| Pulmonary Metastases after Curative Resection in Patients with Colorectal Carcinomas. |
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Park, In Ja , Kim, Hee Cheol , Lee, Gang Hong , Yu, Chang Sik , Kim, Tae Won , Chang, Heung Moon , Kim, Dong Kwan , Park, Seung Il , Kim, Jin Cheon |
1Colorectal Clinic, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
2Department of Surgery, University of Ulsan College of Medicine, Seoul, Korea. jckim@amc.seoul.kr
3Department of Internal Medicine , University of Ulsan College of Medicine, Seoul, Korea.
4Department of Thoracic Surgery, University of Ulsan College of Medicine, Seoul, Korea. |
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| Abstract |
PURPOSE
Pulmonary metastases from colorectal carcinomas have been reported to occur in 10% of all patients who undergo a curative resection. A number of studies have reported aggressive treatments, including lung resection, for pulmonary metastases that appear to prolong the survival in selected cases. The aim of this study was to assess the clinical characteristics, and the prognostic factors of pulmonary metastases, as well as the outcomes after resection of the pulmonary metastases.
METHODS
A retrospective study was performed on 104 patients who presented with primary pulmonary metastases without metastases in other organs after a curative resection for a colorectal carcinoma between January 1994 and December 2000 at Asan Medical Center. Pulmonary metastases were diagnosed by using serial changes in the chest X-ray and the CT.
Univariate (log-rank) and multivariate (Cox's model) analyses were employed to identify the prognostic factors.
RESULTS
The mean interval between colorectal resection and pulmonary metastases (disease-free interval) was 22 (range: 4~64) months. Fifty-eight of 104 patients had pulmonary metastases originating from rectal cancer. More than half of the patients (55.7%) had bilateral multiple metastases.
Fifty-six of 104 patients underwent chemotherapy, 28 conservative therapy, and 20 a pulmonary resection with the extent of the resection varying from a wedge resection of the metastatic nodule to a lobectomy. Prolonged survival was associated with serum CEA levels at the diagnosis of the metastases (P=0.02) and with the type of treatment (P<0.01).
CONCLUSIONS
The s-CEA level at the diagnosis of the pulmonary metastases appears to be a reliable predictor of survival in patients with pulmonary metastases from colorectal cancer. Resection of the pulmonary metastasis in colorectal cancer may significantly prolong survival. Thus, aggressive therapy, including surgery, should be considered for pulmonary metastatic tumors in selected groups. |
| Key Words:
Neoplasm metastasis; Treatment outcome; Carcinoembryonic antigen; colorectal neoplasms; Lung neoplasms |
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