title: Risk factors for survival after lung metastasectomy in colorectal cancer patients: a systematic review and meta-analysis.
abstract: BACKGROUND
  Resection of lung metastases (LM) from colorectal cancer (CRC) is increasingly performed with a curative intent. It is currently not possible to identify those CRC patients who may benefit the most from this surgical strategy. The aim of this study was to perform a systematic review of risk factors for survival after lung metastasectomy for CRC.
  
  
  METHODS
  We performed a meta-analysis of series published between 2000 and 2011, which focused on surgical management of LM from CRC and included more than 40 patients each. Pooled hazard ratios (HR) were calculated by using random effects model for parameters considered as potential prognostic factors.
  
  
  RESULTS
  Twenty-five studies including a total of 2925 patients were considered in this analysis. Four parameters were associated with poor survival: (1) a short disease-free interval between primary tumor resection and development of LM (HR 1.59, 95 % confidence interval [CI] 1.27-1.98); (2) multiple LM (HR 2.04, 95 % CI 1.72-2.41); (3) positive hilar and/or mediastinal lymph nodes (HR 1.65, 95 % CI 1.35-2.02); and (4) elevated prethoracotomy carcinoembryonic antigen (HR 1.91, 95 % CI 1.57-2.32). By comparison, a history of resected liver metastases (HR 1.22, 95 % CI 0.91-1.64) did not achieve statistical significance.
  
  
  CONCLUSIONS
  Clinical variables associated with prolonged survival after surgery for LM in CRC patients include prolonged disease-free interval between primary tumor and metastatic spread, normal prethoracotomy carcinoembryonic antigen, absence of thoracic node involvement, and a single pulmonary lesion.
authors.affiliation: Division of Thoracic Surgery, Centre Hospitalier Vaudois (CHUV), Lausanne, Switzerland.
authors.forename: Michel
authors.initials: M
authors.lastname: Gonzalez
authors.forename: Antoine
authors.initials: A
authors.lastname: Poncet
authors.forename: Christophe
authors.initials: C
authors.lastname: Combescure
authors.forename: John
authors.initials: J
authors.lastname: Robert
authors.forename: Hans Beat
authors.initials: HB
authors.lastname: Ris
authors.forename: Pascal
authors.initials: P
authors.lastname: Gervaz
mesh_terms: D006801:Humans; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D015201:Meta-Analysis as Topic; D059146:Metastasectomy / Q000401:mortality; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate