The benefit of preoperative chemotherapy (pre-CT) and metastasectomy for pulmonary metastasis (PM) from colorectal cancer (CRC) (PM-CRC) are unclear due to a lack of enough studies. However, there are some patients who receive chemotherapy after PM detection and subsequently undergo metastasectomy in clinical practice. The aim of this study was to investigate the impact of response to pre-CT on the outcome of pulmonary metastasectomy for PM-CRC.
The subjects were 92 patients, who received pre-CT before metastasectomy for PM-CRC, identified from the 1237 patients whose PM-CRC were curatively resected at 46 institutions in Japan between 2004 and 2008.
Twenty-six (28%) patients initially judged to have inoperable PM underwent chemotherapy leading to conversion to be resectable and subsequently received metastasectomy. The remaining 66 patients initially judged to have operable PM received pre-CT and subsequently underwent metastasectomy. Fifty-six (61%) patients received fluoropyrimidine based regimens combined with oxaliplatin or irinotecan, and most of the remaining 26 received tegafur/uracil. Pre-CT yielded partial response (PR), stable disease (SD) and progressive disease (PD) in 28 (30%), 26 (28%) and 38 (42%) patients, respectively. At metastasectomy, the proportions of patients with extrathoracic lesion, multiple PMs, and abnormal carcinoembryonic antigen level were 34, 58, and 40%, respectively. Wedge resection was the most frequent (62%) surgical procedure. The five-year disease-free (DFS) and overall survival (OS) rate of the all 92 patients were 25.1% (95% CI 16.4-34.7) and 45.4% (33.4-56.7). The five-year DFS rates of the patients with PR/SD and PD during pre-CT were 28.2% (16.5-41.1) and 20.6% (9.2-35.2), and those of OS were 58.1% (40.8-71.9) and 27.5% (12.9-44.3), respectively. By multivariate analysis, independent prognosticators were two or less PMs (HR = 0.56, 95% CI 0.33-0.94; p = 0.029) for DFS, and performance status 0 (0.44, 0.22-0.90; 0.024) and PR/SD during pre-CT (0.33, 0.18-0.61; < 0.001) for OS.
Response to Pre-CT had some impacts on OS after metastasectomy for PM-CRC: better in the patients with PR/SD compared to PD.
Clinical trial identification
Legal entity responsible for the study
Nonprofit Organization Tsukuba Cancer Clinical Trial Group.
Non-profit organization Tsukuba Cancer Clinical Trial Group.
N. Boku: Honoraria: Ono, BMS, Chugai, Merck Serono, Yakult, Eli Lilly companies. I. Hyodo: Honoraria: Taiho, Chugai, Daiichi-Sankyo, Yakult-Honshya companies. All other authors have declared no conflicts of interest.