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Ziranu P, Ferrari PA, Guerrera F, Bertoglio P, Tamburrini A, Pretta A, Lyberis P, Grimaldi G, Lai E, Santoru M, Bardanzellu F, Riva L, Balconi F, Della Beffa E, Dubois M, Pinna-Susnik M, Donisi C, Capozzi E, Pusceddu V, Murenu A, Puzzoni M, Mathieu F, Sarais S, Alzetani A, Luzzi L, Solli P, Paladini P, Ruffini E, Cherchi R, Scartozzi M. Clinical score for colorectal cancer patients with lung-limited metastases undergoing surgical resection: Meta-Lung Score. Lung Cancer 2023; 184:107342. [PMID: 37573705 DOI: 10.1016/j.lungcan.2023.107342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 08/03/2023] [Accepted: 08/08/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Radical resection of isolated lung metastases (LM) from colorectal cancer (CRC) is debated. Like Fong's criteria in liver metastases, our study was meant to assign a clinical prognostic score in patients with LM from CRC, aiming for better surgery selection. METHODS We retrospectively analyzed data from 260 CRC patients who underwent curative LM resection from December 2002 to January 2022, verifying the impact of different clinicopathological features on the overall survival (OS). RESULTS At the univariate analysis: higher baseline CEA levels (p = 0.0001), disease-free survival less than or equal to 12 months (m) (p = 0.0043), LM size larger than 2 cm (p = 0.0187), multiple resectable nodules (p = 0.0083), and positive nodal status of the primary tumor (p = 0.0011) were associated with worse prognosis. In a Cox regression model, these characteristics retained their independent role for OS (p < 0.0001) and were chosen as criteria to be assigned one point each for clinical risk score. The 5-year survival rate in patients with 0 points was 88%, while no patients with a 5-point score survived at 2 years. Based on the 0-1 vs. 2-5 score range, we obtained a significant difference in median OS: not reached vs. 40.8 months (95 %CI 36 to 87.5), respectively (p < 0.0001) stratifying patients into good and poor prognosis. The prognostic role of the score was also confirmed in terms of median RFS: not reached in 0-1 scored patients vs. 30.5 months (95 %CI 19.4 to 42) in patients with 2-5 scores (p = 0.0006). CONCLUSIONS When LM from CRC is resectable, the Meta-Lung Score provides valuable prognostic information. Indeed, while upfront surgery should be considered in patients with scores of 0 to 1, it should be cautiously suggested in patients with scores of 2 to 5, for whom a prognosis comparison between preventive surgery and other treatments should be investigated in prospective randomized clinical trials.
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Affiliation(s)
- Pina Ziranu
- Medical Oncology Unit, University Hospital and University of Cagliari, Cagliari, Italy
| | - Paolo Albino Ferrari
- Division of Thoracic Surgery at "A. Businco Cancer Center", A.R.N.A.S. Brotzu, Cagliari, Italy.
| | - Francesco Guerrera
- Division of Thoracic Surgery, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Pietro Bertoglio
- Department of Thoracic Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alessandro Tamburrini
- Department of Thoracic Surgery, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Andrea Pretta
- Medical Oncology Unit, University Hospital and University of Cagliari, Cagliari, Italy
| | - Paraskevas Lyberis
- Division of Thoracic Surgery, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Giulia Grimaldi
- Division of Thoracic Surgery at "A. Businco Cancer Center", A.R.N.A.S. Brotzu, Cagliari, Italy
| | - Eleonora Lai
- Medical Oncology Unit, University Hospital and University of Cagliari, Cagliari, Italy
| | - Massimiliano Santoru
- Division of Thoracic Surgery at "A. Businco Cancer Center", A.R.N.A.S. Brotzu, Cagliari, Italy
| | - Fabio Bardanzellu
- Medical Oncology Unit, University Hospital and University of Cagliari, Cagliari, Italy
| | - Laura Riva
- Division of Thoracic Surgery at "A. Businco Cancer Center", A.R.N.A.S. Brotzu, Cagliari, Italy
| | - Francesca Balconi
- Medical Oncology Unit, University Hospital and University of Cagliari, Cagliari, Italy
| | - Eleonora Della Beffa
- Division of Thoracic Surgery, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Marco Dubois
- Medical Oncology Unit, University Hospital and University of Cagliari, Cagliari, Italy
| | - Matteo Pinna-Susnik
- Division of Thoracic Surgery at "A. Businco Cancer Center", A.R.N.A.S. Brotzu, Cagliari, Italy
| | - Clelia Donisi
- Medical Oncology Unit, University Hospital and University of Cagliari, Cagliari, Italy
| | - Enrico Capozzi
- Department of Thoracic Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Valeria Pusceddu
- Medical Oncology Unit, University Hospital and University of Cagliari, Cagliari, Italy
| | - Alessandro Murenu
- Division of Thoracic Surgery at "A. Businco Cancer Center", A.R.N.A.S. Brotzu, Cagliari, Italy
| | - Marco Puzzoni
- Medical Oncology Unit, University Hospital and University of Cagliari, Cagliari, Italy
| | - Federico Mathieu
- Thoracic Surgery Unit, Cardio-Thoracic and Vascular Department, University Hospital of Siena (Azienda Ospedaliera Universitaria Senese, AOUS), Siena, Italy
| | - Sabrina Sarais
- Division of Thoracic Surgery at "A. Businco Cancer Center", A.R.N.A.S. Brotzu, Cagliari, Italy
| | - Aiman Alzetani
- Department of Thoracic Surgery, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Luca Luzzi
- Thoracic Surgery Unit, Cardio-Thoracic and Vascular Department, University Hospital of Siena (Azienda Ospedaliera Universitaria Senese, AOUS), Siena, Italy
| | - Piergiorgio Solli
- Department of Thoracic Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Piero Paladini
- Thoracic Surgery Unit, Cardio-Thoracic and Vascular Department, University Hospital of Siena (Azienda Ospedaliera Universitaria Senese, AOUS), Siena, Italy
| | - Enrico Ruffini
- Division of Thoracic Surgery, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Roberto Cherchi
- Division of Thoracic Surgery at "A. Businco Cancer Center", A.R.N.A.S. Brotzu, Cagliari, Italy
| | - Mario Scartozzi
- Medical Oncology Unit, University Hospital and University of Cagliari, Cagliari, Italy
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Motas N, Davidescu MD, Tanase BC, Rus O, Burlacu AI, Alexe V, Manolache V, Mizea MC, Gheorghiu N, Trifanescu OG, Gales LN, Horvat T, Anghel RM. Oncologic Outcome after Pulmonary Metastasectomy as Part of Multidisciplinary Treatment in a Tertiary Oncological Center. Diagnostics (Basel) 2023; 13:diagnostics13010165. [PMID: 36611457 PMCID: PMC9818764 DOI: 10.3390/diagnostics13010165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/22/2022] [Accepted: 12/27/2022] [Indexed: 01/06/2023] Open
Abstract
(1) Background: Pulmonary metastases are encountered in approximately one-third of patients with malignancies, especially from colorectal, lung, breast, and renal cancers, and sarcomas. Pulmonary metastasectomy is the ablative approach of choice, when possible, as part of the multidisciplinary effort to integrate and personalize the oncological treatment. (2) Methods: The study includes 58 consecutive cases of pulmonary metastasectomies, retrospectively analyzed, performed in 12 consecutive months, in which the pathology reports confirmed lung metastases. (3) Results: Most frequent pathological types of metastases were: 14 of colorectal cancer, 10 breast, 8 lung, and 8 sarcomas. At the time of primary cancer diagnosis, 14 patients (24.14%) were in the metastatic stage. The surgical approach was minimally invasive through uniportal VATS (Video-Assisted Thoracic Surgery) in 3/4 of cases (43 patients, 74%). Almost 20% of resections were typical (lobectomy, segmentectomy). Lymphadenectomy was associated in almost 1/2 of patients and lymph node metastases were found in 11.11% of cases. The mortality rate (intraoperative and 90 days postoperative) is zero. The OS after pulmonary metastasectomy is 87% at 18 months, and the estimated OS for cancer is 90% at 5 years. The worst outcome presents the patients with sarcomas and the best outcome-colorectal and lung cancer. The patients with 1 or 2 resected metastases presented 96% survival at 24 months. (4) Conclusions: After pulmonary metastasectomy, survival is favored by the small number of metastases resected (1 or 2), and by the dimension of metastases under 20.5 mm. The non-anatomic (wedge) type of lung resection may present a lower risk of death compared to lobectomy. No statistical significance on survival has the presence of lymphadenectomy, the laterality right/left lung, the upper/lower lobes. In the future, longer follow-up and prospective randomized trials are needed for drawing definitive conclusions.
