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Gooijer SA, Gazendam ASM, Torensma B, Tuynman JB, Dahele M, Heineman DJ, Braun J, Dickhoff C, Senan S, Schreurs WH, Schneiders FL, van Dorp M. Metastasectomy versus stereotactic body radiotherapy for patients with oligometastatic colorectal lung metastases: a systematic review. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2025; 51:110056. [PMID: 40300380 DOI: 10.1016/j.ejso.2025.110056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2024] [Revised: 03/27/2025] [Accepted: 04/12/2025] [Indexed: 05/01/2025]
Abstract
Metastasectomy and stereotactic body radiotherapy (SBRT) are both guideline-recommended treatment modalities for patients with oligometastatic colorectal lung metastases (CLM). Few evidence is available comparing different local therapies in an oligometastatic population. This systematic review aimed to compare the efficacy of metastasectomy with SBRT for patients with oligometastatic CLM. A systematic literature search was performed according to the PRISMA guidelines to identify studies on metastasectomy and SBRT for patients with oligometastatic CLM. Studies published between 2000 and 2023 were identified through Medline, Embase, and the Cochrane databases. Overall survival (OS), progression-free survival (PFS), and local recurrence rate (LRR) were assessed and compared between both groups. The risk of bias was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool. A total of 141 studies on metastasectomy (n = 29932) and 16 studies on SBRT (n = 1381) were included in the final analysis. The pooled five-year OS was 52.2 % (CI: 49.8-54.5) and 45.0 % (CI: 31.2-58.9) following metastasectomy and SBRT, respectively (p = 0.213). The pooled five-year PFS was 35.1 % (CI: 32.2-38.1) following metastasectomy and 11.7 % (CI: 0-38.2) following SBRT (p < 0.001). The pooled LRR was 10.5 % (CI: 5.5-15.5) following metastasectomy and 28.1 % (CI: 20.8-35.4) following SBRT (p < 0.001). The average GRADE score of the included studies was low. The data suggest that patients with oligometastatic CLM have a comparable OS rate after metastasectomy or SBRT, but PFS and LRR favour a surgical approach. This systematic review supports initiating a randomized controlled trial comparing surgery and SBRT in operable patients with oligometastatic CLM.
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Affiliation(s)
- Simone A Gooijer
- Department of Surgery, Northwest Clinics, Alkmaar, the Netherlands; Department of Cardiothoracic Surgery, Amsterdam University Medical Centre, Amsterdam, the Netherlands.
| | | | - Bart Torensma
- Department of Anaesthesiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Jurriaan B Tuynman
- Department of Surgery, Amsterdam University Medical Centre, Amsterdam, the Netherlands; Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Max Dahele
- Department of Radiation Oncology, Amsterdam University Medical Centre, Amsterdam, the Netherlands; Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - David J Heineman
- Department of Cardiothoracic Surgery, Amsterdam University Medical Centre, Amsterdam, the Netherlands; Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Jerry Braun
- Department of Cardiothoracic Surgery, Amsterdam University Medical Centre, Amsterdam, the Netherlands; Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Chris Dickhoff
- Department of Cardiothoracic Surgery, Amsterdam University Medical Centre, Amsterdam, the Netherlands; Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Suresh Senan
- Department of Radiation Oncology, Amsterdam University Medical Centre, Amsterdam, the Netherlands; Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | | | - Famke L Schneiders
- Department of Radiation Oncology, Amsterdam University Medical Centre, Amsterdam, the Netherlands; Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Martijn van Dorp
- Department of Cardiothoracic Surgery, Amsterdam University Medical Centre, Amsterdam, the Netherlands; Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
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Tatsuta K, Sakata M, Kojima T, Booka E, Kurachi K, Takeuchi H. Updated insights into the impact of adjuvant chemotherapy on recurrence and survival after curative resection of liver or lung metastases in colorectal cancer: a rapid review and meta-analysis. World J Surg Oncol 2025; 23:56. [PMID: 39966950 PMCID: PMC11834510 DOI: 10.1186/s12957-025-03714-4] [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] [Subscribe] [Scholar Register] [Received: 11/25/2024] [Accepted: 02/11/2025] [Indexed: 02/20/2025] Open
Abstract
BACKGROUND Colorectal cancer (CRC) frequently metastasizes to the liver and lungs, leading to poor prognosis. Advances in chemotherapy, minimally invasive surgery, and perioperative care have expanded adjuvant chemotherapy (AC) regimens and eligibility for AC. However, the impact of AC after curative resection of distant metastases on recurrence and prognosis remains uncertain. This study evaluated the role of AC in CRC liver and lung metastases, focusing on cases with curative resection based on the latest studies published in the past five years. METHODS This systematic review followed PRISMA guidelines. Literature searches of Medline and Cochrane Library (2019-2023) identified studies on AC or observation after curative resection of CRC metastases, reporting outcomes such as overall survival (OS) and disease-free survival (DFS). Data analysis was performed using Review Manager and R software, with results expressed as hazard ratios (HR) and 95% confidence intervals (CI). RESULTS Seven studies met the eligibility criteria, including one randomized controlled trial and six retrospective studies, encompassing 1580 patients who underwent curative resection (R0) for CRC metastases. This meta-analysis showed a positive trend in OS for the AC group compared to that for the surgery-alone group (HR 0.86, 95% CI: 0.73-1.01; p = 0.06), but the difference was insignificant. AC significantly improved DFS (HR 0.81, 95% CI: 0.66-0.99; p = 0.04). Subgroup analysis indicated that AC significantly improved DFS and tended to improve OS for liver metastasis. In contrast, AC did not improve OS in cases of lung metastasis. CONCLUSIONS This meta-analysis suggests that AC demonstrated significant positive effects on DFS. Moreover, AC could contribute to improvements in OS. These findings, supported by the latest research, reinforce the recommendation of AC as a valuable strategy for improving both recurrence and survival outcomes in patients with curatively resected distant CRC metastases.
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Affiliation(s)
- Kyota Tatsuta
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Chuo-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Mayu Sakata
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Chuo-ku, Hamamatsu, Shizuoka, 431-3192, Japan.
| | - Tadahiro Kojima
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Chuo-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Eisuke Booka
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Chuo-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Kiyotaka Kurachi
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Chuo-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Hiroya Takeuchi
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Chuo-ku, Hamamatsu, Shizuoka, 431-3192, Japan
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Kobayashi T, Ishida M, Matsui H, Uehara H, I S, Yamada N, Igarashi Y, Hagiwara C, Mori Y, Taniguchi Y, Saito T, Hino H, Hirose Y, Murakawa T, Watanabe J. Relationship of Desmoplastic Reaction and Tumour Budding in Primary and Lung Metastatic Lesions of Colorectal Cancer and Their Prognostic Significance. Cancers (Basel) 2025; 17:583. [PMID: 40002175 PMCID: PMC11852406 DOI: 10.3390/cancers17040583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2024] [Revised: 02/03/2025] [Accepted: 02/07/2025] [Indexed: 02/27/2025] Open
Abstract
Background/Objectives: Histopathological indicators, including desmoplastic reaction (DR) and tumour budding (TB), are significant prognostic indicators for metastatic liver lesions in patients with colorectal cancer (CRC). However, the relationship of DR and TB in primary CRC and metastatic lung lesions and their prognostic significance has not yet been examined. This study aimed to elucidate the association of DR and TB in primary CRC and metastatic lung lesions. Methods: Patients with pT3 or pT4 CRC with lung metastasis who underwent surgical resection of the primary CRC and synchronous or metachronous metastatic lung lesions were enrolled. DR was classified into immature (IM) and non-IM types, and TB was classified into TB1 (<4 buds), TB2 (5-9 buds) and TB3 (≥10 buds) in both the primary CRC and metastatic lung lesions. Results: Overall, 40 patients with CRC (males, 21; females, 19; median age, 70 years; right-side colon, 6; left-side colon, 9; rectum, 25; pT3, 31; pT4, 9) were evaluated. Six and thirty-four patients were classified as having IM and non-IM DR in the metastatic lung lesions, respectively. Thirty-one, seven, and two patients were classified as having TB1, TB2, and TB3, respectively. There was no significant correlation between primary and lung metastatic lesions for DR (κ = 0.08, p = 0.086), whereas TB demonstrated a moderate correlation (κ = 0.47, p = 0.015). The presence of IM DR and TB2/3 in metastatic lung lesions significantly correlated with poor overall survival (p = 0.0020 and 0.044, respectively). Conclusions: histological indicators of metastatic lung lesions in CRC may provide important prognostic information for better patient care.
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Affiliation(s)
- Toshinori Kobayashi
- Department of Colorectal Surgery, Kansai Medical University, 2-5-1, Shinmachi, Hirakata 573-1010, Japan; (H.U.); (S.I.); (N.Y.); (Y.I.); (C.H.); (Y.M.); (J.W.)
| | - Mitsuaki Ishida
- Department of Pathology, Osaka Medical and Pharmaceutical University, 2-7, Daigaku-machi, Takatsuki 569-8686, Japan;
| | - Hiroshi Matsui
- Department of Thoracic Surgery, Kansai Medical University, 2-5-1, Shinmachi, Hirakata 573-1010, Japan; (H.M.); (Y.T.); (T.S.); (H.H.); (T.M.)
| | - Hiroki Uehara
- Department of Colorectal Surgery, Kansai Medical University, 2-5-1, Shinmachi, Hirakata 573-1010, Japan; (H.U.); (S.I.); (N.Y.); (Y.I.); (C.H.); (Y.M.); (J.W.)
| | - Shoichiro I
- Department of Colorectal Surgery, Kansai Medical University, 2-5-1, Shinmachi, Hirakata 573-1010, Japan; (H.U.); (S.I.); (N.Y.); (Y.I.); (C.H.); (Y.M.); (J.W.)
| | - Norikazu Yamada
- Department of Colorectal Surgery, Kansai Medical University, 2-5-1, Shinmachi, Hirakata 573-1010, Japan; (H.U.); (S.I.); (N.Y.); (Y.I.); (C.H.); (Y.M.); (J.W.)
| | - Yuto Igarashi
- Department of Colorectal Surgery, Kansai Medical University, 2-5-1, Shinmachi, Hirakata 573-1010, Japan; (H.U.); (S.I.); (N.Y.); (Y.I.); (C.H.); (Y.M.); (J.W.)
| | - Chie Hagiwara
- Department of Colorectal Surgery, Kansai Medical University, 2-5-1, Shinmachi, Hirakata 573-1010, Japan; (H.U.); (S.I.); (N.Y.); (Y.I.); (C.H.); (Y.M.); (J.W.)
| | - Yoshihiro Mori
- Department of Colorectal Surgery, Kansai Medical University, 2-5-1, Shinmachi, Hirakata 573-1010, Japan; (H.U.); (S.I.); (N.Y.); (Y.I.); (C.H.); (Y.M.); (J.W.)
| | - Yohei Taniguchi
- Department of Thoracic Surgery, Kansai Medical University, 2-5-1, Shinmachi, Hirakata 573-1010, Japan; (H.M.); (Y.T.); (T.S.); (H.H.); (T.M.)
| | - Tomohito Saito
- Department of Thoracic Surgery, Kansai Medical University, 2-5-1, Shinmachi, Hirakata 573-1010, Japan; (H.M.); (Y.T.); (T.S.); (H.H.); (T.M.)
| | - Haruaki Hino
- Department of Thoracic Surgery, Kansai Medical University, 2-5-1, Shinmachi, Hirakata 573-1010, Japan; (H.M.); (Y.T.); (T.S.); (H.H.); (T.M.)
| | - Yoshinobu Hirose
- Department of Pathology, Osaka Medical and Pharmaceutical University, 2-7, Daigaku-machi, Takatsuki 569-8686, Japan;
| | - Tomohiro Murakawa
- Department of Thoracic Surgery, Kansai Medical University, 2-5-1, Shinmachi, Hirakata 573-1010, Japan; (H.M.); (Y.T.); (T.S.); (H.H.); (T.M.)
| | - Jun Watanabe
- Department of Colorectal Surgery, Kansai Medical University, 2-5-1, Shinmachi, Hirakata 573-1010, Japan; (H.U.); (S.I.); (N.Y.); (Y.I.); (C.H.); (Y.M.); (J.W.)
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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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Gao Z, Jin X, Wu YC, Zhang SJ, Wu SK, Wang X. Effect of perioperative chemotherapy on resection of isolated pulmonary metastases from colorectal cancer: A single center experience. World J Gastrointest Oncol 2024; 16:3457-3470. [PMID: 39171184 PMCID: PMC11334032 DOI: 10.4251/wjgo.v16.i8.3457] [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: 06/21/2024] [Accepted: 06/27/2024] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND Numerous studies have assessed surgical resection as a standard treatment option for patients with colorectal cancer (CRC) and resectable pulmonary metastases (PM). However, the role of perioperative chemotherapy after complete resection of isolated PM from patients with CRC patients remains controversial. We hypothesize that perioperative chemotherapy does not provide significant survival benefits for patients undergoing resection of PM from CRC. AIM To determine whether perioperative chemotherapy affects survival after radical resection of isolated PM from CRC. METHODS We retrospectively collected demographic, clinical, and pathologic data on patients who underwent radical surgery for isolated PM from CRC. Cancer-specific survival (CSS) and disease-free survival were calculated using Kaplan-Meier analysis. Inter-group differences were compared using the log-rank test. For multivariate analysis, Cox regression was utilized when indicated. RESULTS This study included 120 patients with a median age of 61.6 years. The 5-year CSS rate was 78.2%, with 36.7% experiencing recurrence. Surgical resection for isolated PM resulted in a 5-year CSS rate of 50.0% for second metastases. Perioperative chemotherapy (P = 0.079) did not enhance survival post-resection. Factors associated with improved survival included fewer metastatic lesions [hazard ratio (HR): 2.51, P = 0.045], longer disease-free intervals (HR: 0.35, P = 0.016), and wedge lung resections (HR: 0.42, P = 0.035). Multiple PM predicted higher recurrence risk (HR: 2.22, P = 0.022). The log-rank test showed no significant difference in CSS between single and repeated metastasectomy (P = 0.92). CONCLUSION Perioperative chemotherapy shows no survival benefit post-PM resection in CRC. Disease-free intervals and fewer metastatic lesions predict better survival. Repeated metastasectomy is warranted for eligible patients.
