Reported Outcome Factors for Pulmonary Resection in Metastatic Colorectal Cancer

Pfannschmidt, Joachim; Hoffmann, Hans; Dienemann, H.

doi:10.1097/jto.0b013e3181dca330

Cited by 126 publications

(91 citation statements)

References 37 publications

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“…Previous studies including our series show the prognostic significance of hilar and/or mediastinal lymph node involvement (4,7,(9)(10)(11). Even if the role of mediastinal systematic nodal dissection remains unclear (12), our results and the bulk of previous literature supported the lymph node sampling practice.…”

Section: Discussionsupporting

confidence: 79%

“…Nonetheless, there is no definite agreement on the value of its prognostic role: the majority of authors failed to confirm a correlation between primary tumor stage and survival (4,17).…”

Section: Discussionmentioning

confidence: 99%

“…Patients affected by metastatic CRC experienced a poor prognosis. Whenever feasible, surgery was considered an effective therapeutic option, with reported 5-year overall survival (OS) rates after radical resection ranging from 41% to 68% (3,4).…”

Section: Introductionmentioning

confidence: 99%

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Surgery of colorectal cancer lung metastases: analysis of survival, recurrence and re-surgery

Guerrera¹,

Mossetti²,

Ceccarelli³

et al. 2016

J. Thorac. Dis.

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Background: Surgery is considered an effective therapeutic option for patients with lung metastasis (MTS) of colorectal cancer (CRC). The purpose of the study was to evaluate efficacy and feasibility of lung metastasectomy in CRC patients and to explore factors of prognostic relevance. Methods: This is a retrospective study of patients operated for lung MTS of CRC from 2004 to 2012 in a single Institution. Overall survival (OS) was the primary endpoint. Secondary endpoints were progression free survival (PFS) in resection status R0 and OS in in patients submitted to re-resections. In order to evaluate prognostic factors, a multivariable Cox proportional hazard model was performed.Results: One-hundred eighty-eight consecutive patients were included in the final analysis. The median follow-up (FU) was 45 months. The 5-year OS and PFS were 53% (95% CI: 44-60%) and 33% (95% CI: 25-42%), respectively. Two-and 5-year survival after re-resection were 79% (95% CI: 63-89%) and 49% (95% CI: 31-65%), respectively. Multivariate adjusted analysis showed that primary CRC pathological TNM stages (P=0.019), number of resected MTS ≥5 (P=0.009) and lymph nodal involvement (P<0.0001) are independent predictors of poor prognosis. Conclusions: Patients operated and re-operated for lung MTS from CRC cancers showed encouraging survival rates. Our results indicated that primary CRC stage, number of MTS and lymph nodal involvement are strong predictive factors. Prognosis after surgery remained comforting up to four resected MTS. Adjuvant chemotherapy seems to have a benefit on survival in patients affected by multiple metastases.Finally, according to the high rate of unidentified lymph node involvement in pre-operative setting, lymph node sampling should be advisable for a correct staging. randomized trial and the undefined role of metastasectomy remained the unsolved problem in the management of patients with pulmonary metastasis (MTS) of CRC (5).The purpose of the study was to evaluate the efficacy and the feasibility of lung metastasectomy in colorectal cancer (CRC) in our institution. Moreover, we aimed at exploring prognostic factors for survival and evaluating survival pattern in patients submitted to re-resections. MethodsWe included all consecutive patients who underwent lung metastectomy for pulmonary metastases from CRC at Department of Thoracic Surgery, University of Torino, Italy-from 2004 to 2012. Data were retrospective collected from the surgical registry of our Department. Follow-up (FU) data were acquired by routine visits, telephone contacts or from administrative data (outpatient regional registry). FU was completed over July 2014. Our Institutional Review Board approved the study. Inclusion criteria for lung metastasectomy comprised locally controlled primary CRC, no evidence of extra-thoracic lesions excluding hepatic metastases, single or multiple pulmonary nodules suitable for a radical resection. Stage of primary CRC was assigned according to the Union Internationale Contre le Cancer (UICC) staging system. Pre-op...

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Section: Discussionsupporting

confidence: 79%

“…Nonetheless, there is no definite agreement on the value of its prognostic role: the majority of authors failed to confirm a correlation between primary tumor stage and survival (4,17).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Surgery of colorectal cancer lung metastases: analysis of survival, recurrence and re-surgery

Guerrera¹,

Mossetti²,

Ceccarelli³

et al. 2016

J. Thorac. Dis.

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“…Even though they were well described, these criteria were questioned by some authors, as discussed in the review by Pfannschmidt et al [3]. For example, the number of lung metastases were reported to be a prognostic factor by two authors, although it was reported to have no influence in 12 other studies.…”

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confidence: 87%

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Tampellini¹,

Ardissone²,

Scagliotti³

2013

The Oncologist

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“…Impact of cyclooxygenase-2 and prostaglandin-E2 expression on clinical outcome after pulmonary metastasectomy carefully selected patients 5-year survival rates of 40-68% are reported (7). Commonly accepted inclusion criteria for pulmonary metastasectomy (PM) are: (I) controlled primary tumor; (II) complete resection of all metastatic lesions; (III) exclusion of disseminated, extrathoracic disease; and (IV) an adequate performance status (8).…”

Section: Original Articlementioning

confidence: 99%

Impact of cyclooxygenase-2 and prostaglandin-E2 expression on clinical outcome after pulmonary metastasectomy

et al. 2017

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Background: Pulmonary metastasectomy (PM) is a standard procedure in the treatment of stage IV colorectal cancer (CRC). In most centers the indication for PM is solely based on clinical factors without taking the tumor biology into account. This results in diverse outcomes ranging from long-term remission to early recurrence. Inflammation is considered a hallmark of cancer development and progression. On the other hand the accessibility of CRC cells to the immune system reflects the grade of tumor aggressiveness.We sought to investigate the impact of cyclooxygenase-2 (COX-2) and prostaglandin-E2 (PGE2) expression in pulmonary metastases on different outcome parameters following PM. Results: COX-2 and PGE2 were detected in nearly every pulmonary CRC metastasis. Staining intensities of pulmonary metastases correlated only weakly with intensities found in primary tumors. When dividing metastases in high expressing and low expressing tumors, a trend towards longer recurrence free survival and improved survival was found in tumors with strong COX-2 and PGE2 staining. Conclusions:In conclusion, this pilot study shows that COX-2 and PGE2 are uniformly overexpressed in pulmonary metastases from CRC. High expression of COX-2 and PGE2 seems to reflect a beneficial tumor biology with late tumor recurrence and prolonged overall survival after PM.

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Reported Outcome Factors for Pulmonary Resection in Metastatic Colorectal Cancer

Cited by 126 publications

References 37 publications

Surgery of colorectal cancer lung metastases: analysis of survival, recurrence and re-surgery

Surgery of colorectal cancer lung metastases: analysis of survival, recurrence and re-surgery

In Reply

Impact of cyclooxygenase-2 and prostaglandin-E2 expression on clinical outcome after pulmonary metastasectomy

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