Prognostic factors and analysis of microsatellite instability in resected pulmonary metastases from colorectal carcinoma.
BACKGROUND
In this study, we analyze our experience with pulmonary resection for metastases from colorectal carcinoma. The aims were to search for factors influencing prognosis and to investigate the presence of microsatellite instability in the primary tumors and the corresponding lung metastases.


METHODS
We identified 81 patients who underwent surgical resection between 1991 and 2004. The microsatellite instability was determined by immunohistochemical evaluation of MSH2 and MLH1 in 117 lesions (41 primary tumors and 76 lung metastases).


RESULTS
Overall 3-, 5-, and 10-year survival rates were 50%, 42%, and 30%, respectively. Univariate analysis showed that stage of the primary tumor (p = 0.037), radicalness of the resection (p = 0.019), and stratification into groups according to the International Registry of Lung Metastases classification (p = 0.039) were prognostic factors. Multivariate analysis showed that stage of the primary tumor (p = 0.030) and the radicalness of the resection (p = 0.014) were independent prognostic factors. All tumors displayed preserved expression of MSH2 and MLH1 and were considered microsatellite stable lesions.


CONCLUSIONS
Pulmonary resection of metastases from colorectal carcinoma results in long-term survival in selected patients. Complete resection, stage of the primary tumor and stratification into groups according to the International Registry of Lung Metastases classification were prognostic factors. All the metastases and the corresponding primary tumors were microsatellite stable lesions. This finding seems to demonstrate that pulmonary metastases are infrequent in colorectal carcinomas with microsatellite instability.
Melloni
Giulio
G
Department of Thoracic Surgery, Scientific Institute H San Raffaele, Milan, Italy. giulio.melloni@hsr.it
Doglioni
Claudio
C
Bandiera
Alessandro
A
Carretta
Angelo
A
Ciriaco
Paola
P
Arrigoni
Gianluigi
G
Zannini
Piero
P
D048868:Adaptor Proteins, Signal Transducing / Q000235:genetics*; D000230:Adenocarcinoma / Q000188:drug therapy / Q000235:genetics* / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D042822:Genomic Instability; D006801:Humans; D015993:Life Tables; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary / Q000601:surgery; D008175:Lung Neoplasms / Q000188:drug therapy / Q000235:genetics* / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D018895:Microsatellite Repeats; D008875:Middle Aged; D000070957:MutL Protein Homolog 1; D051718:MutS Homolog 2 Protein / Q000235:genetics*; D009363:Neoplasm Proteins / Q000235:genetics*; D009687:Nuclear Proteins / Q000235:genetics*; D011013:Pneumonectomy / Q000706:statistics & numerical data*; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D015996:Survival Rate
D048868:Adaptor Proteins, Signal Transducing; C501486:MLH1 protein, human; D009363:Neoplasm Proteins; D009687:Nuclear Proteins; C497172:MSH2 protein, human; D000070957:MutL Protein Homolog 1; D051718:MutS Homolog 2 Protein; D005472:Fluorouracil