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Affiliation(s)
- Zhao Gao
- Department of Medical Oncology, Peking University First Hospital, Beijing 10000, China
| | - Xuan Jin
- Department of Medical Oncology, Peking University First Hospital, Beijing 10000, China
| | - Ying-Chao Wu
- Department of General Surgery, Peking University First Hospital, Beijing 10000, China
| | - Shi-Jie Zhang
- Department of Thoracic Surgery, Peking University First Hospital, Beijing 10000, China
| | - Shi-Kai Wu
- Department of Medical Oncology, Peking University First Hospital, Beijing 10000, China
| | - Xin Wang
- Department of General Surgery, Peking University First Hospital, Beijing 10000, China
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Evdokimova SF, Bolotina LV, Kornietskaya AL, Sidorov DV, Kaprin AD. Adjuvant oxaliplatin-based chemotherapy comparing observation alone after radical resection of metachronous metastases of colorectal cancer: interim analysis. MEDITSINSKIY SOVET = MEDICAL COUNCIL 2024:154-160. [DOI: 10.21518/ms2023-453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
Abstract
Introduction. Despite the registered standard treatment option for patients who underwent radical resection for metachronous metastases of colorectal cancer (CRC), the feasibility of adjuvant chemotherapy (ACT) for all patients seems controversial. Due to studies demonstrating improved disease-free survival rates with postoperative chemotherapy vs observation, it would seem that there is reasonable expectation of improved overall survival (OS) rates, which, however, were not statistically different between groups. This article presents the interim results of our own study.Aim. To analyse the efficacy of ACT vs dynamic observation in patients who underwent surgery for metachronous metastases of colorectal cancer.Materials and methods. It was a prospective-retrospective, non-randomized, non-inferiority study. A total of 120 patients were recruited between June 2008 and September 2022. The ACT group included 71 patients. All patients received only oxaliplatin-based chemotherapy regimens; the dynamic observation group included 49 patients.Results. The interim analysis showed that the median disease-free survival (mDFS) in the ACT group (n = 71) was 20.9 months (13.7–28.3) vs 24.4 months in the dynamic observation group (n = 49) (11.1–37.7), HR: 0.76 (95% CI: 0.45–1.29), p = 0.29. Two-year disease-free survival (DFS) rates were 46.6% in the post-surgery chemotherapy (CT) group (n = 50) and 55.5% in the experimental group (n = 31), HR: 0.69 (95% CI: 0.39–1.2), p = 0.21.Conclusion. ACT has not improved the long-term treatment outcomes in patients who underwent radical resection for metachronous metastases of CRC.
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Affiliation(s)
| | | | | | | | - A. D. Kaprin
- Hertsen Moscow Oncology Research Institute; Peoples’ Friendship University of Russia
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Hashimoto S, Tominaga T, Nonaka T, Noda K, Kiya S, Shiraishi T, Oishi K, Takamura Y, Yamazaki S, Araki M, Sumida Y, Miyazaki T, Kamohara R, Morino S, Matsumoto K, Nakamura A, Nagayasu T. Long-term outcomes and early recurrence after resection for metachronous pulmonary metastases from colorectal cancer. Langenbecks Arch Surg 2023; 409:24. [PMID: 38158429 DOI: 10.1007/s00423-023-03209-4] [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: 09/30/2023] [Accepted: 12/17/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE Properly selecting patients for aggressive curative resection for pulmonary metastases (PMs) from colorectal cancer (CRC) is desirable. We purposed to clarify prognostic factors and risk factors for early recurrence after metachronous PM resection. METHODS Clinical data of 151 patients who underwent R0 resection for metachronous PMs from CRC at two institutions between 2008 and 2021 were reviewed. RESULTS Seventy-six patients (50.3%) were male, and the median age was 71 (42-91) years. The numbers of colon/rectal cancers were 76/75, with pStage I/II/III/IV/unknown in 15/34/86/13/3. The duration from primary surgery to PM was 19.7 (1.0-106.4) months. The follow-up period was 41.9 (0.3-156.2) months. The 1-, 3-, and 5-year recurrence-free survival (RFS) rates were 75.1%, 53.7%, and 51.1%, and the 1-, 3-, and 5-year overall survival (OS) rates were 97.7%, 87.5%, and 68.2%. On multivariate analysis, lymph node metastasis of the primary lesion (HR 1.683, 95%CI 1.003-2.824, p = 0.049) was an independent predictor of poor RFS, and history of resection for extrapulmonary metastasis (e-PM) (HR 2.328, 95%CI 1.139-4.761, p = 0.021) was an independent predictor of poor OS. Patients who experienced early recurrence (< 6 months) after PM resection showed poorer OS than others (3-year OS 50.8% vs. 90.2%, p = 0.002). On multivariate analysis, e-PM was an independent predictor of early recurrence after PM resection (OR 3.989, 95%CI 1.002-15.885, p = 0.049). CONCLUSION Since a history of e-PM was a predictor of early recurrence and poor OS after R0 resection for PM, surgical treatment of patients with a history of e-PM should be considered carefully.
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Affiliation(s)
- Shintaro Hashimoto
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8511, Japan
| | - Tetsuro Tominaga
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8511, Japan.
| | - Takashi Nonaka
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8511, Japan
| | - Keisuke Noda
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8511, Japan
| | - Soishiro Kiya
- Department of Surgery, Sasebo City General Hospital, Sasebo, Japan
| | - Toshio Shiraishi
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8511, Japan
| | - Kaido Oishi
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8511, Japan
| | - Yuma Takamura
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8511, Japan
| | - Shoto Yamazaki
- Department of Surgery, Sasebo City General Hospital, Sasebo, Japan
| | - Masato Araki
- Department of Surgery, Sasebo City General Hospital, Sasebo, Japan
| | - Yorihisa Sumida
- Department of Surgery, Sasebo City General Hospital, Sasebo, Japan
| | - Takuro Miyazaki
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8511, Japan
- Department of Surgery, Sasebo City General Hospital, Sasebo, Japan
| | - Ryotaro Kamohara
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8511, Japan
- Department of Surgery, Sasebo City General Hospital, Sasebo, Japan
| | - Shigeyuki Morino
- Department of Surgery, Sasebo City General Hospital, Sasebo, Japan
| | - Keitaro Matsumoto
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8511, Japan
| | - Akihiro Nakamura
- Department of Surgery, Sasebo City General Hospital, Sasebo, Japan
| | - Takeshi Nagayasu
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8511, Japan
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Evdokimova S, Kornietskaya A, Bolotina L, Sidorov D, Kaprin A. Postoperative Chemotherapy After Surgical Resection of Metachronous Metastases of Colorectal Cancer: A Systematic Review. World J Oncol 2023; 14:26-31. [PMID: 36895991 PMCID: PMC9990738 DOI: 10.14740/wjon1568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 02/02/2023] [Indexed: 03/01/2023] Open
Abstract
Currently, 6 months of perioperative or adjuvant chemotherapy (ACT) is a standard treatment option after radical surgical removal of metachronous metastases in patients with metastatic colorectal cancer (CRC). Data show that ACT improves relapse-free survival in such patients, although no difference in overall survival rate was observed. We perform a systematic review to evaluate the efficacy of adjuvant chemotherapy after radical resection of metachronous metastases in CRC.
