Predictors of recurrent pulmonary metastases and survival after pulmonary metastasectomy for colorectal cancer

Shanda H Blackmon, Elizabeth H Stephens, Arlene M Correa, Wayne Hofstetter, Min P Kim, Reza J Mehran, David C Rice, Jack A Roth, Stephen G Swisher, Garrett L Walsh, Ara A Vaporciyan
Annals of Thoracic Surgery 2012, 94 (6): 1802-9

BACKGROUND: Resection of pulmonary colorectal carcinoma metastases may provide long-term benefit, but patient selection remains controversial. The objective of this study was to identify preoperative predictors of survival and lung recurrence for patients undergoing resection of such lesions.

METHODS: A prospectively collected database was retrospectively reviewed to identify patients who underwent their first colorectal carcinoma pulmonary metastasectomy. Two multivariate logistic analyses were performed to identify preoperative predictors of survival and lung recurrence. Preoperative factors, pathologic colorectal carcinoma stage, additional sites of metastases, timing of metastatic occurrence, and premetastasectomy disease-free interval were included in the univariate analyses.

RESULTS: From January 2000 to December 2010, 229 patients met inclusion criteria. The mean age was 60 years, and 100 patients (43.7%) were women. The overall median time and 5-year survival rate were 70.1 months and 55.4%, respectively, after the first pulmonary metastasectomy. Median follow-up was 37.2 months. Age older than 60 years (hazard ratio [HR], 1.03; 95% confidence interval [CI], 1.005 to 1.052; p=0.016), male sex (HR, 1.84; 95% CI, 1.089 to 3.094; p=0.023), and more than three lung metastases (HR, 1.15; 95% CI, 1.024 to 1.282; p=0.018) predicted survival at 5 years in one multivariate analysis. In the second, more than three lung metastases present at first metastasectomy (HR, 1.19; 95% CI, 1.071 to 1.321; p=0.001) and the preoperative disease-free interval of less than 3 years (HR, 0.99; 95% CI, 0.973 to 0.997; p=0.013) predicted lung recurrence.

CONCLUSIONS: Older age, male sex, and more lung metastases predict poorer survival after resection of pulmonary colorectal cancer metastases. The number of lung metastases present at the first metastasectomy and the preoperative disease-free interval predicted recurrence in the lung.

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