Takehiro Okumura1, Narikazu Boku2, Tomoyuki Hishida3, Yasuhisa Ohde4, Yukinori Sakao5, Katsuo Yoshiya6, Masahiko Higashiyama7, Ichinosuke Hyodo8, Keita Mori9, Haruhiko Kondo10. 1. Department of Surgery, University Hospital Mizonokuchi, Teikyo University School of Medicine, Kanagawa, Japan. Electronic address: taokumura@gmail.com. 2. Division of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan. 3. Department of Thoracic Surgery, National Cancer Center Hospital East, Chiba, Japan. 4. Division of Thoracic Surgery, Shizuoka Cancer Center, Shizuoka, Japan. 5. Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan. 6. Department of Chest Surgery, Niigata Cancer Center Hospital, Niigata, Japan. 7. Department of General Thoracic Surgery, Osaka Medical Center for Cancer & Cardiovascular Diseases, Osaka, Japan. 8. Division of Gastroenterology Clinical Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan. 9. Clinical Research Support Center, Niigata Cancer Center Hospital, Niigata, Japan. 10. General Thoracic Surgery, School of Medicine, Kyorin University, Tokyo, Japan.
Abstract
BACKGROUND: This study investigated recent clinical outcomes and prognostic factors of metastasectomy for pulmonary metastasis (PM) from colorectal cancer. METHODS: Data for 785 patients with PM from colorectal cancer who underwent curative resection, including 376 patients treated with postmetastasectomy adjuvant chemotherapy, between 2004 and 2008, were collected from 46 Japanese hospitals. Disease-free and overall survival was analyzed. Potential prognostic factors were assessed. RESULTS: The 5-year disease-free and overall survival rates (95% confidence interval) of all patients were 37.1% (33.7% to 40.9%) and 68.1% (64.6% to 71.8%), respectively, over a median follow-up of 65 months. On multivariable analysis, no survival benefit for postmetastasectomy adjuvant chemotherapy was observed (hazard ratio, 0.85; 95% confidence interval, 0.65 to 1.12; p = 0.25), and the independent poor prognostic factors for overall survival (hazard ratio, 95% confidence interval) were age 70 years and older (1.50, 1.15 to 1.97), disease-free interval of less than 2 years (1.76, 1.31 to 2.35), extrathoracic metastatic lesion treated curatively before PM resection (1.35, 1.01 to 1.79), abnormal carcinoembryonic antigen level (1.99, 1.53 to 2.58), and three or more PMs (1.72, 1.20 to 2.45). The 5-year overall survival rates (95% confidence interval) of the low-risk (no prognostic factor, n = 87), moderate-risk (1 to 2 factors, n = 539), and high-risk (≥3 factors, n = 159) groups were 89.4% (82.2% to 98.2%), 72.5% (68.3% to 76.8%), and 48.9% (41.7% to 57.3%), respectively. CONCLUSIONS: Metastasectomy of PM from colorectal cancer was associated with a favorable prognosis. Patients could be classified into three risk groups using five prognostic factors. This grouping may be useful for identifying an optimal treatment strategy according to risk in future studies.
BACKGROUND: This study investigated recent clinical outcomes and prognostic factors of metastasectomy for pulmonary metastasis (PM) from colorectal cancer. METHODS: Data for 785 patients with PM from colorectal cancer who underwent curative resection, including 376 patients treated with postmetastasectomy adjuvant chemotherapy, between 2004 and 2008, were collected from 46 Japanese hospitals. Disease-free and overall survival was analyzed. Potential prognostic factors were assessed. RESULTS: The 5-year disease-free and overall survival rates (95% confidence interval) of all patients were 37.1% (33.7% to 40.9%) and 68.1% (64.6% to 71.8%), respectively, over a median follow-up of 65 months. On multivariable analysis, no survival benefit for postmetastasectomy adjuvant chemotherapy was observed (hazard ratio, 0.85; 95% confidence interval, 0.65 to 1.12; p = 0.25), and the independent poor prognostic factors for overall survival (hazard ratio, 95% confidence interval) were age 70 years and older (1.50, 1.15 to 1.97), disease-free interval of less than 2 years (1.76, 1.31 to 2.35), extrathoracic metastatic lesion treated curatively before PM resection (1.35, 1.01 to 1.79), abnormal carcinoembryonic antigen level (1.99, 1.53 to 2.58), and three or more PMs (1.72, 1.20 to 2.45). The 5-year overall survival rates (95% confidence interval) of the low-risk (no prognostic factor, n = 87), moderate-risk (1 to 2 factors, n = 539), and high-risk (≥3 factors, n = 159) groups were 89.4% (82.2% to 98.2%), 72.5% (68.3% to 76.8%), and 48.9% (41.7% to 57.3%), respectively. CONCLUSIONS: Metastasectomy of PM from colorectal cancer was associated with a favorable prognosis. Patients could be classified into three risk groups using five prognostic factors. This grouping may be useful for identifying an optimal treatment strategy according to risk in future studies.
Authors: Bruna Pellini; Nadja Pejovic; Wenjia Feng; Noah Earland; Peter K Harris; Abul Usmani; Jeffrey J Szymanski; Faridi Qaium; Jacqueline Mudd; Marvin Petty; Yuqiu Jiang; Ashla Singh; Christopher A Maher; Lauren E Henke; Haeseong Park; Matthew A Ciorba; Hyun Kim; Matthew G Mutch; Katrina S Pedersen; Benjamin R Tan; William G Hawkins; Ryan C Fields; Aadel A Chaudhuri Journal: JCO Precis Oncol Date: 2021-02-12