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Risk Factors for Survival after Lung Metastasectomy in Colorectal Cancer Patients: A Systematic Review and Meta-Analysis

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Resection of lung metastases (LM) from colorectal cancer (CRC) is increasingly performed with a curative intent. It is currently not possible to identify those CRC patients who may benefit the most from this surgical strategy. The aim of this study was to perform a systematic review of risk factors for survival after lung metastasectomy for CRC.

Methods

We performed a meta-analysis of series published between 2000 and 2011, which focused on surgical management of LM from CRC and included more than 40 patients each. Pooled hazard ratios (HR) were calculated by using random effects model for parameters considered as potential prognostic factors.

Results

Twenty-five studies including a total of 2925 patients were considered in this analysis. Four parameters were associated with poor survival: (1) a short disease-free interval between primary tumor resection and development of LM (HR 1.59, 95 % confidence interval [CI] 1.27–1.98); (2) multiple LM (HR 2.04, 95 % CI 1.72–2.41); (3) positive hilar and/or mediastinal lymph nodes (HR 1.65, 95 % CI 1.35–2.02); and (4) elevated prethoracotomy carcinoembryonic antigen (HR 1.91, 95 % CI 1.57–2.32). By comparison, a history of resected liver metastases (HR 1.22, 95 % CI 0.91–1.64) did not achieve statistical significance.

Conclusions

Clinical variables associated with prolonged survival after surgery for LM in CRC patients include prolonged disease-free interval between primary tumor and metastatic spread, normal prethoracotomy carcinoembryonic antigen, absence of thoracic node involvement, and a single pulmonary lesion.

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Authors and Affiliations

  1. Division of Thoracic Surgery, Centre Hospitalier Vaudois (CHUV), Lausanne, Switzerland

    Michel Gonzalez MD & Hans Beat Ris MD

  2. Division of Clinical Epidemiology, University Hospital Geneva, Geneva, Switzerland

    Antoine Poncet MD & Christophe Combescure MD

  3. Department of Thoracic Surgery, University Hospital Geneva, Geneva, Switzerland

    John Robert MD

  4. Division of Coloproctology, Clinique La Colline, Geneva, Switzerland

    Pascal Gervaz MD

Authors
  1. Michel Gonzalez MD
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  2. Antoine Poncet MD
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  3. Christophe Combescure MD
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  4. John Robert MD
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  5. Hans Beat Ris MD
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  6. Pascal Gervaz MD
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Correspondence to Pascal Gervaz MD.

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Gonzalez, M., Poncet, A., Combescure, C. et al. Risk Factors for Survival after Lung Metastasectomy in Colorectal Cancer Patients: A Systematic Review and Meta-Analysis. Ann Surg Oncol 20, 572–579 (2013). https://doi.org/10.1245/s10434-012-2726-3

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  • DOI: https://doi.org/10.1245/s10434-012-2726-3

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