[Prognostic factors associated with resectable pulmonary metastases from colorectal cancer]. / Factores pronósticos en metástasis pulmonares resecables de carcinoma colorrectal.

OBJECTIVE: To analyze prognostic factors associated with survival in a group of patients who underwent resection of pulmonary metastases from colorectal cancer. PATIENTS AND METHODS: A retrospective review was performed for 55 consecutive patients who had undergone resection of pulmonary metastases from colorectal adenocarcinoma between January 1993 and June 2004. Univariate and multivariate analyses were performed to assess the effect of the recorded variables on overall survival. RESULTS: Median overall survival was 32.9 months and the probability of survival at 1, 3, and 5 years was 79%, 44%, and 22%, respectively. Survival was lower in patients in whom the largest metastasis was at least 4 cm (8.6 vs 34.5 months, P=.0085) and in patients with elevated levels of carcinoembryonic antigen (24.5 vs 41.4 months, P=.05). Significantly longer survival was observed in patients who received adjuvant chemotherapy after surgery (49.8 vs 30.9 months, P=.0058). Preoperative positron emission tomography (PET) and the absence of previous or synchronous liver metastases were associated with a nonsignificant trend toward increased survival. In the multivariate analysis, only size of the largest pulmonary metastasis influenced overall survival (P=.036). CONCLUSIONS: The preoperative variables that best predicted survival in our patients were size of the largest pulmonary metastasis and the level of carcinoembryonic antigen. Prospective studies are needed to determine the usefulness of PET for tumor staging prior to resection of pulmonary metastases.

Factores pronósticos en metástasis pulmonares resecables de carcinoma colorrectal / Prognostic factors associated with resectable pulmonary metastases from colorectal cancer

Objetivo: Estudiar los factores pronósticos de supervivencia en una serie de pacientes con metástasis pulmonares resecadas de cáncer colorrectal. Pacientes y métodos: Se revisaron retrospectivamente los casos de 55 pacientes consecutivos a quienes entre enero de 1993 y junio de 2004 se había practicado una metastasectomía pulmonar de adenocarcinoma colorrectal. Se realizó un análisis univariante y multivariante para la supervivencia global con las variables recogidas. Resultados: La mediana de la supervivencia global fue de 32,9 meses, con una probabilidad de supervivencia a 1, 3 y 5 años del 79, el 44 y el 22%, respectivamente. La supervivencia fue inferior (p = 0,0085) en los pacientes en que la metástasis mayor era de 4 cm o más respecto a aquellos en que era menor de 4 cm (8,6 frente a 34,5 meses), y en los pacientes con títulos elevados de antígeno carcinoembrionario frente a aquéllos con valores normales (24,5 frente a 41,4 meses; p = 0,05). Quienes recibieron quimioterapia adyuvante tras la cirugía vivieron significativamente más (49,8 frente a 30,9 meses; p = 0,0058). La realización de una tomografía por emisión de positrones preoperatoria y la ausencia de metástasis hepáticas previas o sincrónicas se asociaron a una tendencia no significativa hacia una mejor supervivencia. En el análisis multivariante sólo el tamaño de la metástasis pulmonar mayor influyó en la supervivencia global (p = 0,036). Conclusiones: El tamaño de la metástasis mayor y el valor del antígeno carcinoembrionario fueron las variables preoperatorias que mejor predijeron la supervivencia de nuestros pacientes. Se necesitan estudios prospectivos que valoren el papel de la tomografía por emisión de positrones como estudio de extensión previo a metastasectomías pulmonares

Objective: To analyze prognostic factors associated with survival in a group of patients who underwent resection of pulmonary metastases from colorectal cancer. Patients and methods: A retrospective review was performed for 55 consecutive patients who had undergone resection of pulmonary metastases from colorectal adenocar-cinoma between January 1993 and June 2004. Univariate and multivariate analyses were performed to assess the effect of the recorded variables on overall survival. Results: Median overall survival was 32.9 months and the probability of survival at 1, 3, and 5 years was 79%, 44%, and 22%, respectively. Survival was lower in patients in whom the largest metastasis was at least 4 cm (8.6 vs 34.5 months, P=.0085) and in patients with elevated levels of carcinoembryonic antigen (24.5 vs 41.4 months, P=.05). Significantly longer survival was observed in patients who received adjuvant chemotherapy after surgery (49.8 vs 30.9 months, P=.0058). Preoperative positron emission tomography (PET) and the absence of previous or synchronous liver metastases were associated with a nonsignificant trend toward increased survival. In the multivariate analysis, only size of the largest pulmonary metastasis influenced overall survival (P=.036). Conclusions: The preoperative variables that best predicted survival in our patients were size of the largest pulmonary metastasis and the level of carcinoembryonic antigen. Prospective studies are needed to determine the usefulness of PET for tumor staging prior to resection of pulmonary metastases