title: Heterogeneity of Tumor Sizes in Multiple Pulmonary Metastases of Colorectal Cancer as a Prognostic Factor.
abstract: BACKGROUND
  The number of metastatic lesions is closely correlated with prognosis in most cancers. The aim of this study was to clarify the relationship between individual heterogeneity of metastatic tumor sizes and prognosis in patients with multiple pulmonary metastasis of colorectal cancer who received surgical treatment.
  
  
  METHODS
  Clinical data for patients who had pulmonary metastasis from colorectal cancer and underwent curative resection at 46 Japanese institutions between January 2004 and December 2008 were collected. Among 898 patients eligible considering these inclusion criteria, 247 patients had multiple metastases and were analyzed. A difference between the maximum and minimum tumor diameters (Dmax-min) on pathologic findings was used to evaluate size heterogeneity.
  
  
  RESULTS
  The overall survival rate was 75% at 3 years and 58% at 5 years, with a median follow-up period of 65 months (range, 0 to 112). When Dmax-minof 5 mm was set as a cutoff value, overall survival was significantly different between small (≤5 mm, n = 95) and large (>5 mm, n = 152) tumor groups (5-year survival rates, 66.5% and 53.3%, respectively; log rank test, p = 0.025). Multivariate analysis using a Cox proportional hazards model revealed that disease-free interval from resection of primary lesion, serum carcinoembryonic antigen level, number of pulmonary metastases, and Dmax-minwere independent prognostic factors.
  
  
  CONCLUSIONS
  The heterogeneity of metastatic tumor sizes may be an indicator for prognosis in patients with multiple pulmonary metastases of colorectal cancer who underwent resection.
authors.affiliation: Department of Thoracic Surgery, Yao Municipal Hospital, Osaka, Japan; Division of Thoracic Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan. Electronic address: tomohiro.maniwa@hosp-yao.osaka.jp.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Maniwa
authors.affiliation: Clinical Trial Coordination Office, Shizuoka Cancer Center Hospital, Shizuoka, Japan.
authors.forename: Keita
authors.initials: K
authors.lastname: Mori
authors.affiliation: Division of Thoracic Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan.
authors.forename: Yasuhisa
authors.initials: Y
authors.lastname: Ohde
authors.affiliation: Department of Surgery, University Hospital Mizonokuchi, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Takehiro
authors.initials: T
authors.lastname: Okumura
authors.affiliation: Division of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Narikazu
authors.initials: N
authors.lastname: Boku
authors.affiliation: Department of Thoracic Surgery, National Cancer Center Hospital East, Chiba, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Hishida
authors.affiliation: Department of Thoracic Surgery, Aichi Cancer Center Hospital, Aichi, Japan.
authors.forename: Yukinori
authors.initials: Y
authors.lastname: Sakao
authors.affiliation: Department of Chest Surgery, Niigata Cancer Center Hospital, Niigata, Japan.
authors.forename: Katsuo
authors.initials: K
authors.lastname: Yoshiya
authors.affiliation: Division of Gastroenterology Clinical Medicine, Faculty of Medicine, University of Tsukuba University Hospital, Ibaraki, Japan.
authors.forename: Ichinosuke
authors.initials: I
authors.lastname: Hyodo
authors.affiliation: General Thoracic Surgery, School of Medicine, Kyorin University, Tokyo, Japan.
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Kondo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000556:secondary; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011013:Pneumonectomy; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor