Histopathologic prognostic factors in resected colorectal lung metastases.
BACKGROUND
Pulmonary metastasectomy is a standard method of treatment for selective pulmonary metastases of colorectal cancer. However, the pathologic factors of metastatic lesions that affect survival and tumor recurrence after pulmonary resection are less well defined. The pathologic findings of colorectal pulmonary metastases have not been correlated with clinical outcome. The study was conducted to clarify the characteristics and identify the prognostic factors of the pulmonary metastases of colorectal cancer.


METHODS
Between July 1992 and November 2002, 89 patients underwent the complete resection of pulmonary metastases of primary colorectal carcinoma, and we pathologically reviewed the surgical specimens of 136 metastatic lesions from these patients.


RESULTS
There were no perioperative deaths. The overall 5-year survival rate was 61.4%. No clinical factors were associated with the outcome. The univariate analysis of pathologic factors revealed aerogenous spread with floating cancer cell clusters (ASFC) (p = 0.004), vascular invasion (p = 0.002), lymphatic invasion (p = 0.032), and pleural invasion (p = 0.037) to be prognostic factors. The multivariate analysis showed vascular invasion (p = 0.02) and ASFC (p = 0.02) to be independent prognostic factors. The 5-year survival rate of patients whose lesions were positive for both ASFC and vascular invasion was 24.7% and much poorer than in the patients with ASFC without vascular invasion (78.6%), vascular invasion but without ASFC (80.2%), and patients negative for both (93.3%) (p = 0.0002).


CONCLUSIONS
The morphologic features of ASFC and vascular invasion at metastatic sites are prognostic factors for colorectal cancer patients who have undergone pulmonary metastasectomy.
Shiono
Satoshi
S
Pathology Division, National Cancer Center Research Institute East, National Cancer Center Hospital East, Chiba, Japan.
Ishii
Genichiro
G
Nagai
Kanji
K
Yoshida
Junji
J
Nishimura
Mitsuyo
M
Murata
Yukinori
Y
Tsuta
Koji
K
Nishiwaki
Yutaka
Y
Kodama
Tetsuro
T
Ochiai
Atsushi
A
D000230:Adenocarcinoma / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D000310:Adrenal Gland Neoplasms / Q000556:secondary / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001808:Blood Vessels / Q000473:pathology; D001984:Bronchial Neoplasms / Q000556:secondary; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology*; D003131:Combined Modality Therapy; D005260:Female; D006498:Hepatectomy; D006801:Humans; D015993:Life Tables; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary / Q000601:surgery; D008175:Lung Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010997:Pleural Neoplasms / Q000556:secondary; D011013:Pneumonectomy / Q000379:methods; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome