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Gao Z, Wu SK, Zhang SJ, Wang X, Wu YC, Jin X. Adjuvant chemotherapy for isolated resectable colorectal lung metastasis: A retrospective study using inverse probability treatment weighting propensity analysis. World J Gastrointest Surg 2024; 16:3171-3184. [PMID: 39575266 PMCID: PMC11577391 DOI: 10.4240/wjgs.v16.i10.3171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Revised: 08/17/2024] [Accepted: 08/29/2024] [Indexed: 09/27/2024] Open
Abstract
BACKGROUND The benefit of adjuvant chemotherapy (ACT) for patients with no evidence of disease after pulmonary metastasis resection (PM) from colorectal cancer (CRC) remains controversial. AIM To assess the efficacy of ACT in patients after PM resection for CRC. METHODS This study included 96 patients who underwent pulmonary metastasectomy for CRC at a single institution between April 2008 and July 2023. The primary endpoint was overall survival (OS); secondary endpoints included cancer-specific survival (CSS) and disease-free survival (DFS). An inverse probability of treatment-weighting (IPTW) analysis was conducted to address indication bias. Survival outcomes compared using Kaplan-Meier curves, log-rank test, Cox regression and confirmed by propensity score-matching (PSM). RESULTS With a median follow-up of 27.5 months (range, 18.3-50.4 months), the 5-year OS, CSS and DFS were 72.0%, 74.4% and 51.3%, respectively. ACT had no significant effect on OS after PM resection from CRC [original cohort: P = 0.08; IPTW: P = 0.15]. No differences were observed for CSS (P = 0.12) and DFS (P = 0.68) between the ACT and non-ACT groups. Multivariate analysis showed no association of ACT with better survival, while sublobar resection (HR = 0.45; 95%CI: 0.20-1.00, P = 0.049) and longer disease-free interval (HR = 0.45; 95%CI: 0.20-0.98, P = 0.044) were associated with improved survival. CONCLUSION ACT does not improve survival after PM resection for CRC. Further well-designed randomized controlled trials are needed to determine the optimal ACT regimen and duration.
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Affiliation(s)
- Zhao Gao
- Department of Medical Oncology, Peking University First Hospital, Beijing 100034, China
| | - Shi-Kai Wu
- Department of Medical Oncology, Peking University First Hospital, Beijing 100034, China
| | - Shi-Jie Zhang
- Department of Thoracic Surgery, Peking University First Hospital, Beijing 100034, China
| | - Xin Wang
- Department of Gastrointestinal Surgery, Peking University First Hospital, Beijing 100034, China
| | - Ying-Chao Wu
- Department of Gastrointestinal Surgery, Peking University First Hospital, Beijing 100034, China
| | - Xuan Jin
- Department of Medical Oncology, Peking University First Hospital, Beijing 100034, China
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2
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Ise I, Kawai K, Nakano D, Takao M, Natsume S, Kato H, Nakamori S, Dejima A, Yamaguchi T. Hazard function analysis of prognosis after recurrent colorectal cancer. Langenbecks Arch Surg 2024; 409:123. [PMID: 38613567 PMCID: PMC11015996 DOI: 10.1007/s00423-024-03308-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 04/03/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND AND OBJECTIVES Mean survival time (MST) is used as the indicator of prognosis in patients with a colorectal cancer (CRC) recurrence. The present study aimed to visualize the changes in death risk after a CRC recurrence using hazard function analysis (HFA) to provide an alternative prognostic indicator to MST. METHODS The medical records of 725 consecutive patients with a recurrence following R0 radical surgery for CRC were retrospectively reviewed. RESULTS The five-year, post-recurrence survival rate was 37.8%, and the MST was 3.5 years while the risk of death peaked at 2.9 years post-recurrence. Seven variables were found to predict short-term survival, including the number of metastatic organs ≥ 2, non-surgical treatment for the recurrence, and a short interval before recurrence. In patients with a recurrence in one organ, the MST was four years, the peak time of death predicted by HFA was 2.9 years, and the five-year survival rate was 45.8%. In patients with a surgical resection of the recurrence, the MST was 8 years, the peak time of death was 3.3 years, and the five-year survival rate was 62%. CONCLUSIONS The present study established a novel method of assessing changes in mortality risk over time using HFA in patients with a CRC recurrence.
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Affiliation(s)
- Ichiro Ise
- Department of Colorectal Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan.
| | - Kazushige Kawai
- Department of Colorectal Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Daisuke Nakano
- Department of Colorectal Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Misato Takao
- Department of Colorectal Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Soichiro Natsume
- Department of Colorectal Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Hiroki Kato
- Department of Colorectal Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Sakiko Nakamori
- Department of Colorectal Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Akira Dejima
- Department of Colorectal Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Tatsuro Yamaguchi
- Department of Colorectal Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
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Gkikas A, Kakos C, Lampridis S, Godolphin PJ, Patrini D. Preoperative prognostic factors for 5-year survival following pulmonary metastasectomy from colorectal cancer: a systematic review and meta-analysis. Eur J Cardiothorac Surg 2023; 63:ezad059. [PMID: 36806915 DOI: 10.1093/ejcts/ezad059] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 01/05/2023] [Accepted: 02/19/2023] [Indexed: 02/23/2023] Open
Abstract
OBJECTIVES We seek to identify preoperative prognostic factors and measure their effect on 5-year survival following pulmonary metastasectomy (PM) for Colorectal Cancer (CRC). METHODS We systematically reviewed the databases of Cochrane Library, MEDLINE, Embase and Google Scholar from January 2000 to April 2021 to identify preoperative factors that have been investigated for their prognostic effect on survival following PM. Quality assessment was performed using the QUIPS tool. The prognostic effect of each identified factor on 5-year survival post-PM was estimated using random-effects meta-analyses. RESULTS We identified 115 eligible articles which included 13 294 patients who underwent PM from CRC. The overall 5-year survival after resection of the lung metastasis was 54.1%. The risk of bias of the included studies was at least moderate in 93% (107/115). Seventy-seven preoperative factors had been investigated for their prognostic effect. Our analysis showed that 11 factors had favourable and statistically significant prognostic effect on 5-year survival post-PM. These included solitary metastasis, size <2 cm, unilateral location, N0 thoracic disease, no history of extra-thoracic or liver metastasis, normal carcinoembryonic antigen levels both before PM and CRC excision, no neo-adjuvant chemotherapy before PM, CRC T-stage < T4 and no p53 mutations on CRC. Disease-free interval at 24 months did not appear to affect 5-year survival. CONCLUSIONS Despite the considerable risk of bias in the literature, our study consolidates the available evidence on preoperative prognostic factors for PM from CRC. These findings can complement both clinical practice and the design of future research on the field of PM.
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Affiliation(s)
- Andreas Gkikas
- Department of General Surgery, Hillingdon Hospital, The Hillingdon Hospitals NHS Foundation Trust, London, UK
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Christos Kakos
- Department of General Surgery, Royal Victoria Hospital, Belfast, UK
| | - Savvas Lampridis
- Department of Thoracic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Peter J Godolphin
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Davide Patrini
- Department of Thoracic Surgery, University College London Hospitals, London, UK
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4
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Guo R, Yan S, Wang F, Su H, Xie Q, Zhao W, Yang Z, Li N, Yu J. A novel diagnostic model for differentiation of lung metastasis from primary lung cancer in patients with colorectal cancer. Front Oncol 2022; 12:1017618. [PMID: 36353559 PMCID: PMC9639374 DOI: 10.3389/fonc.2022.1017618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/06/2022] [Indexed: 11/25/2022] Open
Abstract
Objective This study aimed to evaluate the 18F-FDG PET/CT in differentiating lung metastasis(LM) from primary lung cancer(LC) in patients with colorectal cancer (CRC). Methods A total of 120 CRC patients (80 male, 40 female) who underwent 18F-FDG PET/CT were included. The diagnosis of primary lung cancer or lung metastasis was based on histopathology The patients were divided into a training cohort and a validation cohort randomized 1:1. Independent risk factors were extracted through the clinical information and 18F-FDG PET/CT imaging characteristics of patients in the validation cohort, and then a diagnostic model was constructed and a nomograms was made. ROC curve, calibration curve, cutoff, sensitivity, specificity, and accuracy were used to evaluate the prediction performance of the diagnostic model. Results One hundred and twenty Indeterminate lung lesions (ILLs) (77 lung metastasis, 43 primary lung cancer) were analyzed. No significant difference in clinical characteristics and imaging features between the training and the validation cohorts (P > 0. 05). Using uni-/multivariate analysis, pleural tags and contour were identified as independent predictors. These independent predictors were used to establish a diagnostic model with areas under the receiver operating characteristic curves (AUCs) of 0.92 and 0.89 in the primary and validation cohorts, respectively. The accuracy rate of the diagnostic model for differentiating LM from LC were higher than that of subjective diagnosis (P < 0.05). Conclusions Pleural tags and contour were identified as independent predictors. The diagnostic model of ILLs in patients with CRC could help differentiate between LM and LC.
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Affiliation(s)
- Rui Guo
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), National Medical Products Administration (NPMA) Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, Beijing, China
| | - Shi Yan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic Surgery II, Peking University Cancer Hospital and Institute, Beijing, China
| | - Fei Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), National Medical Products Administration (NPMA) Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, Beijing, China
| | - Hua Su
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), National Medical Products Administration (NPMA) Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, Beijing, China
| | - Qing Xie
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), National Medical Products Administration (NPMA) Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, Beijing, China
| | - Wei Zhao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), National Medical Products Administration (NPMA) Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, Beijing, China
| | - Zhi Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), National Medical Products Administration (NPMA) Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, Beijing, China
- *Correspondence: Zhi Yang, ; Nan Li, ; Jiangyuan Yu,
| | - Nan Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), National Medical Products Administration (NPMA) Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, Beijing, China
- *Correspondence: Zhi Yang, ; Nan Li, ; Jiangyuan Yu,
| | - Jiangyuan Yu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), National Medical Products Administration (NPMA) Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, Beijing, China
- *Correspondence: Zhi Yang, ; Nan Li, ; Jiangyuan Yu,
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Matsuguma H, Mun M, Sano A, Yoshino I, Hashimoto H, Shintani Y, Iida T, Shiono S, Chida M, Kuroda H, Nakayama M, Shiraishi Y, Funai K, Kawamura M. Time to Incurable Recurrence for Patients Treated With Pulmonary Metastasectomy for Colorectal Cancer. Ann Surg Oncol 2022; 29:6909-6917. [PMID: 35717520 DOI: 10.1245/s10434-022-11904-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 03/12/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Probability of cure is important for patients with lung metastasis who must decide whether to undergo metastasectomy. Although progression-free survival (PFS) is thought to reflect this, it does not include curative effects by repeat metastasectomy. Thus, the authors developed a new indicator, time to incurable recurrence (TTIR), in which only incurable recurrence was set as an event that included death, with incurable recurrence defined as recurrence not treated by definitive local therapy (DLT), recurrence treated by DLT but with PFS maintained less than 2 years, or recurrence followed by re-recurrence. METHODS This multi-institutional study included 339 patients who underwent lung metastasectomy for colorectal cancer between 1990 and 2008. RESULTS Among the 339 patients, 191 experienced recurrence, 77 received DLT for recurrence, 38 had a PFS of 2 years or longer after the treatment, and 33 had maintained a PFS at the last follow-up date. The patients had PFS ranging from 39 to 212 months (median, 101 months). The 5-year OS, PFS, and TTIR rates were respectively 63.4%, 42.2%, and 51.9%. The TTIR curve was similar to the OS curve 7 years after the initial metastasectomy. The difference between TTIR and PFS at 7 years was 9.7%, indicating probability of cure by repeat DLT. Multivariable analysis showed different prognostic factors among OS, PFS, and TTIR. CONCLUSION At the initial metastasectomy, TTIR may reflect probability of a cure, including cure by repeat DLT, and can be used to analyze prognostic factors associated with cure.
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Affiliation(s)
| | - Mingyon Mun
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Atsushi Sano
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, Tokyo, Japan
| | - Ichiro Yoshino
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Hiroshi Hashimoto
- Department of Thoracic Surgery, National Defense Medical College, Saitama, Japan
| | - Yasushi Shintani
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tomohiko Iida
- Department of Thoracic Surgery, Kimitsu Central Hospital, Chiba, Japan
| | - Satoshi Shiono
- Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Masayuki Chida
- Department of General Thoracic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Hiroaki Kuroda
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Aichi, Japan
| | - Mitsuo Nakayama
- Department of General Thoracic Surgery, Saitama Medical Center, Saitama, Japan
| | - Yuji Shiraishi
- Section of Chest Surgery, Fukujuji Hospital, Tokyo, Japan
| | - Kazuhito Funai
- First Department of Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Masafumi Kawamura
- Division of General Thoracic Surgery, Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
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Liu T, Chang W, Wang H, Lin Q, Wei Y, Tang W, Liu Y, Chen Y, Niu Z, Jiang Y, Ren L, Xu J. Anatomical Resection Improves Disease-Free Survival After Lung Metastasectomy of Colorectal Cancer. Cancer Manag Res 2022; 13:9429-9437. [PMID: 35002321 PMCID: PMC8722571 DOI: 10.2147/cmar.s341543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/10/2021] [Indexed: 12/01/2022] Open
Abstract
Purpose This study aimed to evaluate the role of anatomical resection (AR) in lung metastasectomy (LM) of colorectal cancer (CRC) and to investigate clinically relevant prognostic factors. Patients and Methods The medical records of 350 consecutive patients who underwent LM of CRC from 2011 to 2019 were reviewed. The patients were designated into AR group (lobectomy and segmentectomy), and non-anatomical resection (NAR) group (wedge resection), respectively. Kaplan–Meier method was used to analyze disease-free survival (DFS), pulmonary-specific disease-free survival (PDFS) and overall survival (OS). Cox proportional hazards regression model was performed to analyze the factors associated with DFS, PDFS and OS. Results A total of 92 (31.2%) patients were enrolled in AR group and 203 (68.8%) in non-anatomical resection (NAR) group. AR significantly improved the 3-year DFS (64.1% vs 46.8%, HR 0.587, 95% CI 0.397–0.867, P = 0.007) and PDFS (75.0% vs 60.1%, HR 0.565, 95% CI 0.356–0.899, P = 0.016) compared with NAR. However, the extent of resection did not significantly impact the 3-year OS (AR 92.4% vs NAR 85.7%, HR 0.511, 95% CI 0.224–1.165, P = 0.110). In multivariate analysis, AR was identified as a protective factor for DFS (HR 0.576, 95% CI 0.356–0.934, P = 0.025) and PDFS (HR 0.631, 95% CI 0.409–0.973, P = 0.037). Preoperative abnormal CA19-9 was identified as the only prognostic factor for OS. Conclusion AR was superior to NAR for DFS and PDFS after LM from CRC.
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Affiliation(s)
- Tianyu Liu
- Colorectal Cancer Center, Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Wenju Chang
- Colorectal Cancer Center, Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.,Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive Technology, Shanghai, People's Republic of China
| | - Hao Wang
- Department of Thoracic Surgery; Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Qi Lin
- Colorectal Cancer Center, Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.,Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive Technology, Shanghai, People's Republic of China
| | - Ye Wei
- Colorectal Cancer Center, Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.,Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive Technology, Shanghai, People's Republic of China
| | - Wentao Tang
- Colorectal Cancer Center, Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Yu Liu
- Colorectal Cancer Center, Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Yijiao Chen
- Colorectal Cancer Center, Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Zhengchuan Niu
- Colorectal Cancer Center, Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Yudong Jiang
- Colorectal Cancer Center, Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Li Ren
- Colorectal Cancer Center, Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.,Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive Technology, Shanghai, People's Republic of China
| | - Jianmin Xu
- Colorectal Cancer Center, Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.,Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive Technology, Shanghai, People's Republic of China
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Nikolic N, Radosavljevic D, Gavrilovic D, Nikolic V, Stanic N, Spasic J, Cacev T, Castellvi-Bel S, Cavic M, Jankovic G. Prognostic Factors for Post-Recurrence Survival in Stage II and III Colorectal Carcinoma Patients. ACTA ACUST UNITED AC 2021; 57:medicina57101108. [PMID: 34684145 PMCID: PMC8538010 DOI: 10.3390/medicina57101108] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/08/2021] [Accepted: 10/11/2021] [Indexed: 12/15/2022]
Abstract
Background and objectives: This study aimed to evaluate prognostic factors for post-recurrence survival in local and locally advanced colorectal cancer patients. Materials and Methods: A total of 273 patients with stage III and high-risk stage II colorectal cancer were prospectively enrolled. All patients underwent operative treatment of the primary tumor and adjuvant fluorouracil-based chemotherapy. Results: Over the three-year period (2008–2010), a cohort of 273 patients with stage III and high-risk stage II colorectal cancer had been screened. During follow up, 105 (38.5%) patients had disease recurrence. Survival rates 1-, 3- and 5-year after recurrence were 53.9, 18.2 and 6.5%, respectively, and the median post-recurrence survival time was 13 months. Survival analysis showed that age at diagnosis (p < 0.01), gender (p < 0.05), elevated postoperative Ca19-9 (p < 0.01), tumor histology (adenocarcinoma vs. mucinous vs. signet ring tumors, p < 0.01) and tumor stage (II vs. III, p < 0.05) had a significant influence on post-recurrence survival. Recurrence interval and metastatic site were not related to survival following recurrence. Multivariate analysis showed that older age (HR 2.43), mucinous tumors (HR 1.51) and tumors expressing Ca19-9 at baseline (HR 3.51) were independently associated with survival following recurrence. Conclusions: Baseline patient and tumor characteristics largely predicted patient outcomes after disease recurrence. Recurrence intervals in local and locally advanced colorectal cancer were not found to be prognostic factors for post-recurrence survival. Older age, male gender, stage III and mucinous histology were poor prognostic factors after the disease had recurred. Stage II patients had remarkable post-recurrence survival compared to stage III patients.
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Affiliation(s)
- Neda Nikolic
- Institute for Oncology and Radiology of Serbia, 11000 Belgrade, Serbia; (D.R.); (D.G.); (V.N.); (N.S.); (J.S.); (M.C.)
- Correspondence:
| | - Davorin Radosavljevic
- Institute for Oncology and Radiology of Serbia, 11000 Belgrade, Serbia; (D.R.); (D.G.); (V.N.); (N.S.); (J.S.); (M.C.)
| | - Dusica Gavrilovic
- Institute for Oncology and Radiology of Serbia, 11000 Belgrade, Serbia; (D.R.); (D.G.); (V.N.); (N.S.); (J.S.); (M.C.)
| | - Vladimir Nikolic
- Institute for Oncology and Radiology of Serbia, 11000 Belgrade, Serbia; (D.R.); (D.G.); (V.N.); (N.S.); (J.S.); (M.C.)
| | - Nemanja Stanic
- Institute for Oncology and Radiology of Serbia, 11000 Belgrade, Serbia; (D.R.); (D.G.); (V.N.); (N.S.); (J.S.); (M.C.)
| | - Jelena Spasic
- Institute for Oncology and Radiology of Serbia, 11000 Belgrade, Serbia; (D.R.); (D.G.); (V.N.); (N.S.); (J.S.); (M.C.)
| | - Tamara Cacev
- Division of Molecular Medicine, Rudjer Boskovic Institute, 10000 Zagreb, Croatia;
| | - Sergi Castellvi-Bel
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Gastroenterology Department, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, 08007 Barcelona, Spain;
| | - Milena Cavic
- Institute for Oncology and Radiology of Serbia, 11000 Belgrade, Serbia; (D.R.); (D.G.); (V.N.); (N.S.); (J.S.); (M.C.)
| | - Goran Jankovic
- Clinic for Gastroenterology and Hepatology, Clinical Centre of Serbia, 11000 Belgrade, Serbia;
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8
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Martijn VD, Jelle Egbert B, Bart T, Christian D, Frank Jozef Christiaan VDB, Wilhelmina Hendrika S, Michel G, Geert K, David Jonathan H. Pulmonary metastasectomy with lymphadenectomy for colorectal pulmonary metastases: A systematic review. Eur J Surg Oncol 2021; 48:253-260. [PMID: 34656390 DOI: 10.1016/j.ejso.2021.09.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 09/19/2021] [Accepted: 09/27/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Routine lymphadenectomy during metastasectomy for pulmonary metastases of colorectal cancer has been recommended by several recent expert consensus meetings. However, evidence supporting lymphadenectomy is limited. The aim of this study was to perform a systematic review of the literature on the impact of simultaneous lymph node metastases on patient survival during metastasectomy for colorectal pulmonary metastases (CRPM). METHODS A systematic review was conducted according to the PRISMA guidelines of studies on lymphadenectomy during pulmonary metastasectomy for CRPM. Articles published between 2000 and 2020 were identified from Medline, Embase and the Cochrane Library without language restriction. Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework was used to assess the risk of bias and applicability of included studies. Survival rates were assessed and compared for the presence and level of nodal involvement. RESULTS Following review of 8054 studies by paper and abstract, 27 studies comprising 3619 patients were included in the analysis. All patients included in these studies underwent lymphadenectomy during pulmonary metastasectomy for CRPM. A total of 690 patients (19.1%) had simultaneous lymph node metastases. Five-year overall survival for patients with and without lymph node metastases was 18.2% and 51.3%, respectively (p < .001). Median survival for patients with lymph node metastases was 27.9 months compared to 58.9 months in patients without lymph node metastases (p < .001). Five-year overall survival for patients with N1 and N2 lymph node metastases was 40.7% and 10.9%, respectively (p = .064). CONCLUSION Simultaneous lymph node metastases of CRPM have a detrimental impact on survival and this is most apparent for mediastinal lymph node metastases. Therefore, lymphadenectomy during pulmonary metastasectomy for CRPM can be advised to obtain important prognostic value.
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Affiliation(s)
- van Dorp Martijn
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Cancer Center Amsterdam, De Boelelaan, 1117, Amsterdam, the Netherlands.
| | | | - Torensma Bart
- Leiden University Medical Centre, Department of Anesthesiology, Albinusdreef 2, Leiden, the Netherlands
| | - Dickhoff Christian
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Cancer Center Amsterdam, De Boelelaan, 1117, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Cardiothoracic Surgery, Cancer Center Amsterdam, De Boelelaan, 1117, Amsterdam, the Netherlands
| | | | | | - Gonzalez Michel
- Centre Hospitalier Vaudois, Department of Thoracic Surgery, Rue du Bugnon 46, Lausanne, Switzerland
| | - Kazemier Geert
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Cancer Center Amsterdam, De Boelelaan, 1117, Amsterdam, the Netherlands
| | - Heineman David Jonathan
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Cancer Center Amsterdam, De Boelelaan, 1117, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Cardiothoracic Surgery, Cancer Center Amsterdam, De Boelelaan, 1117, Amsterdam, the Netherlands
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Okazaki Y, Shibutani M, Wang E, Nagahara H, Fukuoka T, Iseki Y, Maeda K, Hirakawa K, Ohira M. Efficacy of adjuvant chemotherapy after complete resection of pulmonary metastasis from colorectal cancer. Mol Clin Oncol 2021; 15:205. [PMID: 34462661 PMCID: PMC8375035 DOI: 10.3892/mco.2021.2367] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/19/2021] [Indexed: 11/20/2022] Open
Abstract
The most effective treatment for pulmonary metastasis from colorectal cancer (CRC) is complete resection. However, as the recurrence rate after resection of the pulmonary metastases from CRC is high, postoperative adjuvant chemotherapy is often performed in clinical practice. The purpose of the present study was to evaluate the efficacy and safety of single-agent adjuvant chemotherapy after resection of pulmonary metastasis from CRC. The medical records of 16 patients who underwent the first complete resection of pulmonary metastasis from CRC were retrospectively reviewed. A total of eight patients were treated with single-agent adjuvant chemotherapy after resection of pulmonary metastasis, and oral fluoropyrimidines were selected in all regimens. As a result, the relapse-free survival rate after resection of pulmonary metastasis in the group that received postoperative adjuvant chemotherapy was significantly improved in comparison with the group treated with surgery alone. In the subgroup analysis, patients who benefited from postoperative adjuvant chemotherapy in some high-risk groups were selected, including patients with a high tumor stage or poor immunological status. In conclusion, single-agent adjuvant chemotherapy after resection of pulmonary metastasis from CRC was effective for reducing the risk of recurrence and was safe to administer. In addition, certain risk factors may identify patients who would receive more benefit from postoperative adjuvant chemotherapy after resection of pulmonary metastasis from CRC.
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Affiliation(s)
- Yuki Okazaki
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Abeno-ku, Osaka 545-8585, Japan
| | - Masatsune Shibutani
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Abeno-ku, Osaka 545-8585, Japan
| | - En Wang
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Abeno-ku, Osaka 545-8585, Japan
| | - Hisashi Nagahara
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Abeno-ku, Osaka 545-8585, Japan
| | - Tatsunari Fukuoka
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Abeno-ku, Osaka 545-8585, Japan
| | - Yasuhito Iseki
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Abeno-ku, Osaka 545-8585, Japan
| | - Kiyoshi Maeda
- Department of Gastroenterological Surgery, Osaka City General Hospital, Miyakojima-ku, Osaka 534-0021, Japan
| | - Kosei Hirakawa
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Abeno-ku, Osaka 545-8585, Japan
| | - Masaichi Ohira
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Abeno-ku, Osaka 545-8585, Japan
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Okazaki Y, Shibutani M, Wang EN, Nagahara H, Fukuoka T, Iseki Y, Kashiwagi S, Tanaka H, Maeda K, Hirakawa K, Ohira M. Prognostic Significance of the Immunological Indices in Patients Who Underwent Complete Resection of Pulmonary Metastases of Colorectal Cancer. In Vivo 2021; 35:1091-1100. [PMID: 33622906 DOI: 10.21873/invivo.12354] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 11/27/2020] [Accepted: 11/28/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND/AIM The neutrophil-to-lymphocyte ratio (NLR) and the density of tumor-infiltrating lymphocytes (TILs) have been reported as immunological prognostic factors for various cancers. We evaluated the association between the prognosis and the immunological status in patients who underwent complete resection of pulmonary metastases of colorectal cancer (CRC). PATIENTS AND METHODS We evaluated the associations between the NLR before the resection of pulmonary metastases and the relapse-free survival (RFS) or overall survival (OS), or between the density of TILs in the pulmonary metastasis and the RFS or OS. RESULTS The RFS and OS were significantly worse in the NLR-High group than in the NLR-Low group. The RFS was significantly longer in the CD3+TILs-High group than in the CD3+TILs-Low group. CONCLUSION The NLR and the density of TILs may have prognostic significance in patients who undergo complete resection of pulmonary metastases of CRC.
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Affiliation(s)
- Yuki Okazaki
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Masatsune Shibutani
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan;
| | - E N Wang
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hisashi Nagahara
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Tatsunari Fukuoka
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yasuhito Iseki
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shinichiro Kashiwagi
- Department of Breast and Endocrine Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hiroaki Tanaka
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kiyoshi Maeda
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.,Department of Gastroenterological Surgery, Osaka City General Hospital, Osaka, Japan
| | - Kosei Hirakawa
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Masaichi Ohira
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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11
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The Assessment of Prognostic Factors for Lung Metastasectomy in Colorectal Cancer Patients With Previously Resected Liver Metastases. Int Surg 2021. [DOI: 10.9738/intsurg-d-15-00333.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The purpose of this study is to investigate the prognostic factors of lung metastasectomy in patients with previously resected liver metastases. Thirty-three patients underwent complete resection of lung metastases after previous liver metastasectomy from colorectal cancer between January 2004 and December 2013. In univariate analyses, all cumulative survival curves were estimated using the Kaplan-Meier method, and differences in variables were evaluated using the log-rank test. Multivariate analyses were performed using the Cox proportional hazards regression model. The 5-year survival rate of all 33 patients after lung metastasectomy was 31%. Univariate analysis identified 2 significant prognostic factors: preoperative serum carcinoembryonic antigen level (P = 0.035) and maximum tumor size (P = 0.029). Subgroup analysis with a combination of these 2 independent prognostic factors revealed 2-year survival rates of 100%, 92.3%, and 0% for patients with 0, 1, and 2 risk factors, respectively. We identified 2 independent poor prognostic factors for pulmonary metastasectomy in patients with previously resected liver metastases: high serum carcinoembryonic antigen level before lung metastasectomy, and maximum size of lung metastases. When these 2 factors are combined, higher- and lower-risk subgroups can be identified, which may help select patients with previously resected liver metastases who benefit most from lung metastasectomy.
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12
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Yi C, Li J, Tang F, Ning Z, Tian H, Xiao L, Wang A, Zong Z. Is Primary Tumor Excision and Specific Metastases Sites Resection Associated With Improved Survival in Stage Ⅳ Colorectal Cancer? Results From SEER Database Analysis. Am Surg 2020; 86:499-507. [PMID: 32684032 DOI: 10.1177/0003134820919729] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE We aimed to explore the prognostic value of primary tumor and specific metastases excision on survival among patients with stage IV colorectal cancer (CRC) in the Surveillance, Epidemiology, and End Results (SEER) database. METHODS Patients with stage IV CRC were selected using SEER database between 2010 and 2013. Survival rate was calculated according to the Kaplan-Meier method, and differences between curves were tested by the log-rank test. Cox proportional hazards model was used in the multivariable analysis. RESULTS Included in this study were 27 878 patients with distant metastatic CRC. Among the single organ site of metastatic CRC, patients with solitary metastasis of lung showed the highest median overall survival (OS). Both primary and metastatic sites surgical resection for patients with liver, lung, and simultaneous liver and lung metastases had better median OS. Age younger than 65 years, Asian and Pacific Islander, distal colon and rectum, and palliative primary tumor and metastatic lesions resection were associated with better OS after multivariate analysis. Palliative primary tumor and metastatic lesions resection had a significant survival benefit compared with nonsurgical group in selected patients. CONCLUSION These findings support the use of preemptive surgery in the management of highly selected metastatic CRC patients.
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Affiliation(s)
- Chenghao Yi
- 47861 Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jinpeng Li
- 47861 Department of Gastroenterology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Fuxin Tang
- 26469 Department of Gastrointestinal Surgery and Hernia Center, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangzhou, China
| | - Zhikun Ning
- 47861 Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Huakai Tian
- 47861 Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Longlin Xiao
- 47861 Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Anan Wang
- 47861 Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Zhen Zong
- 47861 Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
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Li H, Hu H, Li B, Sun X, Sun Y, Chen H. What is the appropriate surgical strategy for pulmonary metastasis of colorectal cancer? Medicine (Baltimore) 2020; 99:e21368. [PMID: 32791745 PMCID: PMC7387060 DOI: 10.1097/md.0000000000021368] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Pulmonary metastasectomy is considered to be a feasible method for selected colorectal cancer (CRC) patients. This study aimed to optimize the individualized surgical strategy of pulmonary metastasectomy, especially in choice of surgery extent and systematic mediastinal lymph nodes dissection.Data of 267 CRC patients who underwent pulmonary metastasectomy from July 2011 to July 2017 in Shanghai Cancer Center Fudan University were reviewed. Recurrence-free survival (RFS), overall survival (OS) and other clinical characteristics were compared between patients who accepted different surgical strategy.A total of 93 (34.8%) patients underwent lobectomy, 162 (60.7%) wedge resection, and 12 (4.5%) segmentectomy. Mediastinal lymph nodes dissection or sampling was performed in 106 (39.7%) patients. The median follow-up phase was 32.5 months (range 7.2-104.7 months). Patients were divided into 2 groups according to the surgical extent, lobectomy group and sublobar resection group. The median RFS and OS were 46.4 and 76.5 months for patients underwent, respectively. In the patients whose tumor diameter was ≥ 1.5 cm, RFS (5-year; 44.9% vs 29.8%, log-rank P = .03; hazard ratio, 0.71; 95% CI 0.52-0.89, P = .026) was better in the lobectomy group; however, no difference was found in OS. Meanwhile, in the patients whose tumor size was <1.5 cm, no difference was observed in RFS, as well as in OS. In the patients with metastatic lesion size ≥1.5 cm, a trend towards better RFS was found in patients received lymph nodes dissection, but it did not reach statistical significance.Lobectomy has more curative significance for CRC patients with single pulmonary metastatic lesion ≥1.5 cm. Systematic mediastinal lymph nodes dissection did not improve clinical outcome for CRC patients occurred pulmonary metastasis.
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Affiliation(s)
- Hang Li
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center
- Institute of Thoracic Oncology
- Department of Oncology, Shanghai Medical College, Fudan University
| | - Hong Hu
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center
- Institute of Thoracic Oncology
- Department of Oncology, Shanghai Medical College, Fudan University
| | - Bin Li
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center
- Institute of Thoracic Oncology
- Department of Oncology, Shanghai Medical College, Fudan University
| | - Xiangjie Sun
- Department of Oncology, Shanghai Medical College, Fudan University
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yihua Sun
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center
- Institute of Thoracic Oncology
- Department of Oncology, Shanghai Medical College, Fudan University
| | - Haiquan Chen
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center
- Institute of Thoracic Oncology
- Department of Oncology, Shanghai Medical College, Fudan University
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Surgery versus stereotactic radiotherapy for treatment of pulmonary metastases. A systematic review of literature. Future Sci OA 2020; 6:FSO471. [PMID: 32518686 PMCID: PMC7273364 DOI: 10.2144/fsoa-2019-0120] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
It is not clear as to which is the best treatment among surgery and stereotactic radiotherapy (SBRT) for lung oligometastases. A systematic review of literature with a priori selection criteria was conducted on articles on the treatment of pulmonary metastases with surgery or SBRT. Only original articles with a population of patients of more than 50 were selected. After final selection, 61 articles on surgical treatment and 18 on SBRT were included. No difference was encountered in short-term survival between pulmonary metastasectomy and SBRT. In the long-term surgery seems to guarantee better survival rates. Mortality and morbidity after treatment are 0–4.7% and 0–23% for surgery, and 0–2% and 4–31% for SBRT. Surgical metastasectomy remains the treatment of choice for pulmonary oligometastases. Patients with metastatic cancer with a limited number of deposits may benefit from surgical removal or irradiation of tumor nodules in addiction to chemotherapy. Surgical resection has been demonstrated to improve survival and, in some cases, can be curative. Stereotactic radiotherapy is emerging as a less invasive alternative to surgery, but settings and implications of the two treatments are profoundly different. The two techniques show similar results in the short-term, with lower complications rates for radiotherapy, while in the long-term surgery seems to guarantee higher survival rates.
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15
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Yamada K, Ozawa D, Onozato R, Suzuki M, Fujita A, Ojima H. Optimal timing for the resection of pulmonary metastases in patients with colorectal cancer. Medicine (Baltimore) 2020; 99:e19144. [PMID: 32118717 PMCID: PMC7478587 DOI: 10.1097/md.0000000000019144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
This study aims to clarify the surgical treatment time of pulmonary metastasis in patients with colorectal cancer.Early relapse after resection of pulmonary metastasis is often encountered when the interval from the detection of pulmonary metastasis to pulmonary metastasectomy was short.In this retrospective analysis, data of patients with colorectal cancer who underwent surgical treatment of pulmonary metastasis at the Gunma Prefectural Cancer Center, Gunma, from April 2001 through September 2018 were evaluated. The patients were divided into 2 groups. We examined the interval period from the diagnosis of pulmonary metastasis to pulmonary metastasectomy. This period was divided into every 3 months, and the prognosis of each group was compared with clarify the appropriate timing of pulmonary metastasectomy.The primary endpoints were 5-year overall survival and recurrence-free survival rates.The most significant difference was observed when the cutoff value was 9 months (5-year recurrence-free survival 45.8% vs 85.6%, P < .01). No significant difference was found in any background factors between the 2 groups. Twenty-five patients (34.7%) experienced recurrence after pulmonary metastasectomy. The most common site of recurrence was the lung (48%). Among the 12 cases of recurrence of pulmonary metastasis, 11 cases belonged to the <9 months group. A multivariable survival analysis found that the interval period of <9 months was a significant predictor of recurrence.Our study suggests that clinical follow-up for 9 months prior pulmonary metastasectomy in colorectal patients would improve the prognosis.
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Affiliation(s)
| | | | - Ryouichi Onozato
- Department of general thoracic surgery, Gunma Prefectural Cancer Center, Oota-shi, Gunma, Japan
| | | | - Atsushi Fujita
- Department of general thoracic surgery, Gunma Prefectural Cancer Center, Oota-shi, Gunma, Japan
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16
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Huang WL, Chen YY, Chang CC, Yen YT, Lai WW, Lin BW, Lee JC, Tseng YL. Pulmonary metastasectomy for colorectal cancer: Prognosis analysis disaggregated by the origin of the primary tumor. Asian J Surg 2020; 43:1069-1073. [PMID: 31974054 DOI: 10.1016/j.asjsur.2020.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 12/09/2019] [Accepted: 01/02/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The metastatic pattern differs between colon cancer and rectal cancer because of the distinct venous drainage systems. It is unclear whether colon cancer and rectal cancer are associated with different prognostic factors based on the anatomic difference. METHODS We assessed the prognostic factors and survival outcomes of patients with colorectal cancer who underwent pulmonary metastasectomy (PM), disaggregated by the location of primary colorectal cancer. The Cox proportional hazards model was used to identify variables that influenced the outcomes of pulmonary metastasectomy. RESULTS Between 2008 and 2017, 179 patients underwent PM classified into colon cancer and rectal cancer groups based on the site of origin of metastasis. The median postoperative follow-up was 2.3 years (range, 0.1-10.6). The post-PM 5-year survival rate in the colon cancer and rectal cancer groups was 42.5% and 39.9%, respectively (p = 0.310). On multivariable Cox proportional hazards analysis, presence of previous liver metastasis [hazard ratio (HR), 2.32; 95% confidence interval (CI), 1.19-4.51; p = 0.013], numbers of tumors (≥2; HR, 6.56; 95% CI, 2.07-20.79; p = 0.001), and abnormal preoperative carcinoembryonic antigen (CEA) level (HR, 2.50; 95% CI, 1.34-4.64; p = 0.001) were independent prognostic factors in patients with metastatic rectal cancer. CONCLUSIONS Prognostic correlates of post-PM survival differ between colon and rectal cancer. Rectal cancer patients have worse prognosis if they have a history of liver metastasis, multiple pulmonary metastases, or abnormal preoperative CEA. These results may help assess the survival benefit of PM and facilitate treatment decision-making.
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Affiliation(s)
- Wei-Li Huang
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Chung University, Tainan, Taiwan
| | - Ying-Yuan Chen
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Chung University, Tainan, Taiwan
| | - Chao-Chun Chang
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Chung University, Tainan, Taiwan
| | - Yi-Ting Yen
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Chung University, Tainan, Taiwan
| | - Wu-Wei Lai
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Chung University, Tainan, Taiwan
| | - Bo-Wen Lin
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jenq-Chang Lee
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yau-Lin Tseng
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Chung University, Tainan, Taiwan.
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17
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Oguri Y, Okui M, Yamamichi T, Asakawa A, Harada M, Horio H. The impact of pulmonary metastasectomy from gastric cancer. Mol Clin Oncol 2019; 11:401-404. [PMID: 31497298 PMCID: PMC6719255 DOI: 10.3892/mco.2019.1910] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 04/22/2019] [Indexed: 11/06/2022] Open
Abstract
Gastric cancer remains the most commonly-occurring cancer and the third most frequent cause of cancer-associated mortality in Japan. Solitary pulmonary metastasis of gastric cancer is rare and the outcome of pulmonary metastasectomy is still unclear. Herein we report the impact of pulmonary resection in patients with metastasis from gastric cancer. The present study retrospectively reviewed the preoperative data and clinical courses of 10 patients who underwent pulmonary resection for metastasis from gastric cancer at our institution between July 1986 and December 2017. The data on the outcomes, including morbidity, mortality and survival, were obtained from the patient records. All patients were followed-up from the time of pulmonary resection until mortality or referral to another hospital. The statistical analyses were performed using EZR (Saitama Medical Center, Jichi Medical University, Saitama, Japan), which is a graphical user interface for the R software program (The R Foundation for Statistical Computing, Vienna, Austria). The study population included 7 male patients and 3 female patients. A total of 5 patients underwent total gastrectomy, and 5 underwent distal gastrectomy. The median disease-free interval after initial gastric resection was 34.5 months. Five patients received adjuvant chemotherapy, of the 10 thoracotomies, 5 were lobectomy, 3 were wedge resection and 2 were segmentectomy. The median overall survival following pulmonary metastasectomy was 59 months and the 5-year survival rate was 40.5%. Taken together, the results of the present study suggest that pulmonary resection may be an effective therapeutic option for metastatic gastric cancer when a patient has a solitary metastatic lesion.
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Affiliation(s)
- Yohei Oguri
- Department of Thoracic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 113-8677, Japan
| | - Masayuki Okui
- Department of Thoracic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 113-8677, Japan
| | - Takashi Yamamichi
- Department of Thoracic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 113-8677, Japan
| | - Ayaka Asakawa
- Department of Thoracic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 113-8677, Japan
| | - Masahiko Harada
- Department of Thoracic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 113-8677, Japan
| | - Hirotoshi Horio
- Department of Thoracic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 113-8677, Japan
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18
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Jamel S, Tukanova K, Markar S. Detection and management of oligometastatic disease in oesophageal cancer and identification of prognostic factors: A systematic review. World J Gastrointest Oncol 2019; 11:741-749. [PMID: 31558978 PMCID: PMC6755111 DOI: 10.4251/wjgo.v11.i9.741] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 06/25/2019] [Accepted: 07/29/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Oesophageal cancer is the eighth most common cancer worldwide. The prognosis of oesophageal cancer patients still remains poor. The 5-year survival rate rarely exceeds 5% in case of metastatic disease. Some patients may however present with oligometastasis which can be treated with loco-regional therapy.
AIM To assess the current practice regarding the management of patients with oligometastatic oesophageal cancer and identify prognostic factors affecting survival following treatment for oligometastasis.
METHODS A systematic search of the literature was performed in Cochrance Library, MEDLINE and EMBASE databases from September 1950 to January 2019. Relevant electronic databases were searched for studies assessing the clinical outcome of oligometastasis.
RESULTS A total of 14 publications were included, of which 12 studies assessing metachronous oligometastasis and 2 on synchronous oligometastasis. All included articles evaluated the specific outcomes of metastasis, management modality and survival outcomes. The majority of the patients presented with oesophageal squamous cell carcinoma. The median disease free interval (time to recurrence) in patients was 19.6 mo and the overall survival reached 30.8 months. Unfavourable prognostic factors were assessed in eight studies and included time to recurrence < 12 mo, large diameter pulmonary lesions (> 20 mm), disease free interval (DFI) < 12 mo, extra-pulmonary metastasis, primary tumour pathological stage III/IV.
CONCLUSION Oligometastatic oesophageal cancer in selected patients is amenable to loco-regional treatment, and the overall survival of this patient cohort may be improved with patient and tumour-specific treatments.
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Affiliation(s)
- Sara Jamel
- Department Surgery and Cancer, Imperial College London, London W2 1NY, United Kingdom
| | - Karina Tukanova
- Department Surgery and Cancer, Imperial College London, London W2 1NY, United Kingdom
| | - Sheraz Markar
- Department Surgery and Cancer, Imperial College London, London W2 1NY, United Kingdom
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19
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Jamel S, Tukanova K, Markar S. Detection and management of oligometastatic disease in oesophageal cancer and identification of prognostic factors: A systematic review. World J Gastrointest Oncol 2019. [DOI: 10.4251/wjgo.v11.i9.0000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Sponholz S, Schirren M, Oguzhan S, Schirren J. Morbidity, mortality, and survival in elderly patients undergoing pulmonary metastasectomy for colorectal cancer. Int J Colorectal Dis 2018; 33:1401-1409. [PMID: 30056558 DOI: 10.1007/s00384-018-3136-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/20/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE The number of elderly patients with colorectal cancer is increasing. Nevertheless, they are undertreated compared to younger patients. This study compares postoperative morbidity, mortality, survival, and morbidity risk factors of elderly and younger patients undergoing pulmonary metastasectomy (PM). METHODS We retrospectively analyzed our prospective database of 224 patients operated for colorectal lung metastases between 1999 and 2014. Two groups were defined to evaluate the influence of the patients' age (A: < 70 years; B: ≥ 70 years). Morbidity, mortality, and risk factors for morbidity were analyzed using χ2-test and Fisher's exact test. The Kaplan-Meier method, log-rank test, and multivariate Cox regression were used to assess survival and prognosticators. RESULTS Altogether, minor morbidity, major morbidity, and mortality were 17%, 5.8%, and 0%, respectively. Between groups A (n = 170) and B (n = 54), there was no difference in minor and major morbidity (p = 0.100) or mortality (0%). Heart arrhythmia was a risk factor for increased morbidity in group B (p = 0.007). The 5-, 10-, and 15-year survival rates were 43%, 30%, and 27%, respectively, in group A and 55%, 36 and 19%, respectively, in group B (p = 0.316). Disease-free interval ≥ 36 months (p = 0.023; OR 2.88) and anatomic resections (p = 0.022; OR 3.05) were associated with prolonged survival in elderly patients. CONCLUSIONS Morbidity, mortality, and overall survival after PM with lymphadenectomy for elderly patients were comparable to younger patients. A disease-free interval > 36 months and anatomic lung resections might be associated with prolonged survival. However, elderly patients should also be evaluated for a curative treatment.
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Affiliation(s)
- S Sponholz
- Department of Thoracic Surgery, Agaplesion Markus Krankenhaus, Wilhelm-Epstein-Str. 4, 60431, Frankfurt, Germany.
| | - Moritz Schirren
- Department of Thoracic Surgery, Agaplesion Markus Krankenhaus, Wilhelm-Epstein-Str. 4, 60431, Frankfurt, Germany
| | - Selma Oguzhan
- Department of Thoracic Surgery, Agaplesion Markus Krankenhaus, Wilhelm-Epstein-Str. 4, 60431, Frankfurt, Germany
| | - Joachim Schirren
- Department of Thoracic Surgery, Agaplesion Markus Krankenhaus, Wilhelm-Epstein-Str. 4, 60431, Frankfurt, Germany
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Ohtaki Y, Shimizu K, Nagashima T, Nakazawa S, Obayashi K, Azuma Y, Iijima M, Kosaka T, Yajima T, Ogawa H, Tsutsumi S, Arai M, Mogi A, Kuwano H. Clinical and Radiological Discrimination of Solitary Pulmonary Lesions in Colorectal Cancer Patients. World J Surg 2018; 42:1161-1170. [PMID: 28983707 DOI: 10.1007/s00268-017-4243-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES The lung is one of the most common organs of metastasis from colorectal cancer (CRC), and we have encountered lung cancer patients with a history of CRC. There have been few studies regarding methods used to discriminate between primary lung cancer (PLC) and pulmonary metastasis from CRC (PM-CRC) based only on preoperative findings. We retrospectively investigated predictive factors discriminating between these lesions in patients with a history of CRC. METHODS Between 2006 and 2015, 117 patients with a history of CRC (44 patients with 47 PLC and 73 patients with 102 PM-CRC) underwent subsequent or concurrent resection of pulmonary lesions. We compared the clinical and radiological characteristics of 100 patients with solitary lesions (43 PLC and 57 PM-CRC). Using univariate and multivariate analyses, we examined predictive factors for discrimination of these two lesions. RESULTS All tumors with findings of ground-glass opacity (GGO) were PLC (n = 19). In a multivariate analysis of 81 radiologically solid tumors, two factors were found to be significant independent predictors of PLC: a history of stage I CRC and presence of pleural indentation. All tumors in 26 patients with either GGO or both a stage I CRC history and pleural indentation were PLC, while most tumors in patients without all three factors were PM-CRC (43/44; 97.7%). CONCLUSIONS The presence or absence of GGO, pathological CRC stage, and pleural indentation could be useful factors to distinguish between PLC and PM-CRC.
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Affiliation(s)
- Yoichi Ohtaki
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Maebashi, Gunma, Japan
| | - Kimihiro Shimizu
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Maebashi, Gunma, Japan.
| | - Toshiteru Nagashima
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Maebashi, Gunma, Japan
| | - Seshiru Nakazawa
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Maebashi, Gunma, Japan
| | - Kai Obayashi
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Maebashi, Gunma, Japan
| | - Yoko Azuma
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Maebashi, Gunma, Japan
| | - Misaki Iijima
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Maebashi, Gunma, Japan
| | - Takayuki Kosaka
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Maebashi, Gunma, Japan
| | - Toshiki Yajima
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Maebashi, Gunma, Japan
| | - Hiroomi Ogawa
- Division of Digestive Surgery, Integrative Center of General Surgery, Gunma University Hospital, Maebashi, Gunma, Japan
| | - Soichi Tsutsumi
- Division of Digestive Surgery, Integrative Center of General Surgery, Gunma University Hospital, Maebashi, Gunma, Japan
| | - Motohiro Arai
- Clinical Department of Pathology, Gunma University Hospital, Maebashi, Gunma, Japan
| | - Akira Mogi
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Maebashi, Gunma, Japan
| | - Hiroyuki Kuwano
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Maebashi, Gunma, Japan.,Division of Digestive Surgery, Integrative Center of General Surgery, Gunma University Hospital, Maebashi, Gunma, Japan
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22
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Individual data meta-analysis for the study of survival after pulmonary metastasectomy in colorectal cancer patients: A history of resected liver metastases worsens the prognosis. Eur J Surg Oncol 2018; 44:1006-1012. [DOI: 10.1016/j.ejso.2018.03.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 03/01/2018] [Accepted: 03/14/2018] [Indexed: 12/17/2022] Open
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23
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Perentes JY, Zellweger M, Gonzalez M. Personalized surgery for the management of pulmonary metastasis. J Thorac Dis 2018; 10:52-55. [PMID: 29600020 DOI: 10.21037/jtd.2017.12.45] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Jean Yannis Perentes
- Service of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Matthieu Zellweger
- Service of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Michel Gonzalez
- Service of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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24
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Sun F, Chen L, Shi M, Yang X, Li M, Yang X, Dai X, Zhan C, Shi Y, Wang Q. Prognosis of video-assisted thoracoscopic pulmonary metastasectomy in patients with colorectal cancer lung metastases: an analysis of 154 cases. Int J Colorectal Dis 2017; 32:897-905. [PMID: 28176005 DOI: 10.1007/s00384-017-2768-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2017] [Indexed: 02/04/2023]
Abstract
PURPOSE Video-assisted thoracoscopic surgery (VATS) is widely used in thoracic surgery and increasingly applied to pulmonary metastasectomy. The purpose of this study was to identify prognostic factors of patients undergoing VATS pulmonary metastasectomy from colorectal cancer (CRC). METHODS Between January 2005 and June 2015, a total of 154 patients underwent VATS pulmonary metastasectomy from CRC. Patient demographic data and characteristics of the primary tumor and pulmonary metastasis were analyzed to identify factors significantly correlated with prognosis. RESULTS The median follow-up period after pulmonary resection was 37 months. The cumulative 5-year overall survival rate after VATS pulmonary metastasectomy from CRC was 71.3%. History of metastasis to other sites (p = 0.035), status of mediastinal lymph nodes (p < 0.001), and preoperative carcinoembryonic antigen (CEA) level (p = 0.013) were identified as independent prognostic factors. Subgroup analysis with a combination of these three independent prognostic factors revealed 5-year OS rates of 91.0, 70.0, 30.3, and 0.0% for patients with zero, one, two, and three risk factors, respectively. Other factors, such as sex, disease-free interval, T stage of primary tumor, and status of lymph node near the primary tumor, were not significantly associated with prognosis. CONCLUSION VATS pulmonary metastasectomy is efficacious for patients with CRC pulmonary metastases. History of metastasis to other sites, status of mediastinal lymph nodes, and preoperative CEA level were identified as independent prognostic factors. The number of risk factors significantly influenced patient survival.
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Affiliation(s)
- Fenghao Sun
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, No. 180, Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Li Chen
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, No. 180, Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Mengkun Shi
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, No. 180, Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Xiaodong Yang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, No. 180, Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Ming Li
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, No. 180, Fenglin Road, Xuhui District, Shanghai, 200032, China.,Eight-Year Program Clinical Medicine, Grade of 2014, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Xinyu Yang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, No. 180, Fenglin Road, Xuhui District, Shanghai, 200032, China.,Eight-Year Program Clinical Medicine, Grade of 2014, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Xiyu Dai
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, No. 180, Fenglin Road, Xuhui District, Shanghai, 200032, China.,Eight-Year Program Clinical Medicine, Grade of 2014, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Cheng Zhan
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, No. 180, Fenglin Road, Xuhui District, Shanghai, 200032, China.
| | - Yu Shi
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, No. 180, Fenglin Road, Xuhui District, Shanghai, 200032, China.
| | - Qun Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, No. 180, Fenglin Road, Xuhui District, Shanghai, 200032, China
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25
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Yokoyama S, Mitsuoka M, Kinugasa T, Hashiguchi T, Matsumoto R, Murakami D, Nishi T, Yoshiyama K, Kashihara M, Takamori S, Akagi Y. Survival after initial lung metastasectomy for metastatic colorectal cancer in the modern chemotherapeutic era. BMC Surg 2017; 17:54. [PMID: 28486937 PMCID: PMC5424358 DOI: 10.1186/s12893-017-0252-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 04/19/2017] [Indexed: 02/06/2023] Open
Abstract
Background A clear survival benefit has been reported for lung metastasectomy for colorectal cancer, and several clinicopathological prognostic factors have been proposed in the past. However, clinical advances, such as chemotherapy and radiographic imaging, should have improved patient outcome and may have altered prognosticators. This study aimed to assess patient survival and determine prognostic factors for survival and recurrence in patients who underwent initial lung metastasectomy for colorectal cancer in the modern clinical era. Methods Clinicopathological data and outcomes of 59 patients who underwent curative initial lung metastasectomy for colorectal cancer from 2004 to 2012 at a single institution in Japan were retrospectively investigated. Survival was estimated using the Kaplan - Meier method, and Cox proportional hazards regression models were used to estimate the prognostic impacts of each variable in univariate and multivariate analysis. Results The 5-years overall and disease-free survival rates were 54.3 and 40.6%, respectively. A disease-free interval < 24 months after colorectal cancer resection (P = 0.004) and a serum carcinoembryonic antigen ≥ 5.0 ng/mL before initial lung metastasectomy (P = 0.015) were independent predictors for poor overall survival. Moreover, the disease-free interval after colorectal cancer resection < 24 months (P = 0.010) and a colorectal cancer with N2 stage disease (P = 0.018) were independently associated with poor disease-free survival. On the other hand, the number of lung metastasis was not identified as a poor prognostic factor for both overall and disease-free survival. Conclusions Our findings demonstrated similar or slightly better overall survival, and substantially favorable disease-free survival as compared with past reports. Poor prognostic factors for overall survival appeared not to differ from those of past studies, although this modern series did not determine the number of lung metastasis as a poor prognostic factor, which should be investigated in future studies. Moreover, initial lung metastasectomy is not expected to be a curable treatment for patients with both a short disease-free survival after colorectal cancer resection and colorectal cancers with N2 stage disease.
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Affiliation(s)
- Shintaro Yokoyama
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Masahiro Mitsuoka
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.
| | - Tetsushi Kinugasa
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Toshihiro Hashiguchi
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Ryoichi Matsumoto
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Daigo Murakami
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Tatsuya Nishi
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Koichi Yoshiyama
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Masaki Kashihara
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Shinzo Takamori
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Yoshito Akagi
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
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26
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Zabaleta J, Aguinagalde B, Lopez I, Fernandez-Monge A, Izquierdo JM, Emparanza JI. Survival after pulmonary metastasectomy in colorectal cancer patients: does a history of resected liver metastases worsen the prognosis? A literature review. Cancer Biol Med 2017; 14:281-286. [PMID: 28884044 PMCID: PMC5570604 DOI: 10.20892/j.issn.2095-3941.2017.0073] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Objective : To assess the impact of past liver metastases on the survival duration of patients who are undergoing surgery for lung metastases. Methods : We conducted a review of literature published from 2007 to 2014. The studies were identified by searching PubMed, MEDLINE, and Embase and were supplemented by a manual search of the references listed by the retrieved studies. The following search terms were used: lung metastasectomy, pulmonary metastasectomy, lung metastases, and lung metastasis. We selected retrospective and prospective studies published from 2007 to 2014 on patients with lung metastases from colorectal cancer and were undergoing surgery with curative intent. We excluded reviews, studies that focused on surgical techniques, patients who were treated non-surgically, analyses of specific subgroups of patients, and those that did not report follow-up of the patients undergoing surgery. Results : We identified 28 papers that assessed survival after lung metastases, 21 of which were mostly retrospective studies that identified previous liver metastases to explore their impact on patient survival. In more than half of the papers analyzed (63.2%), patients with a history of resected liver metastases had a lower survival rate than those who did not have such a history, and the difference was statistically significant in eight of these studies. However, data were presented differently, and authors reported mean survival time, survival rates, or hazard ratios. Conclusions : A history of liver metastases seems to be a negative prognostic factor, but the individual data need to undergo a meta-analysis.
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Affiliation(s)
- Jon Zabaleta
- Thoracic surgery service, Hospital Universitario, Donostia, Gipuzkoa 20014, Spain
| | - Borja Aguinagalde
- Thoracic surgery service, Hospital Universitario, Donostia, Gipuzkoa 20014, Spain
| | - Iker Lopez
- Thoracic surgery service, Hospital Universitario, Donostia, Gipuzkoa 20014, Spain
| | | | - Jose M Izquierdo
- Thoracic surgery service, Hospital Universitario, Donostia, Gipuzkoa 20014, Spain
| | - Jose I Emparanza
- Thoracic surgery service, Hospital Universitario, Donostia, Gipuzkoa 20014, Spain
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27
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Maniwa T, Mori K, Ohde Y, Okumura T, Boku N, Hishida T, Sakao Y, Yoshiya K, Hyodo I, Kondo H. Heterogeneity of Tumor Sizes in Multiple Pulmonary Metastases of Colorectal Cancer as a Prognostic Factor. Ann Thorac Surg 2016; 103:254-260. [PMID: 27743634 DOI: 10.1016/j.athoracsur.2016.07.070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 06/06/2016] [Accepted: 07/28/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND The number of metastatic lesions is closely correlated with prognosis in most cancers. The aim of this study was to clarify the relationship between individual heterogeneity of metastatic tumor sizes and prognosis in patients with multiple pulmonary metastasis of colorectal cancer who received surgical treatment. METHODS Clinical data for patients who had pulmonary metastasis from colorectal cancer and underwent curative resection at 46 Japanese institutions between January 2004 and December 2008 were collected. Among 898 patients eligible considering these inclusion criteria, 247 patients had multiple metastases and were analyzed. A difference between the maximum and minimum tumor diameters (Dmax-min) on pathologic findings was used to evaluate size heterogeneity. RESULTS The overall survival rate was 75% at 3 years and 58% at 5 years, with a median follow-up period of 65 months (range, 0 to 112). When Dmax-min of 5 mm was set as a cutoff value, overall survival was significantly different between small (≤5 mm, n = 95) and large (>5 mm, n = 152) tumor groups (5-year survival rates, 66.5% and 53.3%, respectively; log rank test, p = 0.025). Multivariate analysis using a Cox proportional hazards model revealed that disease-free interval from resection of primary lesion, serum carcinoembryonic antigen level, number of pulmonary metastases, and Dmax-min were independent prognostic factors. CONCLUSIONS The heterogeneity of metastatic tumor sizes may be an indicator for prognosis in patients with multiple pulmonary metastases of colorectal cancer who underwent resection.
