1. The presence of lung metastases does not influence survival in liver metastatic colorectal cancer
Jennie Engstrand1, Henrik Nilsson1, Cecilia Strömberg2, Eduard Jonas3, Jacob Freedman1
1 Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Surgery and Urology, Stockholm, Sweden
2 Karolinska Institutet, Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska University
Hospital, Division of Surgery, Stockholm, Sweden
3 Surgical Gastroenterology Unit, Department of Surgery, Groote Schuur Hospital, University of Cape Town Health Sciences Faculty, Cape
Town, South Africa
Conclusion
The presence of lung metastases seem to have a limited impact on survival in liver metastatic CRC.
Lung metastatic right-sided colon cancer had a worse survival as compared to left-sided colon cancer. This is in coherence with previous studies on worse survival in metastatic right-sided colon cancer.
Ongoing randomized studies will hopefully determine whether resection of liver metastases in the presence of unresectable lung metastases will result in a survival benefit as compared to chemotherapy only.
p<0.001
p=0.006
p=0.204
Kaplan-Meier survival estimates of patients with non-metastatic CRC and different metastatic pattern.
Background
The indications for liver resection of colorectal cancer liver metastases (CRCLM) are continuously expanding and the presence of extra-hepatic metastases are no longer an absolute contraindication for hepatic resection.
Aim
To describe how lung metastases influence survival in liver metastatic colorectal cancer (CRC) and if there is a difference in survival depending on primary tumour site. .
Results
In this population-based study of 1026 patients with CRC, liver and lung metastases were diagnosed in 26.5% and 16.9%, respectively.
Lung metastases were more likely to be diagnosed in left-sided and rectal cancers as compared to right-sided cancers (19.7% vs. 13.2%, p=0.010).
The presence of lung metastases did not significantly influence OS in multivariate analysis, neither in the entire CRC cohort (HR: 1.23, CI: 0.93 to 1.62) nor in patients with liver metastatic CRC (HR: 1.11, CI: 0.80 to 1.53).
Patients with lung metastatic right-sided colon cancer had a significantly worse 5-year OS as compared to lung metastatic left-sided colon cancer (13.0% versus 21.1%, p=0.008)
Methods
Patients diagnosed with CRC during 2008 in the region of Stockholm, Sweden, were identified through the Swedish Colorectal Cancer Register and followed for 5 years.
Information on liver and lung metastatic pattern was retrieved from electronic patient charts. Factors influencing overall survival (OS) were examined using Cox proportional hazards model with 95 per cent confidence interval (CI). Survival curves were estimated by the Kaplan-Meier method and OS was compared using log-rank test.
Kaplan-Meier survival estimates of lung metastatic right-sided versus left-sided colon cancer. Right-sided colon cancer (RCC). Left-sided colon cancer (LCC).
p=0.008
Jennie Engstrand
M.D.
Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Surgery and Urology, Stockholm, Sweden
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