Abstract 418P
Background
Colorectal cancer lung metastases (CRLM) are a common form of newly diagnosed advanced disease and relapse after radical treatment (ttm) of early-stage tumours. In oligometastatic patients (pts), pulmonary resection is usually considered in some point of the multimodal ttm approach. Nevertheless, the real benefit of lung metastasectomy and perioperative chemotherapy in survival is in constant debate and strong prognostic factors are still lacking.
Methods
We performed a retrospective study to evaluate the clinical and pathological characteristics of a cohort of pts with CRLM assessed in a multidisciplinary tumour board, both synchronous and metachronous, to assess the role of surgical resection as part of oligometastatic disease local ttm and to identify prognostic factors. Demographic and clinicopathological data were collected and the impact of metastasectomy in disease outcome, with or without perioperative chemotherapy (PCT), was determined. Overall survival (OS) was estimated by Kaplan–Meier method.
Results
Of 270 pts registered between January 2012 and October 2020, 106 (39.2%) were suitable for surgical ttm. Median age at diagnosis was 64 years old (27-82) and 74 (69.8%) pts were male. Most frequent primary tumour location were rectum (44.2%) and sigmoid (36.5%). Metachronous CRLM were found in 84 pts (79.2%) and in 22 pts (20.8%) they were present at diagnosis. In early-stage pts, stage was pT1-2 (13.4%), pT3 (71.4%), pT4 (14.3%) and pN stage was N- in 38.1% and N+ in 60.9%. After a median follow-up of 78.2 months (mo), median overall survival (mOS) was 110.1 mo and significantly worse in pts with synchronous CRLM (82 vs 123.9 mo; p=0.04). In patients with CRLM as single site of first relapse (n=82) that underwent surgery as initial ttm, the number of CRLM showed prognostic impact with a HR of 5.18, p=0.03 (1 lesion mOS 123.9mo, 2-3 lesions mOS 110.1mo, ≥4 lesions mOS 80.7mo). In the 28 pts (34.1%) that received PCT we found no additional benefit in OS (HR 1.04, 95% CI 0.49-2.2;p=0.91).
Conclusions
Our results are consistent with historical data that show the value or surgical resection of CRLM as part of multidisciplinary approach, but also put into question the real impact of perioperative systemic treatment in improving survival.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.