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Affiliation(s)
- Tomohiro Maniwa
- Department of Thoracic Surgery, Yao Municipal Hospital, Osaka, Japan; Division of Thoracic Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan.
| | - Keita Mori
- Clinical Trial Coordination Office, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Yasuhisa Ohde
- Division of Thoracic Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Takehiro Okumura
- Department of Surgery, University Hospital Mizonokuchi, Teikyo University School of Medicine, Tokyo, Japan
| | - Narikazu Boku
- Division of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Tomoyuki Hishida
- Department of Thoracic Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Yukinori Sakao
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Aichi, Japan
| | - Katsuo Yoshiya
- Department of Chest Surgery, Niigata Cancer Center Hospital, Niigata, Japan
| | - Ichinosuke Hyodo
- Division of Gastroenterology Clinical Medicine, Faculty of Medicine, University of Tsukuba University Hospital, Ibaraki, Japan
| | - Haruhiko Kondo
- General Thoracic Surgery, School of Medicine, Kyorin University, Tokyo, Japan
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28
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Pagès PB, Le Pimpec-Barthes F, Bernard A. [Surgery for pulmonary metastases from colorectal cancer: Predictive factors for survival]. Rev Mal Respir 2016; 33:838-852. [PMID: 27133381 DOI: 10.1016/j.rmr.2016.02.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 02/11/2016] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Colorectal cancer is the 3rd commonest cause of death from cancer: 5% of patients will develop lung metastases. The management of oligometastatic disease is based on the objective of optimal local control. STATE OF THE ART To date, no results from randomized control trials support the resection of pulmonary metastases in oligometastastic colorectal cancer patients. However, numerous series, mainly retrospective, report long-term survival for highly selected patients, with 5-year survival ranging from 45 to 65% in the most recent series. The consensual predictive factors of a good prognosis are: a disease free-interval>36 months, a number of metastases≤3, a normal level of carcino-embryonic antigen and the absence of hilar or mediastinal lymph node involvement. PERSPECTIVES Around 20 to 40% of patients will develop recurrence, probably linked to the presence of undetectable micrometastases. Therefore, experimental work is being undertaken to develop new treatment techniques such as isolated lung perfusion, radiofrequency ablation and stereotactic radiation therapy. CONCLUSION Highly selected patients suffering from colorectal cancer lung metastases could benefit from resection with improved survival and disease-control.
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Affiliation(s)
- P-B Pagès
- Service de chirurgie cardiovasculaire et thoracique, CHU Bocage central, université de Bourgogne, 14, rue Gaffarel, BP 77908, 21079 Dijon cedex, France.
| | - F Le Pimpec-Barthes
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris-Descartes, 75015 Paris, France
| | - A Bernard
- Service de chirurgie cardiovasculaire et thoracique, CHU Bocage central, université de Bourgogne, 14, rue Gaffarel, BP 77908, 21079 Dijon cedex, France
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29
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Iijima Y, Akiyama H, Atari M, Fukuhara M, Nakajima Y, Kinosita H, Uramoto H. Pulmonary Resection for Metastatic Gastric Cancer. Ann Thorac Cardiovasc Surg 2016. [PMID: 27118522 DOI: 10.5761/atcs.oa.16-00049,] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Pulmonary metastasectomy has come to be recognized as an effective treatment for selected patients with some malignancies. On the other hand, the role of pulmonary metastasectomy for gastric cancer is still unknown. Metastasectomy is rarely indicated in cases of pulmonary metastasis from gastric cancer, because in most cases, the metastasis occurs in the form of lymphangitic carcinomatosis and the lesions are numerous. The purpose of this study was to determine the surgical outcomes and prognostic factors for survival after pulmonary metastasectomy. METHODS From 1985 to 2012, 10 patients underwent pulmonary metastasectomy for gastric cancer at Saitama Cancer Center, Japan. The overall survival rate was examined by the Kaplan-Meier method and univariate analysis was carried out to identify prognostic factors. RESULTS The overall 3-year survival rate was 30.0 %. The median follow-up period was 26.8 months (range, 6.5-96.6) after the pulmonary metastasectomy. Univariate analysis revealed an advanced pathological stage of the gastric cancer and occurrence of extrapulmonary metastasis before the pulmonary metastasectomy as unfavorable prognostic factors. CONCLUSION Pulmonary metastasectomy should be considered in selected patients with lung metastasis from gastric cancer. An advanced pathological stage of gastric cancer and occurrence of extrapulmonary metastasis before the pulmonary metastasectomy are unfavorable prognostic factors.
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Affiliation(s)
- Yoshihito Iijima
- Division of Thoracic Surgery, Saitama Cancer Center, Saitama, Japan
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30
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Iijima Y, Akiyama H, Atari M, Fukuhara M, Nakajima Y, Kinosita H, Uramoto H. Pulmonary Resection for Metastatic Gastric Cancer. Ann Thorac Cardiovasc Surg 2016; 22:230-6. [PMID: 27118522 DOI: 10.5761/atcs.oa.16-00049] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Pulmonary metastasectomy has come to be recognized as an effective treatment for selected patients with some malignancies. On the other hand, the role of pulmonary metastasectomy for gastric cancer is still unknown. Metastasectomy is rarely indicated in cases of pulmonary metastasis from gastric cancer, because in most cases, the metastasis occurs in the form of lymphangitic carcinomatosis and the lesions are numerous. The purpose of this study was to determine the surgical outcomes and prognostic factors for survival after pulmonary metastasectomy. METHODS From 1985 to 2012, 10 patients underwent pulmonary metastasectomy for gastric cancer at Saitama Cancer Center, Japan. The overall survival rate was examined by the Kaplan-Meier method and univariate analysis was carried out to identify prognostic factors. RESULTS The overall 3-year survival rate was 30.0 %. The median follow-up period was 26.8 months (range, 6.5-96.6) after the pulmonary metastasectomy. Univariate analysis revealed an advanced pathological stage of the gastric cancer and occurrence of extrapulmonary metastasis before the pulmonary metastasectomy as unfavorable prognostic factors. CONCLUSION Pulmonary metastasectomy should be considered in selected patients with lung metastasis from gastric cancer. An advanced pathological stage of gastric cancer and occurrence of extrapulmonary metastasis before the pulmonary metastasectomy are unfavorable prognostic factors.
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Affiliation(s)
- Yoshihito Iijima
- Division of Thoracic Surgery, Saitama Cancer Center, Saitama, Japan
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31
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Systemic Versus Local Therapies for Colorectal Cancer Pulmonary Metastasis: What to Choose and When? J Gastrointest Cancer 2016; 47:223-31. [DOI: 10.1007/s12029-016-9818-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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32
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Hachimaru A, Maeda R, Suda T, Takagi Y. Repeat pulmonary resection for recurrent lung metastases from colorectal cancer: an analysis of prognostic factors. Interact Cardiovasc Thorac Surg 2016; 22:826-30. [PMID: 26920721 DOI: 10.1093/icvts/ivv382] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 11/01/2015] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES The purpose of this study was to investigate the prognostic factors for repeat lung metastasectomy in patients with colorectal cancer, which may be clinically helpful in defining a subset of patients who are most likely to benefit from repeat lung metastasectomy. METHODS In total, 138 patients underwent complete lung resection for the first time due to metastases of colorectal cancer between January 2004 and December 2013 at Fujita Health University School of Medicine. Among them, 33 underwent repeat pulmonary metastasectomy for lung tumour recurrence. Kaplan-Meier survival curves and log-rank tests were used to analyse the survival rates. RESULTS No patient died as a direct result of surgery, and all patients were discharged after the repeat pulmonary metastasectomy. The 5-year survival rate after the initial pulmonary resection of the 33 patients who underwent repeat lung resection was 64%, which was not significantly different from that of the 105 patients who did not undergo repeat lung resection (5-year survival rate, 61%; P = 0.779). Univariate analysis identified only one significant prognostic factor: preoperative serum carcinoembryonic antigen (CEA) level (P = 0.002). The 5-year survival rates of patients with high preoperative CEA levels and normal CEA levels after repeat metastasectomy were significantly different at 47 and 90%, respectively. CONCLUSIONS Prethoracotomy serum CEA levels affect survival rates after repeat pulmonary resection. The preoperative assessment of serum CEA levels before repeat metastasectomy is important when considering repeat pulmonary resection, and prethoracotomy CEA levels should be taken into account when selecting patients for repeat lung resection.
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Affiliation(s)
- Ayumi Hachimaru
- Division of Thoracic and Cardiovascular Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Ryo Maeda
- Division of Thoracic and Cardiovascular Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Takashi Suda
- Division of Thoracic and Cardiovascular Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Yasushi Takagi
- Division of Thoracic and Cardiovascular Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
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33
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Hernández J, Molins L, Fibla JJ, Heras F, Embún R, Rivas JJ. Role of major resection in pulmonary metastasectomy for colorectal cancer in the Spanish prospective multicenter study (GECMP-CCR). Ann Oncol 2016; 27:850-5. [PMID: 27113270 DOI: 10.1093/annonc/mdw064] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 02/06/2016] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Patients with pulmonary metastases from colorectal cancer (CRC) may benefit from aggressive surgical therapy. The objective of this study was to determine the role of major anatomic resection for pulmonary metastasectomy to improve survival when compared with limited pulmonary resection. PATIENTS AND METHODS Data of 522 patients (64.2% men, mean age 64.5 years) who underwent pulmonary resections with curative intent for CRC metastases over a 2-year period were reviewed. All patients were followed for a minimum of 3 years. Disease-specific survival (DSS) and disease-free survival (DFS) were assessed with the Kaplan-Meier method. Factors associated with DSS and DFS were analyzed using a Cox proportional hazards regression model. RESULTS A total of 394 (75.6%) patients underwent wedge resection, 19 (3.6%) anatomic segmentectomy, 5 (0.9%) lesser resections not described, 100 (19.3%) lobectomy, and 4 (0.8%) pneumonectomy. Accordingly, 104 (19.9%) patients were treated with major anatomic resection and 418 (80.1%) with lesser resection. Operations were carried out with video-assisted thoracoscopic surgery (VATS) in 93 patients. The overall DSS and DFS were 55 and 28.3 months, respectively. Significant differences in DSS and DFS in favor of major resection versus lesser resection (DSS median not reached versus 52.2 months, P = 0.03; DFS median not reached versus 23.9 months, P < 0.001) were found. In the multivariate analysis, major resection appeared to be a protective factor in DSS [hazard ratio (HR) 0.6, 95% confidence interval (CI) 0.41-0.96, P = 0.031] and DFS (HR 0.5, 95% CI 0.36-0.75, P < 0.001). The surgical approach (VATS versus open surgical resection) had no effect on outcome. CONCLUSION Major anatomic resection with lymphadenectomy for pulmonary metastasectomy can be considered in selected CRC patient with sufficient functional reserve to improve the DSS and DFS. Further prospective randomized studies are needed to confirm the present results.
