Survival, disease-free interval, and associated tumor features in patientswith colon/rectal carcinomas and their resected intra-pulmonary metastases

Objective: Colon/rectum cancer often presents with intrapulmonary metastase s. Surgical resection can be performed in a selected group of patients. In this study, the search for possible prognostic factors of patients with pri mary colon/rectum cancer and lung metastases was performed. Methods: Medica l records of 110 patients operated on pulmonary metastases of primary colon /rectum cancer were reviewed. The clinical parameters include age, sex, pTN M/UICC stage, grading, localization, surgical and adjuvant therapy of the p rimary cancer. The number, maximum diameter and total intra-thoracic resect ed tumor-mass('load'), the pre-thoracotomy serum carcinoembryonic antigen ( CEA) levels, localization of the metastases (uni- vs, bilateral), the prese nce of hilar/mediastinal tumor-infiltrated lymph nodes, the surgical proced ure and performed therapy schemes of lung metastases were recorded. Results : The cumulated 5- and 10-year total survival after diagnosis of the primar y carcinomas was estimated to 71 and 33.7%, respectively. After resection o f the pulmonary metastases, the 3- and 5-year post-thoracotomy survival mea sured 57 and 32.6%, respectively. The median time interval between diagnosi s of the primary cancer and thoracotomy (disease free interval (DFI)) was f ound to be 35 months. A non-negligible percentage of patients (15.4%) displ ayed limited tumor stages of the primary cancer (pT1/2, pN0). The median di ameter of the largest metastasis measured 28 mm, and the median resected in trathoracic tumor-load was calculated to 11.4 cm(3). In only 8 patients hil ar or mediastinal tumor-involved lymph nodes were found. A potentially cura tive resection of lung metastases was recorded in 96 patients. The overall survival was significantly correlated with the DFI and the number of intrap ulmonary metastases. The DFI correlated significantly with the tumor load a nd the number of metastases; the postthoracotomy survival with the number o f metastases, tumor-load and pre-thoracotomy serum CEA level. Treatment, st age and grade of the primary cancer, occurrence of liver metastases and loc al recurrences, mode of treatment of metastases and postoperative residual stage had no significant correlation with either total nor post-thoracotomy survival. Conclusions: Pulmonary metastases occur even in patients with li mited tumor-stages of primary colon/rectum cancer. DFI is the major paramet er to estimate the total survival of patients with lung metastases. The sur vival after thoracotomy depends on the number of metastases, the intrapulmo nary tumor load and the presence of elevated serum CEA level prior to thora cotomy. (C) 2001 Elsevier Science B.V. All rights reserved.