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Japanese Journal of Clinical Oncology Advance Access published online on August 24, 2006
Japanese Journal of Clinical Oncology, doi:10.1093/jjco/hyl076
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© 2006 Foundation for Promotion of Cancer Research
Received April 7, 2006
Accepted June 17, 2006

Original Article

Surgical Resection of Pulmonary Metastases From Colorectal Cancer: Four Favourable Prognostic Factors

Rintaro Koga 1 *, Junji Yamamoto 1, Akio Saiura 1, Toshiharu Yamaguchi 1, Enjo Hata 2, and Masayoshi Sakamoto 2

1 Department of Gastroenterological Surgery, Cancer Institute Hospital, Tokyo, Japan
2 Department of Surgery, Mitsui Memorial Hospital, Tokyo, Japan

* To whom correspondence should be addressed.
Rintaro Koga, E-mail: rintaro.koga{at}jfcr.or.jp


  Abstract

Background: Surgical resection has been the first choice for treatment of pulmonary metastases from colorectal cancer; however, indications for surgery have yet to be adequately clarified. In considering strategies for the treatment of pulmonary metastases from colorectal carcinoma, determination of disease status as either systemic or pre-systemic is of primary importance. The aim of this study is to define the characteristics of those patients who are most likely to benefit from surgical resection.

Methods: Fifty-eight patients who underwent pulmonary resection for colorectal metastases were retrospectively reviewed and examined for clinicopathological factors.

Results: Overall, 5-year survival rates were 29%, with a median survival time (MST) of 27 months. Multivariate analysis identified four factors that indicate independent and favourable prognostic impact: three or less tumours, metachronous metastasis, negative hilar and/or mediastinal lymph node metastasis and normal prethoracotomy serum carcinoembryonic antigen level. The 5-year survival rate for 16 patients who satisfied all of these favourable characteristics was 62% (MST = 86 months), which was significantly better than those patients lacking these characteristics. The 5-year survival rate for 13 patients who underwent repeated metastasectomy was 37% (MST = 32 months).

Conclusions: The four factors selected in our multivariate analysis appear to be favourable factors for the practical identification of those patients who are most likely to benefit from surgical resection. Repeated pulmonary resection for lung-only recurrence may benefit carefully selected patients.

Keywords: colorectal cancer; pulmonary metastasis; prognosis; surgical indication.
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