Surgical Outcome and Prognostic Stratification for Pulmonary Metastasis from Colorectal Cancer

Takehiro Okumura, Narikazu Boku, Tomoyuki Hishida, Yasuhisa Ohde, Yukinori Sakao, Katsuo Yoshiya, Masahiko Higashiyama, Ichinosuke Hyodo, Keita Mori, Haruhiko Kondo

Research output: Contribution to journalArticle

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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.

Original languageEnglish
JournalAnnals of Thoracic Surgery
DOIs
Publication statusAccepted/In press - 2017
Externally publishedYes

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Colorectal Neoplasms
Neoplasm Metastasis
Lung
Metastasectomy
Confidence Intervals
Adjuvant Chemotherapy
Disease-Free Survival
Survival Rate
Survival
Carcinoembryonic Antigen
Therapeutics

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Surgical Outcome and Prognostic Stratification for Pulmonary Metastasis from Colorectal Cancer. / Okumura, Takehiro; Boku, Narikazu; Hishida, Tomoyuki; Ohde, Yasuhisa; Sakao, Yukinori; Yoshiya, Katsuo; Higashiyama, Masahiko; Hyodo, Ichinosuke; Mori, Keita; Kondo, Haruhiko.

In: Annals of Thoracic Surgery, 2017.

Research output: Contribution to journalArticle

Okumura, Takehiro ; Boku, Narikazu ; Hishida, Tomoyuki ; Ohde, Yasuhisa ; Sakao, Yukinori ; Yoshiya, Katsuo ; Higashiyama, Masahiko ; Hyodo, Ichinosuke ; Mori, Keita ; Kondo, Haruhiko. / Surgical Outcome and Prognostic Stratification for Pulmonary Metastasis from Colorectal Cancer. In: Annals of Thoracic Surgery. 2017.
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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.",
author = "Takehiro Okumura and Narikazu Boku and Tomoyuki Hishida and Yasuhisa Ohde and Yukinori Sakao and Katsuo Yoshiya and Masahiko Higashiyama and Ichinosuke Hyodo and Keita Mori and Haruhiko Kondo",
year = "2017",
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T1 - Surgical Outcome and Prognostic Stratification for Pulmonary Metastasis from Colorectal Cancer

AU - Okumura, Takehiro

AU - Boku, Narikazu

AU - Hishida, Tomoyuki

AU - Ohde, Yasuhisa

AU - Sakao, Yukinori

AU - Yoshiya, Katsuo

AU - Higashiyama, Masahiko

AU - Hyodo, Ichinosuke

AU - Mori, Keita

AU - Kondo, Haruhiko

PY - 2017

Y1 - 2017

N2 - 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.

AB - 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.

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