasectomy (median survival time of 41.8 months compared with 28.1 or 15.7 months, respectively p = 0.021). Conclusion: The CEA level can be a predictive marker for the prognosis in patients with pulmonary metastases from colorectal carcinoma.

The Validity of a New Edition of Classification for Ovarian Metastasis from Colorectal Cancer

“…The most notable point of this study is that the five-year OS rate and RFS rate of the patients in Group Ov were not significantly different from those of the patients in Group Meta who received R0 resection in our institution. The published five-year survival rates after pulmonary metastasectomy range from 30.5% to 61.4% [20,21]. Regarding hepatic metastases, the five-year survival is reportedly 60% after hepatic metastasectomy [22].…”

Clinical significance of RBM3 expression in surgically treated colorectal lung metastases and paired primary tumors

“…PM is a part of the curative treatment of metastatic colorectal cancer (mCRC). Several prognostic factors for survival after PM have been proposed, such as the stage of the primary tumor, length of the disease‐free interval (DFI) after surgery of the primary tumor, the distribution and number of metastases, involvement of thoracic lymph nodes, and preoperative carcinoembryonic antigen (CEA) value 5–10 . Only one randomized study comparing PM versus continued active monitoring has been published, although it was discontinued due to poor recruitment rate, thus making the results inconclusive 11 .…”

Differential Diagnostic Value of SATB2 in Primary Pulmonary Enteric Adenocarcinoma and Pulmonary Metastases of Colorectal Carcinoma

“…These immunomarkers have limited value in the differential diagnosis of PEA and MCRC. These have caused di culties in diagnosis, but the treatment strategies and prognosis outcomes differ considerably for patients with the two malignancies [20]. Therefore, there is an urgent need to develop new markers to differentiate PEA and MCRC.…”

“…SATB2 is a nuclear matrix-associated transcription factor and a reliable marker of intestinal differentiation [11]. It serves as an important immunomarker to distinguish primary CRC from metastatic tumors [20]. SATB2 is expressed in 86%-93% of primary CRC and 81%-94% of MCRC [11], and the frequency of SATB2 expression in reported conventional lung adenocarcinoma is about 10% [7].…”