The prognostic importance of the number of metastases in pulmonary metastasectomy of colorectal cancer

Abstract

BackgroundThe presence of multiple metastatic pulmonary nodules is a predictor of poor survival after pulmonary metastasectomy. However, there is a paucity of data addressing the exact number of pulmonary metastases over which prognosis becomes grave. The aim of our study is to investigate the prognosis of pulmonary metastasectomy from colorectal cancer (CRC) depending on the number of pulmonary metastases.MethodsPatients who had undergone pulmonary metastasectomy for CRC between November 1994 and December 2013 were included. Survival and recurrence patterns were analyzed with regard to the number of pulmonary metastases. Patients were divided into three groups depending on the number of pulmonary metastases that were detected by the final pathologic report: group I—single metastasis; group II—2–3 metastases; and group III—4+ metastases.ResultsA total of 615 patients who had undergone pulmonary metastasectomy from colorectal cancer were included. The median follow-up period was 31 months (range 2–211 months). The median disease-free interval (DFI) from the time of the primary operation for colorectal cancer was 20 months (range 0–209 months). There were 414 patients in group I (single metastasis), 159 in group II (2–3 metastases), and 42 in group III (4+ metastases). The overall 5-year survival rate was 64.2 %. The 5-year survival rates in groups I, II, and III were 70.0, 56.2, and 33.7 %, respectively (group I vs. II, p < 0.001; group II vs. III, p = 0.012). The 5-year recurrence-free rates were 39.5, 30.6, and 8.5 % in groups I, II, and III, respectively (group I vs. II, p < 0.001; group II vs. III, p = 0.056). Multivariable analysis revealed that age, multiple pulmonary nodules, thoracic lymph node metastasis, and adjuvant chemotherapy are independent predictors of survival.ConclusionsThe overall survival and recurrence after pulmonary metastasectomy for CRC is dependent on the number of metastases. Surgical treatment can be offered to patients with three or fewer pulmonary metastases. However, more meticulous patient selection is required to decide whether a surgical approach is feasible in patients with four or more pulmonary metastases.

Surgery for Colorectal Cancer - Trends, Developments, and Future Perspectives

“…Equally, patients with pulmonary metastasis may benefit from surgical resection [55,56,57]. However, patient selection plays a crucial role with regard to prognosis.…”

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

“…In the reports by Gonzalez and Embun, a short DFI was prognostic of decreased survival-rate (10,11). However, in several other studies, DFI did not reach statistical significance (8,9,22). It seems reasonable to speculate that a short DFI would reflect a more aggressive disease or a more advanced primary tumor, which in turn would be detrimental to survival.…”

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].…”

“…However, heterogeneity of tumor sizes in multiple CRC-PM was an independent factor of the prognosis of the patients [19]. The association of survival and other factors, like age, gender, ASA score, primary tumor staging, tumor-free interval was controversial in different studies [14,[20][21][22][23].…”