Outcome of patients with colorectal cancer undergoing lung metastases resection: a single-institution retrospective analysis
Abstract
Introduction:
This study was undertaken to review a single-institution cohort of patients with metastatic colorectal cancer undergoing lung resection after a multidisciplinary evaluation and to investigate the main prognostic factors for survival.
Methods:
Medical records of 129 patients undergoing lung metastasectomy for colorectal cancer with curative intent from 2001 to 2017 were reviewed. Tissue samples from the primary tumor were analyzed with a multiplex genotyping system for the detection of mutations in RAS and BRAF genes. Survival analyses were carried out by the Kaplan-Meier method. Univariate and multivariable analyses were performed using the log-rank test and the Cox regression model.
Results:
Postoperative morbidity and mortality were 13.2% and 0%, respectively. At a median follow-up time of 62.5 months, median overall survival was 90.5 months and median relapse-free survival was 42.8 months. Multivariable analysis for overall survival identified synchronous versus metachronous metastatic presentation as the only prognostic factor, whereas relapse-free survival was independently associated with synchronous versus metachronous metastatic presentation, number of metastases, and postoperative chemotherapy.
Conclusions:
This study shows particularly favorable survival outcomes for patients undergoing lung metastasectomy. The validity of some of the main prognostic factors was confirmed and a positive effect of postoperative chemotherapy on relapse-free survival was shown. Contrary to other reports, the presence of KRAS mutations was not associated with significant survival differences. Further studies are needed in order to clarify the interactions between molecular, clinical, and pathologic characteristics and treatment-related factors.
Get full access to this article
View all access and purchase options for this article.
References
1. GLOBOCAN. World Health Organization International Agency for Research on Cancer, http://www.uicc.org/resources/globocan (2016).
2. Penna C, Nordlinger B. Colorectal metastasis (liver and lung). Surg Clin North Am 2002; 82: 1075–1090.
3. Cunningham D, Humblet Y, Siena S, et al. Cetuximab monotherapy and cetuximab plus irinotecan in irinotecan-refractory metastatic colorectal cancer. N Engl J Med 2004; 351: 337–345.
4. Giantonio BJ, Levy DE, O’Dwyer PJ, et al; Eastern Cooperative Oncology Group. A phase II study of high dose of bevacizumab in combination with irinotecan, 5-fluorouracil, leucovorin, as initial therapy for advanced colorectal cancers: results from the Eastern Cooperative Oncology Group Study E2200. Ann Oncol 2006; 17: 1399–1403.
5. Treasure T, Milosevic M, Fiorentino F, et al. History and present status of pulmonary metastasectomy in colorectal cancer. World J Gastroenterol 2014; 20: 14517–14526.
6. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: colon cancer, http://www.tri-kobe.org/nccn/guideline/colorectal/english/colon.pdf (2016).
7. Poston G, Guideline Development Group, National Institute for Health and Clinical Excellence. Colorectal cancer: the diagnosis and the management of colorectal cancer, http://guidance.nice.org.uk/CG131/Guidance/pdf/English (2011).
8. Treasure T, Fallowfield L, Lees B, et al. Pulmonary metastasectomy in colorectal cancer: the PulMiCC trial. Thorax 2012; 67: 185–187.
9. Treasure T, Farewell V, Macbeth F, et al. Pulmonary metastasectomy versus continued active monitoring in colorectal cancer (PulMiCC): a multicenter randomised clinical trial. Trials 2019; 20: 718.
10. Cooper JD. Randomized clinical trials for new surgical operations: square peg in a round hole? J Thorac Cardiovasc Surg 2010; 140: 743–746.
11. Pfannschmidt J, Hoffmann H, Dienemann H. Reported outcome factors for pulmonary resection in metastatic colorectal cancer. J Thorac Oncol 2010; 5(6 Suppl 2): S172–S178.
12. Pfannschmidt J, Dienemann H, Hoffmann H. Surgical resection of pulmonary metastases from colorectal cancer: a systematic review of published series. Ann Thorac Surg 2007; 84: 324–338.
13. Primrose J, Treasure T, Fiorentino F. Lung metastasectomy in colorectal cancer: is this surgery effective in prolonging life? Respirology 2010; 15: 742–746.
14. Brunelli A, Kim AW, Berger KI, et al. Physiologic evaluation of the patient with lung cancer being considered for resectional surgery: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2013; 143(5 Suppl): e166–e190S.
15. Pastorino U, Buyse M, Friedel G, et al. Long-term results of lung metastasectomy: prognostic analyses based on 5206 cases. J Thorac Cardiovasc Surg 1997; 113: 37–49.
16. Gonzalez M, Poncet A, Comberscure C, et al. Risk factors for survival after lung metastasectomy in colorectal cancer patients: a systematic review and meta-analysis. Ann Surg Oncol 2013; 20: 572–579.
17. Nakajima J, Iida T, Okumura S, et al. Recent improvement of survival prognosis after pulmonary metastasectomy and advanced chemotherapy for patients with colorectal cancer. Eur J Cardiothorac Surg 2017; 51: 869–873.
18. Numan RC, Baas P, Klomp HM, et al. Optimal surgical management of pulmonary metastases: VATS versus thoracotomy. Respirology 2016; 21: 188–190.
19. Gossot D, Radu C, Girard P, et al. Resection of pulmonary metastases from sarcoma: can some patients benefit from a less invasive approach? Ann Thorac Surg 2009; 87: 238–243.
20. Cerfolio RJ, McCarty T, Bryant AS. Non-imaged pulmonary nodules discovered during thoracotomy for metastasectomy by lung palpation. Eur J Cardiothorac Surg 2009; 3: 786–791; discussion 791.
21. Meng D, Fu L, Wang L, et al. Video-assisted thoracoscopic surgery versus open thoracotomy in pulmonary metastasectomy: a meta-analysis of observational studies. Interact Cardiovasc Thorac Surg 2016; 22: 200–206.
22. Abdelnour-Berchtold E, Perentes JY, Ris HB, et al. Survival and local recurrence after video-assisted thoracoscopic lung metastasectomy. World J Surg 2016; 40: 373–379.
23. Pasalic D, Lu Y, Betancourt-Cuellar SL, et al. Stereotactic ablative radiation therapy for pulmonary metastases: improving overall survival and identifying subgroups at high risk of local failure. Radiother Oncol 2020; 145: 178–185.
24. Qiu H, Katz AW, Chowdhry AK, et al. Stereotactic body radiotherapy for lung metastases from colorectal cancer: prognostic factors for disease control and survival. Am J Clin Oncol 2018; 41: 53–58.
25. Guerrera F, Falcoz P-E, Renaud S, et al. Does perioperative chemotherapy improve survival in patients with resectable lung metastases of colorectal cancer? Interact CardioVasc Thorac Surg 2017; 24: 789–791.
26. Schweiger T, Hegedüs B, Nikolowsky C, et al. EGFR, BRAF and KRAS status in patients undergoing pulmonary metastasectomy from primary colorectal carcinoma: a prospective follow-up study. Ann Surg Oncol 2014; 21: 946–954.
27. Renaud S, Romain B, Falcoz P-E, et al. KRAS and BRAF mutations are prognostic biomarkers in patients undergoing lung metastasectomy of colorectal cancer. Br J Cancer 2015; 112: 720–728.
28. Ghidini M, Personeni N, Bozzarelli S, et al. KRAS mutation in lung metastases from colorectal cancer: prognostic implications. Cancer Med 2016; 5: 256–264.
29. Kim HS, Heo JS, Lee J, et al. The impact of KRAS mutations on prognosis in surgically resected colorectal cancer patients with liver and lung metastases: a retrospective analysis. BMC Cancer 2016; 16: 120.
30. Cejas P, López-Gómez M, Aguayo C, et al. KRAS mutations in primary colorectal cancer tumors and related metastases: a potential role in prediction of lung metastasis. PLoS One 2009; 4: e8199.
31. Moorcraft SY, Jones T, Walker BA, et al. Molecular profiling of colorectal pulmonary metastases and primary tumors: implications for targeted treatment. Oncotarget 2017; 8: 64999–65008.
32. Schweiger T, Starkl V, Glueck O, et al. Clinical impact of c-MET expression and mutational status in patients with colorectal cancer lung metastases. Eur J Cardiothorac Surg 2016; 49: 1103–1111; discussion 1111.
33. Mlecnik B, Van den Eynde M, Bindea G, et al. Comprehensive intrametastatic immune quantification and major impact of immunoscore on survival. J Natl Cancer Inst 2017; 110: 1–12.
34. Istituto Oncologico Veneto. Patients with lung metastases from colorectal cancer treated with surgery: a retrospective analysis of clinical, biomolecular and pathological determinants of Outcome: THE PLUTO STUDY Versione 1.0_del_20/10/2017. Padova, Italy: Istituto Oncologico Veneto; 2017.
35. Renaud S, Guerrera F, Seitlinger J, et al. KRAS exon 2 codon 13 mutation is associated with a better prognosis than codon 12 mutation following lung metastasectomy in colorectal cancer. Oncotarget 2017; 8: 2514–2524.
36. Siddiqui AD, Piperdi B. KRAS mutation in colon cancer: a marker of resistance to EGFR-I therapy. Ann Surg Oncol 2010; 17: 1168–1176.
Cite article
Cite article
Cite article
OR
Download to reference manager
If you have citation software installed, you can download article citation data to the citation manager of your choice
Information, rights and permissions
Information
Published In
Article first published online: June 29, 2020
Issue published: February 2021
Keywords
PubMed: 32597321
Authors
Metrics and citations
Metrics
Article usage*
Total views and downloads: 910
*Article usage tracking started in December 2016
Articles citing this one
Receive email alerts when this article is cited
Web of Science: 2 view articles Opens in new tab
Crossref: 2
- Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC) randomized controlled trial: a systematic review of published responses
- Prognostic value of KRAS mutation in patients undergoing pulmonary metastasectomy for colorectal cancer: A systematic review and meta-analysis
Figures and tables
Figures & Media
Tables
View Options
Access options
If you have access to journal content via a personal subscription, university, library, employer or society, select from the options below:
I am signed in as:
View my profileSign out
I can access personal subscriptions, purchases, paired institutional access and free tools such as favourite journals, email alerts and saved searches.
loading institutional access options
AIOM members can access this journal content using society membership credentials.
AIOM members can access this journal content using society membership credentials.
Alternatively, view purchase options below:
Purchase 24 hour online access to view and download content.
Access journal content via a DeepDyve subscription or find out more about this option.
