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Prognostic factors in patients undergoing complete resection of pulmonary metastases of colorectal cancer: a multi-institutional cumulative follow-up study

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Abstract

Purpose

The aim of this retrospective study was to establish the prognostic factors for overall survival after pulmonary resection for lung metastases of colorectal carcinoma (CRC).

Methods

The baseline characteristics and outcomes of 266 CRC patients undergoing complete pulmonary resection were collected from 19 institutions by the Japanese Society for Cancer of the Colon and Rectum (JSCCR) Study Group. We used the Cox proportional hazard regression to identify independent prognostic factors for OS.

Results

The 5-year overall survival rate of patients undergoing complete resection of isolated pulmonary metastases was 56.5 %. The independent unfavorable prognostic factors after pulmonary resection included stage T4 (p = 0.0004) and N2 (p = 0.0082) as primary cancer-related factors, and more than three metastases (p = 0.0342), bilateral distribution (p = 0.0450), metastatic disease-free interval (DFI) of less than 2 years (p = 0.0257), and a preoperative carcinoembryonic antigen (CEA) level greater than 5.0 ng/mL (p = 0.0209) as pulmonary metastases-related factors.

Conclusions

This retrospective analysis suggested that the indications for pulmonary resection of CRC metastases should be decided not only by the status of lung metastases, but also by pulmonary-related factors such as the T and N stage of the primary lesion, preoperative CEA level, and the DFI.

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Acknowledgments

We thank all the physicians at the institutions participating in the Pulmonary Metastases from Colon Cancer Project for contributing to this case series. Takashi Hirai, M.D., Ph.D. (Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan), Masahiko Watanabe, M.D., Ph.D. (Department of Surgery, Kitasato University, Kanagawa, Japan), Tadahiko Masaki, M.D., Ph.D. (Department of General Gastrointestinal Surgery, Kyorin University, Tokyo, Japan), Kazuo Shirouzu, M.D., Ph.D. (Department of Surgery, Kurume University School of Medicine, Fukuoka, Japan), Hirotoshi Hasegawa, M.D., Ph.D. (Department of Surgery, Keio University, Tokyo, Japan), Yukio Saito, M.D., Ph.D. (Department of Surgery, International Medical Center of Japan, Tokyo, Japan), Koichi Hirata, M.D., Ph.D. (Department of Surgery, Sapporo Medical University, Sapporo, Japan), Toshiaki Watanabe, M.D., Ph.D. (Department of Surgery II, Teikyo University, Tokyo, Japan), Tatsuya Aoki, M.D., Ph.D. (Department of Surgery, Tokyo Medical University, Tokyo, Japan), Kimihiko Funahashi, M.D., Ph.D. (Department of Surgery, Omori Medical Center, Toho University, Tokyo, Japan), Kenjiro Kotake, M.D., Ph.D. (Department of Surgery, Tochigi Cancer Center, Tochigi, Japan), Kenichi Takahashi, M.D., Ph.D. (Department of Surgery, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan), Tsuneo Iiai, M.D., Ph.D. (First Department of Surgery, Niigata University, Niigata, Japan), Kotaro Maeda, M.D., Ph.D. (Department of Surgery, Fujita Health University, Aichi, Japan), Naohiro Tomita, M.D., Ph.D. (Department of Surgery, Hyogo College of Medicine, Hyogo, Japan), Kazuo Hase, M.D., Ph.D. (Department of Surgery, National Defense Medical College, Saitama, Japan), Masato Kusunoki, M.D., Ph.D. (Department of Surgery, Mie University, Mie, Japan), Shimpei Ogawa, M.D., Ph.D. (Department of Surgery II, Tokyo Women’s Medical University), and Yoichiro Homma, M.D. (Department of Surgery II, Tokyo Women’s Medical University).

Conflict of interest

We have no conflict of interest.

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Authors and Affiliations

  1. Department of Surgery II, Tokyo Women’s Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo, 162-8666, Japan

    Tomoichiro Hirosawa, Michio Itabashi & Shingo Kameoka

  2. Department of Thoracic Surgery, Tokyo Women’s Medical University, Tokyo, Japan

    Takamasa Ohnuki

  3. Department of Hygiene and Public Health II, Tokyo Women’s Medical University, Tokyo, Japan

    Naohito Yamaguchi

  4. Department of Surgical Oncology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan

    Kenichi Sugihara

Authors
  1. Tomoichiro Hirosawa
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  2. Michio Itabashi
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  3. Takamasa Ohnuki
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  4. Naohito Yamaguchi
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  5. Kenichi Sugihara
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  6. Shingo Kameoka
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Consortia

Japanese Society for Cancer of the Colon and Rectum (JSCCR) Study Group for Pulmonary Metastases from Colorectal Cancer

Corresponding authors

Correspondence to Tomoichiro Hirosawa or Michio Itabashi.

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Hirosawa, T., Itabashi, M., Ohnuki, T. et al. Prognostic factors in patients undergoing complete resection of pulmonary metastases of colorectal cancer: a multi-institutional cumulative follow-up study. Surg Today 43, 494–499 (2013). https://doi.org/10.1007/s00595-012-0373-8

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  • DOI: https://doi.org/10.1007/s00595-012-0373-8

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