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Affiliation(s)
- Natalia Motas
- Clinic of Thoracic Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Thoracic Surgery, “Prof. Dr. Al. Trestioreanu” Institute of Oncology Bucharest, 022328 Bucharest, Romania
- Correspondence: (N.M.); (M.D.D.)
| | - Mihnea Dan Davidescu
- Clinic of Thoracic Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Thoracic Surgery, “Prof. Dr. Al. Trestioreanu” Institute of Oncology Bucharest, 022328 Bucharest, Romania
- Correspondence: (N.M.); (M.D.D.)
| | - Bogdan Cosmin Tanase
- Clinic of Thoracic Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Thoracic Surgery, “Prof. Dr. Al. Trestioreanu” Institute of Oncology Bucharest, 022328 Bucharest, Romania
| | - Ovidiu Rus
- Department of Thoracic Surgery, “Prof. Dr. Al. Trestioreanu” Institute of Oncology Bucharest, 022328 Bucharest, Romania
| | - Alin Ionut Burlacu
- Clinic of Thoracic Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Thoracic Surgery, “Prof. Dr. Al. Trestioreanu” Institute of Oncology Bucharest, 022328 Bucharest, Romania
| | - Vlad Alexe
- Department of Thoracic Surgery, “Prof. Dr. Al. Trestioreanu” Institute of Oncology Bucharest, 022328 Bucharest, Romania
| | - Veronica Manolache
- Clinic of Thoracic Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Thoracic Surgery, Memorial Oncology Hospital, Șoseaua Gheorghe Ionescu Sisești 8a, 013812 Bucharest, Romania
| | - Madalina Cristiana Mizea
- Clinic of Thoracic Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Thoracic Surgery, “Prof. Dr. Al. Trestioreanu” Institute of Oncology Bucharest, 022328 Bucharest, Romania
| | - Nicolae Gheorghiu
- Department of Thoracic Surgery, “Prof. Dr. Al. Trestioreanu” Institute of Oncology Bucharest, 022328 Bucharest, Romania
| | - Oana Gabriela Trifanescu
- Clinic of Oncology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Radiotherapy II, “Prof. Dr. Al. Trestioreanu” Institute of Oncology Bucharest, 022328 Bucharest, Romania
| | - Laurentia Nicoleta Gales
- Clinic of Oncology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Medical Oncology II, “Prof. Dr. Al. Trestioreanu” Institute of Oncology Bucharest, 022328 Bucharest, Romania
| | - Teodor Horvat
- Clinic of Thoracic Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Thoracic Surgery, “Prof. Dr. Al. Trestioreanu” Institute of Oncology Bucharest, 022328 Bucharest, Romania
| | - Rodica Maricela Anghel
- Clinic of Oncology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Radiotherapy II, “Prof. Dr. Al. Trestioreanu” Institute of Oncology Bucharest, 022328 Bucharest, Romania
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Carvajal C, Facundo H, Puerto P, Carreño J, Beltrán R. Lung Metastasectomy from Colorectal Cancer, 10-year Experience in a South American Cancer Center. Front Surg 2022; 9:913678. [PMID: 36034370 PMCID: PMC9406509 DOI: 10.3389/fsurg.2022.913678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 04/27/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose This study aimed to describe the survival outcomes and factors associated with prognosis in patients undergoing pulmonary metastasectomy with colorectal cancer (CRC) in a cancer center in South America. Material and methods A retrospective analysis of patients that underwent lung metastasectomy due to CRC at National Cancer Institute (INC), Colombia between 2007 and 2017 was performed and Kaplan-Meier survival analysis along with log-rank test and Cox regression multivariate analysis were completed. Results Seventy-five patients with colorectal adenocarcinoma were included in the study. Of them, 57.3% were women with a median age of 62 years [interquartile ranges (IQR): 18.5]. For 45.3% the adenocarcinoma was located in the rectum and 29.3% had stage IV at diagnosis. 56% had a history of controlled extrapulmonary metastasis and 20% of the cases had a history of the metastasis of the liver. The median follow-up was 36.8 months (IQR: 27.4). Three-year and five-year overall survival (OS) was 57.5% [95% confidence interval (CI), 47.0–70.4] and 33.2% (95% CI, 23.4–47.2), respectively. Patients with bilateral, more than one pulmonary metastasis, abnormal postmetastasectomy carcinoembryonic antigen (CEA), history of liver metastasis, and disease-free interval (DFI) ≤12 months had worse OS. Three-year and five-year disease-free survival (DFS) was 30.1% (95% CI, 20.8–43.6) and 21.6% (95% CI, 13.0–35.9), respectively. Bilateral, more than one pulmonary metastasis, and patients with stage IV at diagnosis had the worst DFS. Multivariate analysis in the Cox regression model showed that abnormal postmetastasectomy CEA [Hazard Ratio (HR):1.97, 95% CI, 1.01–3.86, p = 0.045] and DFI ≤ 12 months (HR: 3.08, 95% CI, 1.26–7.53, p = 0.014) were independent factors for worst OS. Conclusions The OS found falls within the wide range described in the world literature but interestingly it falls at the bottom end of this range. The factors associated with worst survival were identified as bilateral, more than one pulmonary metastasis, abnormal postmetastasectomy CEA, history of liver metastasis, and DFI ≤12 months. Contribution to the field Pulmonary metastasectomy is the standard of care in patients with metastatic CRC. However, the literature supporting this conduct is based on retrospective studies and the only randomized controlled trial conducted to date was stopped due to poor recruitment. Limited information is available in South America about survival and factors associated with prognosis in patients with metastatic CRC. While this study is another series that adds to the many studies across the world that describe the use of pulmonary metastasectomy in CRC, it presents critical data as it is one of the few studies carried out in South America. As described in a wide range of world literature, OS found falls in patients that underwent lung metastasectomy due to CRC however; interestingly, in the South American population analyzed here it falls at the bottom end of this range. This may be explained by a large number of patients included with a history of extrapulmonary metastasis as well as may reflect inadequate patient access to reference cancer centers in Colombia. Factors associated with worst survival in our population were bilateral, more than one pulmonary metastasis, abnormal postmetastasectomy CEA, history of liver metastasis, and interval from diagnosis to development of pulmonary metastasis ≤12 months.
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Affiliation(s)
- Carlos Carvajal
- Thoracic Surgery, National Cancer Institute, Bogota, Colombia
| | - Helena Facundo
- Gastro-intestinal surgery, National Cancer Institute, Bogota, Colombia
| | - Paola Puerto
- Oncologic surgery, National Cancer Institute, Bogota, Colombia
| | - José Carreño
- Research Department, National Cancer Institute, Bogota, Colombia
| | - Rafael Beltrán
- Thoracic Surgery, National Cancer Institute, Bogota, Colombia
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Contemporary Management of Locally Advanced and Recurrent Rectal Cancer: Views from the PelvEx Collaborative. Cancers (Basel) 2022; 14:cancers14051161. [PMID: 35267469 PMCID: PMC8909015 DOI: 10.3390/cancers14051161] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/18/2022] [Accepted: 02/21/2022] [Indexed: 12/12/2022] Open
Abstract
Pelvic exenteration is a complex operation performed for locally advanced and recurrent pelvic cancers. The goal of surgery is to achieve clear margins, therefore identifying adjacent or involved organs, bone, muscle, nerves and/or vascular structures that may need resection. While these extensive resections are potentially curative, they can be associated with substantial morbidity. Recently, there has been a move to centralize care to specialized units, as this facilitates better multidisciplinary care input. Advancements in pelvic oncology and surgical innovation have redefined the boundaries of pelvic exenterative surgery. Combined with improved neoadjuvant therapies, advances in diagnostics, and better reconstructive techniques have provided quicker recovery and better quality of life outcomes, with improved survival This article provides highlights of the current management of advanced pelvic cancers in terms of surgical strategy and potential future developments.
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