title: Factors influencing oncological outcomes in patients who develop pulmonary metastases after curative resection of colorectal cancer.
abstract: BACKGROUND
  The prognostic factors after pulmonary resection in patients with colorectal pulmonary metastases remain controversial.
  
  
  OBJECTIVE
  The study aimed to identify the predicting factors for oncological outcomes after curative resection in patients with colorectal cancer and pulmonary metastases.
  
  
  METHODS
  This study is a retrospective review of prospectively collected data.
  
  
  METHODS
  This study was conducted at a tertiary care hospital/referral center in South Korea.
  
  
  METHODS
  Between January 2000 and June 2010, 105 patients who developed pulmonary metastases after curative resection for colorectal cancer were enrolled. Forty-eight patients underwent pulmonary resection, and the remaining 58 were given chemotherapy and/or best supportive care.
  
  
  METHODS
  The primary outcomes measured were the predictive factors of survival and recurrence.
  
  
  RESULTS
  During the 35.9-month median follow-up period, 3- and 5-year overall survival rates were 54.6% and 30.4%. On multivariate analysis, absence of adjuvant chemotherapy after pulmonary metastases (p = 0.003), presence of extrapulmonary metastases (p = 0.001), elevated prelaparotomy serum CEA level (p = 0.015), and absence of pulmonary resection (p = 0.048) were independent prognostic factors for poor overall survival. In patients who underwent pulmonary resection, the 3-year pulmonary recurrence-free survival rate was 78.3%. On multivariate analysis, elevated prelaparotomy serum CEA level (p = 0.018) and disease-free interval ≤ 12 months (p = 0.008) were independent risk factors associated with pulmonary re-recurrence after pulmonary resection.
  
  
  CONCLUSIONS
  This study took place at a single institution and had a small sample size.
  
  
  CONCLUSIONS
  Although we admit, to some degree, the benefits of the selection mechanism, pulmonary metastasectomy from colorectal cancer may improve survival after curative resection of colorectal cancer. Adjuvant chemotherapy, extrapulmonary metastases, and prelaparotomy CEA value are independent prognostic factors for overall survival. Prelaparotomy serum CEA level may be an especially reliable predictor of both overall survival and recurrence-free survival after pulmonary metastasectomy in patients who undergo curative resection for colorectal cancer.
authors.affiliation: Department of Surgery, Chonnam National University, Gwangju, Korea.
authors.forename: Chang Hyun
authors.initials: CH
authors.lastname: Kim
authors.forename: Jung Wook
authors.initials: JW
authors.lastname: Huh
authors.forename: Hun Jin
authors.initials: HJ
authors.lastname: Kim
authors.forename: Sang Woo
authors.initials: SW
authors.lastname: Lim
authors.forename: Sang Yun
authors.initials: SY
authors.lastname: Song
authors.forename: Hyeong Rok
authors.initials: HR
authors.lastname: Kim
authors.forename: Kook Joo
authors.initials: KJ
authors.lastname: Na
authors.forename: Young Jin
authors.initials: YJ
authors.lastname: Kim
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery*; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000556:secondary* / Q000628:therapy*; D008297:Male; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome