SURGERY FOR LUNG METASTASES FROM COLORECTAL-CANCER - ANALYSIS OF PROGNOSTIC FACTORS

Purpose: To identify prognostic factors of improved survival after res ection of isolated pulmonary metastases (PM) from colorectal cancer. P atients and Methods: A retrospective analysis of the records of all pa tients with PM from colorectal cancer who underwent thoracic surgery w ith curative intent before December 1992 at a single surgical center w as performed. Univariate (log-rank) and multivariate (Cox's model) ana lyses of survival were used to identify significant prognostic factors . Results: Eighty-six patients with PM from colon (n = 49) or rectal ( n = 37) canter underwent 102 thoracic operations, which included 21 bi lateral and 10 incomplete resections. The 5- and 10-year probabilities of survival (Kaplan-Meier) after the first thoracic operation were 24 % (95% confidence interval [CI], 15% to 35%) and 20% (95% CI, 13% to 3 1%), respectively. Sex, age, site of the primary tumor (colon or rectu m), disease-free interval (DFI), and previous resection of hepatic met astases were found not to be statistically significant prognostic fact ors. Complete resection, ct limited number (< two) of PM, and a normal prethoracotomy serum carcinoembryonic antigen (CEA) level were predic tors of a longer survival duration by univariate analysis, but only co mplete resection (P = .024) and preoperative CEA level (P = .001) were identified as independent prognostic factors by multivariate analysis . The estimated 5-year survival rate of patients with a normal prethor acotomy CEA level was 60%, as compared with 4% in cases with elevated (> 5 ng/mL) CEA level, Conclusion: Besides resectability, the prethora cotomy serum CEA level appears the most reliable predictor of survival in patients with isolated PM from colorectal cancer. (C) 1996 by Amer ican Society of Clinical Oncology.