Retrospective Cohort Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Aug 15, 2024; 16(8): 3457-3470
Published online Aug 15, 2024. doi: 10.4251/wjgo.v16.i8.3457
Effect of perioperative chemotherapy on resection of isolated pulmonary metastases from colorectal cancer: A single center experience
Zhao Gao, Xuan Jin, Ying-Chao Wu, Shi-Jie Zhang, Shi-Kai Wu, Xin Wang
Zhao Gao, Xuan Jin, Shi-Kai Wu, Department of Medical Oncology, Peking University First Hospital, Beijing 10000, China
Ying-Chao Wu, Xin Wang, Department of General Surgery, Peking University First Hospital, Beijing 10000, China
Shi-Jie Zhang, Department of Thoracic Surgery, Peking University First Hospital, Beijing 10000, China
Co-first authors: Zhao Gao and Xuan Jin.
Co-corresponding authors: Shi-Kai Wu and Xin Wang.
Author contributions: Gao Z and Jin X wrote the manuscript as co-first authors; Wu SK and Wang X conceived of the review and edited the manuscript as co-corresponding authors; Gao Z collected and analyzed the data; Jin X, Wu YC, and Zhang SJ analyzed the data and drafted the article; Gao Z and Jin X contributed equally to this work; and all authors read and approved the final manuscript.
Supported by the 2020 National and Provincial Clinical Key Specialty Capacity Building Projects, No. 2020641.
Institutional review board statement: Our study complies with all ethical regulations of the Peking University First Hospital Ethics Committee (Approval No. 2024-321-001).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors have no relevant financial or non-financial interests to disclose.
Data sharing statement: The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shi-Kai Wu, PhD, Chief Doctor, Department of Medical Oncology, Peking University First Hospital, No. 8 Xishiku Street, Beijing 10000, China. skywu4923@sina.cn
Received: May 11, 2024
Revised: June 21, 2024
Accepted: June 27, 2024
Published online: August 15, 2024
Processing time: 88 Days and 23.7 Hours
Abstract
BACKGROUND

Numerous studies have assessed surgical resection as a standard treatment option for patients with colorectal cancer (CRC) and resectable pulmonary metastases (PM). However, the role of perioperative chemotherapy after complete resection of isolated PM from patients with CRC patients remains controversial. We hypothesize that perioperative chemotherapy does not provide significant survival benefits for patients undergoing resection of PM from CRC.

AIM

To determine whether perioperative chemotherapy affects survival after radical resection of isolated PM from CRC.

METHODS

We retrospectively collected demographic, clinical, and pathologic data on patients who underwent radical surgery for isolated PM from CRC. Cancer-specific survival (CSS) and disease-free survival were calculated using Kaplan-Meier analysis. Inter-group differences were compared using the log-rank test. For multivariate analysis, Cox regression was utilized when indicated.

RESULTS

This study included 120 patients with a median age of 61.6 years. The 5-year CSS rate was 78.2%, with 36.7% experiencing recurrence. Surgical resection for isolated PM resulted in a 5-year CSS rate of 50.0% for second metastases. Perioperative chemotherapy (P = 0.079) did not enhance survival post-resection. Factors associated with improved survival included fewer metastatic lesions [hazard ratio (HR): 2.51, P = 0.045], longer disease-free intervals (HR: 0.35, P = 0.016), and wedge lung resections (HR: 0.42, P = 0.035). Multiple PM predicted higher recurrence risk (HR: 2.22, P = 0.022). The log-rank test showed no significant difference in CSS between single and repeated metastasectomy (P = 0.92).

CONCLUSION

Perioperative chemotherapy shows no survival benefit post-PM resection in CRC. Disease-free intervals and fewer metastatic lesions predict better survival. Repeated metastasectomy is warranted for eligible patients.

Keywords: Pulmonary metastasis; Colorectal cancer; Perioperative chemotherapy; Survival; Repeated pulmonary metastasectomy

Core Tip: Several studies have evaluated surgical resection of isolated pulmonary metastasis as a standard treatment option for colorectal cancer (CRC) patients with resectable pulmonary metastases (PM). However, the role of peri-operative chemotherapy after complete resection of isolated PM from CRC patients is still controversial. We sought to determine whether peri-operative chemotherapy affects survival after radical resection of isolated PM from CRC. As a single center, our study still has certain value. At the same time, due to the long survival period of patients, they will receive a lot of subsequent treatments and there are many factors that interfere with the prognosis. We believe that cancer-specific survival can better reflect the focus of research on these patients, but many studies do not give this. Due to the lack of randomized prospective trials and high-level evidence, our study may support valuable data support for individual participant data meta-analysis and help further research on this type of disease.