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Affiliation(s)
- Sevindzh Evdokimova
- P. Hertsen Moscow Oncology Research Institute - Branch of the National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, Moscow125284, Russia
| | - Anna Kornietskaya
- Department of Chemotherapy, P. Hertsen Moscow Oncology Research Institute - Branch of the National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Larisa Bolotina
- Department of Chemotherapy, P. Hertsen Moscow Oncology Research Institute - Branch of the National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Dmitriy Sidorov
- Abdominal Oncology, City Clinical Oncological Hospital No. 1, Moscow 105005, Russia
| | - Andrey Kaprin
- P. Hertsen Moscow Oncology Research Institute - Branch of the National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, Moscow125284, Russia.,Urology Department, Peoples' Friendship University of Russia, Moscow117198, Russia
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Deng S, Jiang Z, Cao Y, Gu J, Mao F, Xue Y, Qin L, Liu K, Wang J, Wu K, Cai K. Development and validation of a prognostic scoring system for patients with colorectal cancer hepato-pulmonary metastasis: a retrospective study. BMC Cancer 2022; 22:643. [PMID: 35690752 PMCID: PMC9188712 DOI: 10.1186/s12885-022-09738-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hepato-pulmonary metastasis of colorectal cancer (CRC) is a rare disease with poor prognosis. This study aims to establish a highly efficient nomogram model to predict overall survival (OS) and cancer-specific survival (CSS) in patients with colorectal cancer hepato-pulmonary metastasis (CRCHPM). METHODS We retrospectively analyzed the data of patients with CRCHPM from SEER database and Wuhan Union Hospital Cancer Center (WUHCC). A total of 1250 CRCHPM patients were randomly assigned to the training, internal validation, and external validation cohorts from 2010 to 2016.Univariate and multivariate cox analysis were performed to identify independent clinicopathological predictors of OS and CSS, and a nomogram was constructed to predict OS and CSS in CRCHPM patients. RESULTS A nomogram of OS was constructed based on seven independent predictors of age, degree of differentiation, T stage, chemotherapy, number of lsampled lymph nodes, number of positive lymph nodes, and tumor size. Nomogram showed favorable sensitivity in predicting OS at 1, 3 and 5 years, with area under the receiver operating characteristic curve (AUROC) values of 0.802, 0.759 and 0.752 in the training cohort;0.814, 0.769 and 0.716 in the internal validation cohort;0.778, 0.756 and 0.753 in the external validation cohort, respectively. A nomogram of CSS was constructed based on three independent predictors of T stage, chemotherapy, and tumor size. The AUROC values of 1, 3 and 5 years were 0.709,0.588,0.686 in the training cohort; 0.751, 0.648,0.666 in the internal validation cohort;0.781,0.588,0.645 in the external validation cohort, respectively. Calibration curves, Concordance index (C-index), and decision curve analysis (DCA) results revealed that using our model to predict OS and CSS is more efficient than other single clinicopathological characteristics. CONCLUSION A nomogram of OS and CSS based on clinicopathological characteristics can be conveniently used to predict the prognosis of CRCHPM patients.
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Affiliation(s)
- Shenghe Deng
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Zhenxing Jiang
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Yinghao Cao
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Junnan Gu
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Fuwei Mao
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Yifan Xue
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Le Qin
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Ke Liu
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Jiliang Wang
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Ke Wu
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Kailin Cai
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China.
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10
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Chiappetta M, Salvatore L, Congedo MT, Bensi M, De Luca V, Petracca Ciavarella L, Camarda F, Evangelista J, Valentini V, Tortora G, Margaritora S, Lococo F. Management of single pulmonary metastases from colorectal cancer: State of the art. World J Gastrointest Oncol 2022; 14:820-832. [PMID: 35582100 PMCID: PMC9048528 DOI: 10.4251/wjgo.v14.i4.820] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/26/2021] [Accepted: 03/04/2022] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer (CRC) is one of the most common causes of death from cancer. Lung seeding occurs in approximately 10% of patients surgically treated for primary CRC with radical intent: the lung is the most common site of metastases after the liver. While surgical treatment of liver metastases is widely accepted to affect long-term outcomes, more controversial and not standardized is the therapy for CRC patients developing lung metastases. Experience suggests the potential curative role of pulmonary metastasectomy, especially in oligometastatic disease. However, the optimal strategy of care and the definition of prognostic factors after treatment still need to be defined. This review focused on the uncommon scenario of single pulmonary metastases from CRC. We explored pertinent literature and provide an overview of the epidemiology, clinical characteristics and imaging of single pulmonary metastases from CRC. Additionally, we identified the best available evidence for overall management. In particular, we analyzed the role and results of locoregional approaches (surgery, radiotherapy or ablative procedures) and their integration with systemic therapy.
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Affiliation(s)
- Marco Chiappetta
- Department of Thoracic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Lisa Salvatore
- Oncologia Medica Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Maria Teresa Congedo
- Department of Thoracic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Maria Bensi
- Oncologia Medica Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Viola De Luca
- Department of Radiation Therapy, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Leonardo Petracca Ciavarella
- Department of Thoracic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Floriana Camarda
- Oncologia Medica Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Jessica Evangelista
- Department of Thoracic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Vincenzo Valentini
- Department of Radiation Therapy, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Giampaolo Tortora
- Oncologia Medica Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Stefano Margaritora
- Department of Thoracic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Filippo Lococo
- Department of Thoracic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
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11
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Zha S, Li T, Zheng Q, Li L. Whether Patients With Stage Ⅱ/Ⅲ Colorectal Cancer Benefit From Adjuvant Chemotherapy: A Modeling Analysis of Literature Aggregate Data. Front Pharmacol 2022; 13:826785. [PMID: 35222041 PMCID: PMC8864068 DOI: 10.3389/fphar.2022.826785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 01/20/2022] [Indexed: 12/12/2022] Open
Abstract
Objective: This study used model analysis to clarify the benefits and risks of postoperative adjuvant chemotherapy compared with surgery alone in patients with stage II/III colorectal cancer. Methods: Clinical trials involving patients with stage II/III colorectal cancer who underwent surgery alone or those who received post-surgical adjuvant chemotherapy were searched in the PubMed and embase databases. By establishing a survival model, the overall survival (OS) and disease-free survival (DFS) of patients who underwent surgery alone or postoperative adjuvant chemotherapy were quantitatively analyzed to compare the differences between the two. In addition, the incidence of grade 3/4 adverse reactions in the adjuvant chemotherapy group was analyzed using the random effects model in the single-arm meta-analysis. Results: A total of 34 studies containing 33,069 patients were included in the analysis. This study found that postoperative adjuvant chemotherapy can effectively improve the OS and DFS of patients with colorectal cancer. The median OS of the adjuvant chemotherapy group and the surgery-only group was 118.8 months (95% CI: 96.6, 146.6) and 74.6 months (95% CI: 57.8, 96.1) respectively; and median DFS was 86.3 months (95% CI: 67.6, 110.6) and 40.8 months (95% CI: 23.7, 69.6) in the adjuvant chemotherapy and surgery-only groups, respectively. Common grade 3/4 adverse reactions in the adjuvant chemotherapy group include diarrhea, stomatitis, leukopenia, and nausea or vomiting, with an incidence of approximately 3%–6%. Conclusion: Patients with mid-stage colorectal cancer can benefit significantly from postoperative adjuvant chemotherapy. This study provides the necessary quantitative information for decision-making regarding the benefits and risks of receiving adjuvant chemotherapy after resection in patients with colorectal cancer.
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Affiliation(s)
- Sijie Zha
- Center for Drug Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ting Li
- Center for Drug Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qingshan Zheng
- Center for Drug Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lujin Li
- Center for Drug Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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12
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Ogawa H, Yajima T, Sohda M, Shirabe K, Saeki H. Role of surgical resection and its alternative local therapy for pulmonary metastasis of colorectal cancer. Ann Gastroenterol Surg 2021; 5:747-753. [PMID: 34755006 PMCID: PMC8560592 DOI: 10.1002/ags3.12472] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/20/2021] [Accepted: 05/01/2021] [Indexed: 12/23/2022] Open
Abstract
We reviewed surgical and alternative treatments for pulmonary metastasis of colorectal cancer, focusing on recent reports. The standard treatment for pulmonary metastasis of colorectal cancer is pulmonary resection, if resectable, despite the fact that the metastasis is hematogenous to distant organs. Guidelines in several countries, including Japan, have described pulmonary resection as a useful option because of the favorable long-term prognosis reported in various studies pertaining to pulmonary resection. The indications for pulmonary resection have been reviewed in several studies; additionally, the number of metastases, pretreatment carcinoembryonic antigen value, and disease-free interval from the primary resection to pulmonary recurrence have been proposed. However, no consensus has been reached to date. Contrastingly, recent advances in chemotherapy have remarkably improved the outcome of distant metastases, indicating that it is time to reconsider the significance of local treatment, including pulmonary resection. In addition to surgical resection, minimally invasive therapies, such as stereotactic body radiation therapy and radiofrequency ablation have been developed as local treatments for pulmonary metastases, and their long-term results have been reported. Prospective controlled trials and large-scale data analyses are needed to determine the best local treatment for pulmonary metastases and to find the appropriate indication for each treatment.
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Affiliation(s)
- Hiroomi Ogawa
- Department of General Surgical ScienceGraduate School of MedicineGunma UniversityMaebashiJapan
| | - Toshiki Yajima
- Department of General Surgical ScienceGraduate School of MedicineGunma UniversityMaebashiJapan
- Department of Innovative Cancer ImmunotherapyGraduate School of MedicineGunma UniversityMaebashiJapan
| | - Makoto Sohda
- Department of General Surgical ScienceGraduate School of MedicineGunma UniversityMaebashiJapan
| | - Ken Shirabe
- Department of General Surgical ScienceGraduate School of MedicineGunma UniversityMaebashiJapan
| | - Hiroshi Saeki
- Department of General Surgical ScienceGraduate School of MedicineGunma UniversityMaebashiJapan
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13
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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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14
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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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15
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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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16
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Wang H, Ye T, Cai Y, Chen W, Xie H, Ke C. Downregulation of Ascl2 promotes cell apoptosis by enhancing autophagy in colorectal cancer cells. J Gastrointest Oncol 2021; 12:630-638. [PMID: 34012655 DOI: 10.21037/jgo-21-183] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Colorectal cancer (CRC) is the third most common cancer, according to recently published literature. While the incidence and the mortality of CRC has decreased due to effective cancer screening measures, there has been an increase in the number of young patients diagnosed with colon cancer due to unclear reasons. As a target molecule of the Wnt signaling pathway, Ascl2 is an important marker of CRC stem cells and plays an important role in maintaining the nature of colon cancer stem/precursor cells. However, the role of Ascl2 in autophagy in CRC cells is rarely elucidated. Methods In this study, we found that Ascl2 was increased in CRC compared with adjacent tissue. Downregulation of Ascl2 in CRC cells could suppress proliferation and invasion, and induce apoptosis, of CRC cells. Moreover, we found that autophagy-relative protein LC3 increased after Ascl2 knockdown. Furthermore, we treated CRC cells with autophagy inhibitors 3-MA (3-Methyladenine) and CQ (Chloroquine). Results The results showed that autophagy inhibitors could prevent apoptosis, which was induced by Ascl2 knockdown. Finally, we confirmed that the downregulation of Ascl2 in CRC cells could alleviate the pathological process in vivo by xenograft experiment. Conclusions Our findings indicated that si-Ascl2 (small/short interfering) exerted a tumor suppression function in CRC by inducing autophagic cell death, and suggest that Ascl2 targeted therapy represents a novel strategy for CRC treatment.
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Affiliation(s)
- Huipeng Wang
- Department of General Surgery, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Tao Ye
- Department of General Surgery, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Yuankun Cai
- Department of General Surgery, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Wenjie Chen
- Department of General Surgery, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Hongwei Xie
- Department of General Surgery, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Chongwei Ke
- Department of General Surgery, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
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17
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Vidarsdottir H, Siesing C, Nodin B, Jönsson P, Eberhard J, Jirström K, Brunnström H. Clinical significance of RBM3 expression in surgically treated colorectal lung metastases and paired primary tumors. J Surg Oncol 2021; 123:1144-1156. [PMID: 33497473 DOI: 10.1002/jso.26375] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/18/2020] [Accepted: 12/25/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND The lungs are the second most common site of metastases in colorectal cancer (CRC). The aim of this study was to investigate prognostic factors, including RNA-binding motif protein 3 (RBM3) expression, in patients with CRC treated with pulmonary metastasectomy (PM). METHODS The cohort included all patients treated with PM at Skåne University Hospital, Lund, Sweden, from 2000 to 2014. Clinicopathological, treatment, and survival data were collected. Immunohistochemical staining of RBM3 was evaluated on tissue microarrays with samples from all lung metastases and a subset of paired primary tumors. Kaplan-Meier analysis and Cox proportional hazards modeling were applied to examine the associations of investigative factors with overall survival (OS) and recurrence-free survival. RESULTS In total, 216 patients with a primary tumor in the rectum (57%), left colon (34%), or right colon (9%) underwent PM. The 5-year OS rate was 56%. Age > 60 years, more than one metastasis, size of metastasis > 3 cm, disease-free interval < 24 months, low RBM3 score in the lung metastasis, and no adjuvant chemotherapy following PM were prognostic factors for shorter OS. CONCLUSIONS Several prognostic factors, including RBM3 expression, may be of aid in selecting CRC patients with lung metastases for PM as well as adjuvant therapy.
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Affiliation(s)
- Halla Vidarsdottir
- Department of Surgery, Helsingborg Hospital, Helsingborg, Sweden.,Department of Clinical Sciences Lund, Division of Pathology, Lund University, Lund, Sweden
| | - Christina Siesing
- Department of Clinical Sciences Lund, Division of Oncology and Therapeutic Pathology, Lund University, Lund, Sweden
| | - Björn Nodin
- Department of Clinical Sciences Lund, Division of Oncology and Therapeutic Pathology, Lund University, Lund, Sweden
| | - Per Jönsson
- Department of Clinical Sciences Lund, Division of Thoracic Surgery, Lund University, Lund, Sweden
| | - Jakob Eberhard
- Department of Clinical Sciences Lund, Division of Oncology and Therapeutic Pathology, Lund University, Lund, Sweden
| | - Karin Jirström
- Department of Clinical Sciences Lund, Division of Oncology and Therapeutic Pathology, Lund University, Lund, Sweden
| | - Hans Brunnström
- Department of Clinical Sciences Lund, Division of Pathology, Lund University, Lund, Sweden
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