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Affiliation(s)
- J Hernández
- Thoracic Surgery Units, Hospital Universitari del Sagrat Cor, Barcelona
| | - L Molins
- Thoracic Surgery Units, Hospital Universitari del Sagrat Cor, Barcelona
| | - J J Fibla
- Thoracic Surgery Units, Hospital Universitari del Sagrat Cor, Barcelona
| | - F Heras
- Thoracic Surgery Units, Hospital General Universitario de Valladolid, Valladolid
| | - R Embún
- Thoracic Surgery Units, Hospital Universitario Miguel Servet Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
| | - J J Rivas
- Thoracic Surgery Units, Hospital Universitario Miguel Servet Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
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Video-Assisted Thoracoscopic Pulmonary Metastasectomy in Patients with Colorectal Cancer: A Recent 10-Year Single-Institution Experience. World J Surg 2016; 40:1318-23. [DOI: 10.1007/s00268-016-3424-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Park HS, Jung M, Shin SJ, Heo SJ, Kim CG, Lee MG, Beom SH, Lee CY, Lee JG, Kim DJ, Ahn JB. Benefit of Adjuvant Chemotherapy After Curative Resection of Lung Metastasis in Colorectal Cancer. Ann Surg Oncol 2015; 23:928-35. [PMID: 26514121 DOI: 10.1245/s10434-015-4951-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND The survival benefit of adjuvant chemotherapy after colorectal cancer (CRC) lung metastasectomy is uncertain. METHODS We enrolled 221 CRC patients who underwent pulmonary metastasectomy between October 2002 and July 2013, including those with previous liver metastasis that had been curatively resected. Disease-free survival (DFS) and overall survival (OS) were calculated from the day of lung metastasectomy. RESULTS Among all patients, 176 (79.6%) received adjuvant chemotherapy after lung metastasectomy. Median follow-up was 34.7 months from the time of lung metastasectomy [95% confidence interval (95% CI), 7.4-90.9 months]. Patients treated with adjuvant chemotherapy had longer DFS compared with surgery alone (median 32.7 vs 11.2 months respectively, P = 0.076). Multivariate analysis revealed previous liver metastasis, preoperative carcinoembryonic antigen ≥5 ng/mL, disease-free interval <24 months, and surgery without adjuvant chemotherapy as independent risk factors for recurrence. Low-risk patients who had 0-1 risk factors received a significant survival benefit from adjuvant chemotherapy [hazard ratio (HR) 0.54; 95% CI 0.32-0.91, P = 0.020]; however, high-risk patients with ≥2 risk factors did not (HR 1.02; 95% CI 0.48-2.14, P = 0.964). Patients treated with adjuvant chemotherapy showed no OS benefit compared with patients who received surgery alone (median 89.6 vs 86.8 months respectively, P = 0.833). CONCLUSIONS CRC patients received lung metastasectomy could have a DFS benefit from adjuvant chemotherapy, especially in low-risk patients. Larger, prospective studies are needed to evaluate the role of adjuvant chemotherapy after CRC lung metastasectomy.
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Affiliation(s)
- Hyung Soon Park
- Department of Pharmacology and Brain Korea 21 Plus Project for Medical Sciences, Yonsei University College of Medicine, Seoul, South Korea
| | - Minkyu Jung
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.
| | - Sang Joon Shin
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Su Jin Heo
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Chang Gon Kim
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Min Goo Lee
- Department of Pharmacology and Brain Korea 21 Plus Project for Medical Sciences, Yonsei University College of Medicine, Seoul, South Korea
| | - Seung Hoon Beom
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Chang Young Lee
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin Gu Lee
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Dae Joon Kim
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Joong Bae Ahn
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
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Kodama H, Yamakado K, Hasegawa T, Fujimori M, Yamanaka T, Takaki H, Uraki J, Nakatsuka A, Sakuma H. Radiofrequency Ablation Using a Multiple-Electrode Switching System for Lung Tumors with 2.0-5.0-cm Maximum Diameter: Phase II Clinical Study. Radiology 2015; 277:895-902. [PMID: 26053308 DOI: 10.1148/radiol.2015141153] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE To prospectively evaluate the safety and effectiveness of radiofrequency ablation (RFA) by using a multiple-electrode switching system to treat 2.0-5.0-cm lung tumors. MATERIALS AND METHODS The institutional review board approved this prospective phase II study. Written informed consent was obtained from all patients. Between September 2009 and July 2011, RFA using two or three radiofrequency (RF) electrodes and a multiple-electrode switching system was performed for malignant lung tumors with a maximum tumor diameter of 2.0-5.0 cm in nonsurgical candidates. The primary endpoint was safety, as evaluated using the Common Terminology Criteria for Adverse Events. Patients were observed for at least 1 year. Local tumor progression and overall survival were analyzed with the Kaplan-Meier method. RESULTS Thirty-three patients (26 men, seven women; mean age, 70.5 years ± 10.0; age range, 46-87 years) with 35 lung tumors with a mean maximum diameter of 3.0 cm ± 0.7 (standard deviation; range, 2.0-4.4 cm) underwent treatment in 35 sessions. No procedure-related death or grade 4 adverse events (AEs) occurred. Grade 3 AEs occurred in four patients (12%), with pleural effusion requiring chest tube placement in two patients, pneumothorax requiring pleural adhesion in one patient, and pulmonary hemorrhage requiring pulmonary artery coil embolization in one patient. Grade 2 AEs were detected in 13 patients (39%). The 1-year local tumor progression and overall survival rates were 12.7% (95% confidence interval [CI]: 1.0, 25.5) and 81.2% (95% CI: 67.6, 94.8). CONCLUSION RFA with a multiple-electrode switching system may be a safe therapeutic option with which to treat 2.0-5.0-cm lung cancer tumors.
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Affiliation(s)
- Hiroshi Kodama
- From the Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Koichiro Yamakado
- From the Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Takaaki Hasegawa
- From the Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Masashi Fujimori
- From the Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Takashi Yamanaka
- From the Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Haruyuki Takaki
- From the Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Junji Uraki
- From the Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Atsuhiro Nakatsuka
- From the Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Hajime Sakuma
- From the Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
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Patterns and Treatment of Recurrence Following Pulmonary Resection for Colorectal Metastases. World J Surg 2015; 39:1758-66. [DOI: 10.1007/s00268-015-3006-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Nomograms for predicting the prognosis of stage IV colorectal cancer after curative resection: a multicenter retrospective study. Eur J Surg Oncol 2015; 41:457-65. [PMID: 25697470 DOI: 10.1016/j.ejso.2015.01.026] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 01/02/2015] [Accepted: 01/19/2015] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Although stage IV colorectal cancer (CRC) encompasses a wide variety of clinical conditions with diverse prognoses, no statistical model for predicting the postoperative prognosis of stage IV CRC has been established. Thus, we here aimed to construct a predictive model for disease-free survival (DFS) and overall survival (OS) after curative surgery for stage IV CRC using nomograms. METHODS The study included 1133 stage IV CRC patients who underwent curative surgical resection in 19 institutions. Patients were divided into derivation (n = 586) and validation (n = 547) groups. Nomograms to predict the 1- and 3-year DFS rates and the 3- and 5-year OS rates were constructed using the derivation set. Calibration plots were constructed, and concordance indices (c-indices) were calculated. The predictive utility of the nomogram was validated in the validation set. RESULTS The postoperative carcinoembryonic antigen (CEA) level, depth of tumor invasion (T factor), lymph node metastasis (N factor), and number of metastatic organs were adopted as variables for the DFS-predicting nomogram, whereas the postoperative CEA level, T factor, N factor, and peritoneal dissemination were adopted for the nomogram to predict OS. The nomograms showed moderate calibration, with c-indices of 0.629 and 0.640 in the derivation set and 0.604 and 0.637 in the validation set for DFS and OS, respectively. CONCLUSIONS The nomograms developed were capable of estimating the probability of DFS and OS on the basis of only 4 variables, and may represent useful tools for postoperative surveillance of stage IV CRC patients in routine practice.
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Oh SY, Sohn SH, Yim H, Lee D, Suh KW, Kim YB. ALDH1 is a prognostic factor for patients treated with neoadjuvant chemoradiotherapy and radical resection for stage III rectal cancer. J Surg Oncol 2014; 111:243-7. [PMID: 25270363 DOI: 10.1002/jso.23792] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 08/25/2014] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND OBJECTIVES The factors relating to changes within a tumor after preoperative chemoradiotherapy associated with rectal cancer prognosis remain to be determined. The aim of this study was to investigate the expression of CD133 and ALDH1 and to analyze the predictive and prognostic roles in patients with rectal cancer after chemoradiotherapy. METHODS We analyzed the expression levels of ALDH1 and CD133 in patients with middle and lower rectal cancers who underwent preoperative chemoradiotherapy between March 2005 and December 2011. RESULTS The expression of CD133 was not associated with survival. The 5-year overall survival rates were lower in patients with high ALDH1 expression compared to low ALDH1 expression in stage III rectal cancer (61.0% vs. 89.7%, P=0.031). Cox multivariate analysis demonstrated that high ALDH1 expression (HR, 5.425; 95% CI, 1.116-26.373; P=0.036), cT (HR, 12.861; 95% CI, 2.188-75.591; P=0.005), and pN2 (HR, 28.481; 95% CI, 4.757-170.518; P<0.001) were independently associated with overall survival in 51 patients with stage III rectal cancer. CONCLUSIONS Expression of ALDH1 indicates a more aggressive feature of stage III rectal cancer and can stratify stage III rectal cancer into different survival groups.
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Affiliation(s)
- Seung Yeop Oh
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
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Ahmed S, Johnson K, Ahmed O, Iqbal N. Advances in the management of colorectal cancer: from biology to treatment. Int J Colorectal Dis 2014; 29:1031-42. [PMID: 24953060 DOI: 10.1007/s00384-014-1928-5] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/12/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) is the third most common malignant neoplasm worldwide and the fourth leading cause of cancer-related deaths. This article reviews the epidemiology, risk factors, pathogenesis, and prognosis of CRC with special emphasis on advances in the management of CRC over the past decade. METHODS A review of the published English literature was conducted using the search engines PubMed, Medline, EMBASE, and Google Scholar. A total of 127 relevant publications were identified for further review. RESULTS Most CRC are sporadic and are due to genetic instability and multiple somatic mutations. Approximately 80% of cancers are diagnosed at the early stage and are curable. The pathologic stage at presentation is the most important predictor of outcome after resection of early stage cancer. Surgery is the primary treatment modality for localized CRC. Advances in (neo)adjuvant chemotherapy and radiation have reduced the disease recurrence and increased survival in high risk diseases. Although recent advancements in combination chemotherapy and target agents have increased the survival of incurable CRC, it is remarkable that only selected patients with advanced CRC can be cured with multimodality therapy. CONCLUSION Over the past decade, there has seen substantial progress in our understanding of and in the management of CRC.
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Hirosawa T, Itabashi M, Ohnuki T, Yamaguchi N, Sugihara K, Kameoka S. Proposal of a new prognostic staging system for pulmonary metastases from colorectal cancer. Surg Today 2014; 45:576-84. [DOI: 10.1007/s00595-014-0986-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 04/14/2014] [Indexed: 02/08/2023]
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Costi R, Leonardi F, Zanoni D, Violi V, Roncoroni L. Palliative care and end-stage colorectal cancer management: The surgeon meets the oncologist. World J Gastroenterol 2014; 20:7602-7621. [PMID: 24976699 PMCID: PMC4069290 DOI: 10.3748/wjg.v20.i24.7602] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 04/09/2014] [Indexed: 02/07/2023] Open
Abstract
Colorectal cancer (CRC) is a common neoplasia in the Western countries, with considerable morbidity and mortality. Every fifth patient with CRC presents with metastatic disease, which is not curable with radical intent in roughly 80% of cases. Traditionally approached surgically, by resection of the primitive tumor or stoma, the management to incurable stage IV CRC patients has significantly changed over the last three decades and is nowadays multidisciplinary, with a pivotal role played by chemotherapy (CHT). This latter have allowed for a dramatic increase in survival, whereas the role of colonic and liver surgery is nowadays matter of debate. Although any generalization is difficult, two main situations are considered, asymptomatic (or minimally symptomatic) and severely symptomatic patients needing aggressive management, including emergency cases. In asymptomatic patients, new CHT regimens allow today long survival in selected patients, also exceeding two years. The role of colonic resection in this group has been challenged in recent years, as it is not clear whether the resection of primary CRC may imply a further increase in survival, thus justifying surgery-related morbidity/mortality in such a class of short-living patients. Secondary surgery of liver metastasis is gaining acceptance since, under new generation CHT regimens, an increasing amount of patients with distant metastasis initially considered non resectable become resectable, with a significant increase in long term survival. The management of CRC emergency patients still represents a major issue in Western countries, and is associated to high morbidity/mortality. Obstruction is traditionally approached surgically by colonic resection, stoma or internal by-pass, although nowadays CRC stenting is a feasible option. Nevertheless, CRC stent has peculiar contraindications and complications, and its long-term cost-effectiveness is questionable, especially in the light of recently increased survival. Perforation is associated with the highest mortality and remains mostly matter for surgeons, by abdominal lavage/drainage, colonic resection and/or stoma. Bleeding and other CRC-related symptoms (pain, tenesmus, etc.) may be managed by several mini-invasive approaches, including radiotherapy, laser therapy and other transanal procedures.
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Kim HK, Cho JH, Lee HY, Lee J, Kim J. Pulmonary metastasectomy for colorectal cancer: How many nodules, how many times? World J Gastroenterol 2014; 20:6133-6145. [PMID: 24876735 PMCID: PMC4033452 DOI: 10.3748/wjg.v20.i20.6133] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 11/01/2013] [Accepted: 03/05/2014] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer (CRC) is one of the most common cancers worldwide, with 5%-15% of CRC patients eventually developing lung metastasis (LM). Despite doubts about the role of locoregional therapy in the management of systemic disease, many surgeons have performed pulmonary metastasectomy (PM) for CRC in properly selected patients. However, the use of pulmonary metastasectomy remains controversial due to the lack of randomized controlled studies. This article reviews the results of surgical treatment of pulmonary metastases for CRC, focusing on (1) current treatment guidelines and surgical techniques of PM in patients with LM from CRC; (2) outcomes of PM and its prognostic factors; and (3) controversial issues in PM, focusing on repeated metastasectomy, bilateral multiple metastases, and combined liver and lung metastasectomy.
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Kobayashi N, Kohno T, Haruta S, Fujimori S, Shinohara H, Ueno M, Udagawa H. Pulmonary metastasectomy secondary to esophageal carcinoma: long-term survival and prognostic factors. Ann Surg Oncol 2014; 21 Suppl 3:S365-9. [PMID: 24796966 DOI: 10.1245/s10434-014-3677-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Indexed: 12/21/2022]
Abstract
BACKGROUND Lung metastasectomy has become an effective treatment for selected patients with colorectal cancer, renal cancer, and other malignancies; however, limited experience has been reported regarding pulmonary metastasectomy for esophageal carcinoma. We reviewed 23 patients with esophageal cancer who underwent pulmonary metastasectomy and investigated their long-term prognosis and prognostic factors. METHODS A total of 23 patients who underwent 30 curative pulmonary metastasectomies at Toranomon Hospital, Japan, between 2001 and 2011 were included. Four patients underwent repeated metastasectomy. The overall survival rate was examined by the Kaplan-Meier method and various characteristics were assessed by univariate analysis to identify prognostic factors. RESULTS The overall 1-, 3-, and 5-year survival rate was 82.6, 46, and 34.1 %, respectively. Median follow-up was 37.4 months (range 1-114 months). Univariate analysis revealed a history of extrapulmonary metastases before pulmonary metastasectomy, poorly differentiated primary esophageal carcinoma, and short disease-free interval (DFI) as unfavorable prognostic factors. Five patients who underwent repeated metastasectomy for recurrent pulmonary metastases survived a mean 58 months (range 24-114 months). The other patients survived a mean 29.4 months (range 1-109 months). CONCLUSIONS Pulmonary resection for lung metastases from esophageal carcinoma should be considered in selected patients, and repeated metastasectomy should be encouraged. Extrapulmonary metastases before pulmonary metastasectomy, poor differentiation of primary esophageal carcinoma, and short DFI are unfavorable prognostic factors. Due to poor prognosis, metastasectomy in patients with these factors should be more carefully considered before being indicated.
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Affiliation(s)
- Nao Kobayashi
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan,
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Analysis of treatment that includes both hepatic and pulmonary resections for colorectal metastases. Surg Today 2013; 44:702-11. [PMID: 24170275 DOI: 10.1007/s00595-013-0769-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 03/04/2013] [Indexed: 12/23/2022]
Abstract
PURPOSE Hepatic or pulmonary resections for colorectal metastases are regarded as standard treatment worldwide; however, the clinical significance of both hepatic and pulmonary resections for colorectal metastases remains undefined. We reviewed our clinical experience to evaluate the benefit of this treatment. METHODS Between 1986 and 2010, 186 patients underwent potentially curative hepatic and/or pulmonary resections for colorectal metastases. Of these patients, 25 underwent both treatments (Group C), 100 underwent hepatic resections alone (Group H), and 61 underwent pulmonary resections alone (Group L). Univariate and multivariate analyses of the clinical and pathological variables in Group C and comparative survival analyses between Group C and Groups H-L were performed. RESULTS In Group C, the median survival after primary tumor resection, initial metastasectomy, and last metastasectomy were 97, 60, and 35 months, respectively, and the 5-year overall survival rates were 63, 54, and 38%, respectively. Multivariate analyses after initial metastasectomy revealed rectal tumors, multiple hepatic tumors, and simultaneous metastases as poor prognostic factors. Comparative survival analyses revealed no significant difference in overall survival between Group C and Groups H-L. CONCLUSION Hepatic and pulmonary resections for colorectal metastases improve survival and may even offer the potential for cure in selected patients.
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Perera NK, Knight SR. Outcomes after pulmonary metastasectomy for colorectal cancer. ANZ J Surg 2013; 84:556-9. [PMID: 24103011 DOI: 10.1111/ans.12387] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2013] [Indexed: 01/18/2023]
Abstract
BACKGROUND Surgical resection offers the greatest likelihood of cure for appropriately selected patients with pulmonary colorectal carcinoma metastases. We hereby report our experience over the last 19 years at the Austin Hospital, Thoracic Surgery Unit. METHODS This is a retrospective study of a consecutive series of patients with pulmonary colorectal cancer metastases. From 1994 to 2012, 66 patients underwent 83 pulmonary metastasectomies for colorectal cancer at the Austin Hospital. RESULTS Seventy per cent of patients were operated on for single pulmonary metastases. The most common procedure performed was a video-assisted thoracoscopic surgery wedge resection. Median follow-up duration was 25 months. Three-, five-, seven- and ten-year survival was 53.4, 39.6, 34.6 and 23.1%, respectively. CONCLUSION Pulmonary metastasectomy for metastatic colorectal carcinoma continues to offer the greatest survival advantage for appropriately selected patients.
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Affiliation(s)
- Nisal K Perera
- Department of Thoracic Surgery, Austin Hospital, The University of Melbourne, Heidelberg, Victoria, Australia
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Broadbridge VT, Karapetis CS, Beeke C, Woodman RJ, Padbury R, Maddern G, Kim SW, Roder D, Hakendorf P, Price TJ. Do metastatic colorectal cancer patients who present with late relapse after curative surgery have a better survival? Br J Cancer 2013; 109:1338-43. [PMID: 23860523 PMCID: PMC3778277 DOI: 10.1038/bjc.2013.388] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 06/17/2013] [Accepted: 06/24/2013] [Indexed: 12/12/2022] Open
Abstract
Background: Patients who relapse after potentially curative surgery for colorectal cancer tend to relapse within 5 years. There is, however, a group of patients who relapse beyond 5 years after resection and this late relapsing group may have a different behaviour and prognosis. Methods: We analysed data from a prospective population-based registry to compare the characteristics and survival of relapsed patients with metachronous mCRC. Patients were categorised into relapse at <2, 2–5 and >5 years following their initial surgery. Univariate log-rank tests and multivariate Cox regression was performed to determine whether time to relapse (TTR) and other factors were associated with overall survival (OS). Results: A total of 750 metachronous mCRC patients were identified. In all, 56% relapsed ⩽2 years, 32.4% at 2–5 years and 11.6% >5 years. Median survival time from the time of diagnosis of mCRC for the three groups was 17.6, 26.1 and 27.5 months, respectively. Short TTR (<2 years) was significantly associated with survival (HR=0.75, 95% confidence interval (CI)=0.60–0.93 and HR=0.73, 95% CI=0.53–1.01, respectively, for 2–5 and >5 years vs <2 years, P<0.05). However, there was no significant difference in survival between patients who relapsed at 5 years or later compared with those who relapsed between 2 and 5 years (HR=0.98, 95% CI=0.69–1.38, P=0.90). Conclusion: TTR within 2 years is an independent predictor of shorter survival time for mCRC patients who experience a relapse. These data do not support the hypothesis that patients who have late relapse late (>5 years) have a ‘better' biology or survival compared with patients with a TTR of 2–5 years.
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Affiliation(s)
- V T Broadbridge
- Department of Medical Oncology, The Queen Elizabeth Hospital, Woodville, South Australia, Australia
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Ge J, Gou HF, Chen Y, Cheng K, Li LH, Dong H, Gao F, Zhao F, Men HT, Li Q, Qiu M, Su JM, Xu F, Bi F, Liu JY. Clinical characteristics of patients with solitary pulmonary mass after radical treatment for primary cancers: pulmonary metastasis or second primary lung cancer? Cancer Invest 2013; 31:397-403. [PMID: 23758185 DOI: 10.3109/07357907.2013.800092] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
We identified clinical characteristics of 30 pulmonary metastasis (PM) patients and 29 second primary lung cancer (SPLC) patients with feature of solitary pulmonary mass (SPM) after radical treatment of prior cancers. 6.7% and 44.8% patients presented with centrally located SPM and the median event-free durations were 33 and 72 months in PM and SPLC groups, respectively. PM was more likely to be found in prior cancers with stage III. In conclusion, the location of SPM, the event-free duration and the prior tumor staging were important features for differentiating SPLC from PM among patients with SPM after prior cancers.
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Affiliation(s)
- Jun Ge
- Department of Medical Oncology, Cancer Center, The State Key Laboratory of Biotherapy, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan Province, China
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Schlijper RCJ, Grutters JPC, Houben R, Dingemans AMC, Wildberger JE, Van Raemdonck D, Van Cutsem E, Haustermans K, Lammering G, Lambin P, De Ruysscher D. What to choose as radical local treatment for lung metastases from colo-rectal cancer: surgery or radiofrequency ablation? Cancer Treat Rev 2013; 40:60-7. [PMID: 23768754 DOI: 10.1016/j.ctrv.2013.05.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Revised: 05/08/2013] [Accepted: 05/20/2013] [Indexed: 12/24/2022]
Abstract
BACKGROUND Long-term survival can be obtained with local treatment of lung metastases from colorectal cancer. However, it is unclear as to what the optimal local therapy is: surgery, radiofrequency ablation (RFA) or stereotactic radiotherapy (SBRT). METHODS A systematic review included 27 studies matching with the a priori selection criteria, the most important being ≥50 patients and a follow-up period of ≥24months. No SBRT studies were eligible. The review was therefore conducted on 4 RFA and 23 surgical series. RESULTS Four of the surgical studies were prospective, all others were retrospective. No randomized trial was found. The reporting of data differed between the studies, which led to difficulties in the analyses. Treatment-related mortality rates for RFA and surgery were 0% and 1.4-2.4%, respectively, whereas morbidity rates were reported inconsistently but seemed the lowest for surgery. CONCLUSION Due to the lack of phase III trials, no firm conclusions can be drawn, although most evidence supports surgery as the most effective treatment option. High-quality trials comparing currently used treatment modalities such as SBRT, RFA and surgery are needed to inform treatment decisions.
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Affiliation(s)
- Roel C J Schlijper
- Maastricht University, Faculty of Health, Medicine and Life Sciences, School of Medicine, Maastricht, The Netherlands; Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
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