Tomoyuki Hishida1, Masahiro Tsuboi2, Takehiro Okumura3, Narikazu Boku4, Yasuhisa Ohde5, Yukinori Sakao6, Katsuo Yoshiya7, Ichinosuke Hyodo8, Keita Mori9, Haruhiko Kondo10. 1. Department of Thoracic Surgery, National Cancer Center Hospital East, Chiba, Japan. Electronic address: thishida@nifty.com. 2. Department of Thoracic Surgery, National Cancer Center Hospital East, Chiba, Japan. 3. Department of Surgery, University Hospital Mizonokuchi, Teikyo University School of Medicine, Kanagawa, Japan. 4. Division of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan. 5. Division of Thoracic Surgery, Shizuoka Cancer Center, Shizuoka, Japan. 6. Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan. 7. Department of Chest Surgery, Niigata Cancer Center Hospital, Niigata, Japan. 8. Division of Gastroenterology Clinical Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan. 9. Clinical Research Support Center, Shizuoka Cancer Center, Shizuoka, Japan. 10. General Thoracic Surgery, Kyorin University School of Medicine, Tokyo, Japan.
Abstract
BACKGROUND: The purpose of this study was to clarify the long-term survival outcomes after repeated lung resection (RLR) of pulmonary metastases from colorectal cancer (PM-CRC) using data from a Japanese nationwide investigation. METHODS: Among 898 patients who underwent R0 resection of PM-CRC at 46 Japanese institutions between 2004 and 2008, we analyzed the data of 216 patients who experienced recurrence limited to the lung after initial resection of PM-CRC. Overall survival (OS) after RLR was analyzed, and prognostic factors were explored using a multivariate Cox analysis. RESULTS: Of a total 216 patients, 132 (61%) received RLR, and their 5-year OS rate was 75.3%. Twenty-two patients underwent a second RLR, and 2 patients underwent a third RLR; a favorable survival outcome was observed even after a second RLR (5-year OS rate, 55.1%). The prognostic factors associated with worse survival after RLR were concomitant liver metastasis, which had been completely resected or ablated at the initial lung metastasectomy (hazard ratio [HR], 4.84; 95% confidence interval [CI], 1.48-14.8) and location of the primary tumor in the rectum (HR, 3.16; 95% CI, 1.17-9.35). Patients without these 2 poor prognostic factors (n = 58) showed a 5-year OS rate of 82.6% after RLR. CONCLUSIONS: This nationwide database study showed that RLR for resectable lung-limited recurrence after PM-CRC resection could provide favorable survival, especially for patients with colon cancer without liver metastases at the initial PM-CRC resection.
BACKGROUND: The purpose of this study was to clarify the long-term survival outcomes after repeated lung resection (RLR) of pulmonary metastases from colorectal cancer (PM-CRC) using data from a Japanese nationwide investigation. METHODS: Among 898 patients who underwent R0 resection of PM-CRC at 46 Japanese institutions between 2004 and 2008, we analyzed the data of 216 patients who experienced recurrence limited to the lung after initial resection of PM-CRC. Overall survival (OS) after RLR was analyzed, and prognostic factors were explored using a multivariate Cox analysis. RESULTS: Of a total 216 patients, 132 (61%) received RLR, and their 5-year OS rate was 75.3%. Twenty-two patients underwent a second RLR, and 2 patients underwent a third RLR; a favorable survival outcome was observed even after a second RLR (5-year OS rate, 55.1%). The prognostic factors associated with worse survival after RLR were concomitant liver metastasis, which had been completely resected or ablated at the initial lung metastasectomy (hazard ratio [HR], 4.84; 95% confidence interval [CI], 1.48-14.8) and location of the primary tumor in the rectum (HR, 3.16; 95% CI, 1.17-9.35). Patients without these 2 poor prognostic factors (n = 58) showed a 5-year OS rate of 82.6% after RLR. CONCLUSIONS: This nationwide database study showed that RLR for resectable lung-limited recurrence after PM-CRC resection could provide favorable survival, especially for patients with colon cancer without liver metastases at the initial PM-CRC resection.
Authors: Riccardo Lemini; Kristopher Attwood; Tariq Almerey; Jinny Gunn; Tamanie E Yeager; Alexandra W Elias; Kristin Partain; Matthew S Jorgensen; Wenyan Ji; Emmanuel M Gabriel; Dorin T Colibaseanu Journal: J Gastrointest Oncol Date: 2019-12