Prognostic value of distant metastasis sites and surgery in stage IV colorectal cancer: a population-based study

Luo, Dakui; Liu, Qi; Yu, Wencheng; Ma, Yanlei; Zhu, Ji; Lian, Peng; Cai, Sanjun; Li, Qingguo; Li, Xinxiang

doi:10.1007/s00384-018-3091-x

Cited by 59 publications

(57 citation statements)

References 27 publications

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“…Patients with CRC-PM who were submitted to local treatments combined with chemotherapy or chemotherapy alone for pulmonary metastases were included in our study. Our data showed that the 3-year overall survival rate of 119 patients was 51.2%, and the 5-year overall survival rate was 39.7%, which was consistent with the previous literature [8]. Previous studies had mostly focused on the patients undergoing resection of the lung metastases and patients who did not receive lung metastasectomy were excluded.…”

Section: Discussionsupporting

confidence: 91%

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

Cai

Wang

Yang

et al. 2020

Preprint

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Background The effect of local treatments for pulmonary metastases from colorectal cancer (CRC-PM) remains controversial. This study aims to figure out whether local treatments combined with chemotherapy could improve patients’ survival by comparing the outcomes of CRC-PM patients who submitted to local interventions combined with chemotherapy or just chemotherapy.Patients and Methods From January 2009 to July 2019, a total of 119 patients with CRC-PM from two surgical centers were reviewed. Patients were divided into two groups according to treatments for the lung metastases: Local intervention combined with chemotherapy (Group-LI) and Chemotherapy alone (Group-Chem). Overall survival (OS) and progression-free survival (PFS) were assessed with the Kaplan-Meier method. Clinical characteristics associated with prognosis were analyzed by using a Cox proportional hazards regression model. Propensity score matching analyses were used to overcome the possible biases in some baseline characteristics.Result Multivariable analysis revealed that the level of carcinoembryonic antigen (CEA) and treatment for CRC-PM are independent predictors of both OS and PFS. The median OS in Group-LI (n = 39) and Group-Chem (n = 80) were 34.5 months and 13.8 months, respectively(P < 0.001). The 3-year progression-free survival rate in Group-LI and Group-Chem were 75.2% and 45.1% (P < 0.001). After propensity score matching, patients in Group-LI had better OS (HR = 3.304, P = 0.022) and PFS (HR = 4.029, P < 0.001) than Group-Chem.Conclusion. CRC-PM patients with lower lever of CEA or local treatment of lung metastases are more likely to be those with favorable prognosis. Selected CRC-PM patients could benefit from local treatment of pulmonary metastases.

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Section: Discussionsupporting

confidence: 91%

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

Cai

Wang

Yang

et al. 2020

Preprint

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“…However, in this Danish cohort study the benefit for lung metastasectomy was only found in univariate analyses and non-significant benefit was seen at their multivariate analysis for lung metastasectomy, hence selection bias (healthier patients with less metastatic disease, and better biology get operated) is inherent. Luo et colleagues [37] demonstrated in their SEER database analysis that the metastatic site of patients with mCRC has prognostic impact. Indeed, isolated liver metastases have a better prognosis compared to metastases at multiple sites.…”

Section: National Comprehensive Cancer Network (Nccn) Andmentioning

confidence: 99%

Population-based SEER analysis of survival in colorectal cancer patients with or without resection of lung and liver metastases

2020

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Background: Approximately one third of all patients with CRC present with, or subsequently develop, colorectal liver metastases (CRLM). The objective of this population-based analysis was to assess the impact of resection of liver only, lung only and liver and lung metastases on survival in patients with metastatic colorectal cancer (mCRC) and resected primary tumor. Methods: Ten thousand three hundred twenty-five patients diagnosed with mCRC between 2010 and 2015 with resected primary were identified in the Surveillance, Epidemiology and End Results (SEER) database. Overall, (OS) and cancer-specific survival (CSS) were analyzed by Cox regression with multivariable, inverse propensity weight, near far matching and propensity score adjustment. Results: The majority (79.4%) of patients had only liver metastases, 7.8% only lung metastases and 12.8% metastases of lung and liver. 3-year OS was 44.5 and 27.5% for patients with and without metastasectomy (HR = 0.62, 95% CI: 0.58-0.65, P < 0.001). Metastasectomy uniformly improved CSS in patients with liver metastases (HR = 0.72, 95% CI: 0.67-0.77, P < 0.001) but not in patients with lung metastases (HR = 0.84, 95% CI: 0.62-1.12, P = 0.232) and combined liver and lung metastases (HR = 0.89, 95% CI: 0.75-1.06, P = 0.196) in multivariable analysis. Adjustment by inverse propensity weight, near far matching and propensity score and analysis of OS yielded similar results. Conclusions: This is the first SEER analysis assessing the impact of metastasectomy in mCRC patients with removed primary tumor on survival. The analysis provides compelling evidence of a statistically significant and clinically relevant increase in OS and CSS for liver resection but not for metastasectomy of lung or both sites.

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“…46 In a recent review of 8361 patients from 21 studies, 5-year survival rates after the first PM were 24% to as high as 82%, and median survival ranged from 35 to 70 months. 14 49 This study demonstrated that a significant survival benefit was observed for patients who underwent resection of liver and lung metastases. In addition, in patients who underwent resection of both primary and metastatic lesions, those with isolated lung metastases showed better overall survival than isolated liver metastases.…”

Section: Surgical Outcomes and Prognostic Indicatorsmentioning

confidence: 81%

“…An analysis of 15 studies, all including at least 50 patients undergoing PM for CRC with curative intent and totaling 1669 patients, demonstrated a mean 5‐year overall survival of 49%, and a median 5‐year overall survival of 45% with a range of 25% to 72% . A recent analysis of the Surveillance, Epidemiology, and End results (SEER) database found that patients with isolated lung metastases from CRC had a median survival of 20 months, with significantly improved cancer‐specific and overall survival compared with other sites of metastasis . This study demonstrated that a significant survival benefit was observed for patients who underwent resection of liver and lung metastases.…”

Section: Surgical Outcomes and Prognostic Indicatorsmentioning

confidence: 99%

Surgical management of colorectal lung metastases

Phillips

Hasson

2019

Journal of Surgical Oncology

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Pulmonary metastasectomy for colorectal cancer is an established means of treatment for select patients. This article will highlight the recent evidence published in the literature related to current practices for the surgical management of colorectal lung metastases and propose a diagnostic algorithm for use in clinical practice. It will also discuss controversies related to pulmonary metastasectomy, including the optimal timing of surgery, the extent of lymph node sampling/dissection, and the extent of surgical resection.

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Prognostic value of distant metastasis sites and surgery in stage IV colorectal cancer: a population-based study

Abstract: The metastatic site was an independent prognostic factor in stage IV colorectal cancer. Also, carefully chosen patients may benefit from surgery.

Cited by 59 publications

References 27 publications

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

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

Population-based SEER analysis of survival in colorectal cancer patients with or without resection of lung and liver metastases

Surgical management of colorectal lung metastases

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