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Clinical and Radiological Discrimination of Solitary Pulmonary Lesions in Colorectal Cancer Patients

World Journal of Surgery volume 42, pages 1161–1170 (2018)Cite this article

Abstract

Objectives

The lung is one of the most common organs of metastasis from colorectal cancer (CRC), and we have encountered lung cancer patients with a history of CRC. There have been few studies regarding methods used to discriminate between primary lung cancer (PLC) and pulmonary metastasis from CRC (PM-CRC) based only on preoperative findings. We retrospectively investigated predictive factors discriminating between these lesions in patients with a history of CRC.

Methods

Between 2006 and 2015, 117 patients with a history of CRC (44 patients with 47 PLC and 73 patients with 102 PM-CRC) underwent subsequent or concurrent resection of pulmonary lesions. We compared the clinical and radiological characteristics of 100 patients with solitary lesions (43 PLC and 57 PM-CRC). Using univariate and multivariate analyses, we examined predictive factors for discrimination of these two lesions.

Results

All tumors with findings of ground-glass opacity (GGO) were PLC (n = 19). In a multivariate analysis of 81 radiologically solid tumors, two factors were found to be significant independent predictors of PLC: a history of stage I CRC and presence of pleural indentation. All tumors in 26 patients with either GGO or both a stage I CRC history and pleural indentation were PLC, while most tumors in patients without all three factors were PM-CRC (43/44; 97.7%).

Conclusions

The presence or absence of GGO, pathological CRC stage, and pleural indentation could be useful factors to distinguish between PLC and PM-CRC.

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References

  1. Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J et al (2013) Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. Eur J Cancer 49:1374–1403

    CAS  Article  PubMed  Google Scholar 

  2. Sclafani F, Incarbone M, Rimassa L et al (2013) The role of hepatic metastases and pulmonary tumor burden in predicting survival after complete pulmonary resection for colorectal cancer. J Thorac Cardiovasc Surg 145:97–103

    Article  PubMed  Google Scholar 

  3. Sakamoto Y, Sakaguchi Y, Oki E et al (2012) Surgical outcomes after resection of both hepatic and pulmonary metastases from colorectal cancer. World J Surg 36:2708–2713. doi:10.1007/s00268-012-1708-8

    Article  PubMed  Google Scholar 

  4. Sakamoto T, Tsubota N, Iwanaga K et al (2001) Pulmonary resection for metastases from colorectal cancer. Chest 119:1069–1072

    CAS  Article  PubMed  Google Scholar 

  5. Renaud S, Falcoz PE, Olland A et al (2015) The intrathoracic lymph node ratio seems to be a better prognostic factor than the level of lymph node involvement in lung metastasectomy of colorectal carcinoma. Interact CardioVasc Thorac Surg 20:215–221

    Article  PubMed  Google Scholar 

  6. Renaud S, Alifano M, Falcoz PE et al (2014) Does nodal status influence survival? Results of a 19-year systematic lymphadenectomy experience during lung metastasectomy of colorectal cancer. Interact CardioVasc Thorac Surg 18:482–487

    Article  PubMed  PubMed Central  Google Scholar 

  7. Lin BR, Chang TC, Lee YC et al (2009) Pulmonary resection for colorectal cancer metastases: duration between cancer onset and lung metastasis as an important prognostic factor. Ann Surg Oncol 16:1026–1032

    Article  PubMed  Google Scholar 

  8. Cho S, Song IH, Yang HC et al (2013) Prognostic factors of pulmonary metastasis from colorectal carcinoma. Interact CardioVasc Thorac Surg 17:303–307

    Article  PubMed  PubMed Central  Google Scholar 

  9. Chen F, Hanaoka N, Sato K et al (2009) Prognostic factors of pulmonary metastasectomy for colorectal carcinomas. World J Surg 33:505–511. doi:10.1007/s00268-008-9875-3

    CAS  Article  PubMed  Google Scholar 

  10. Watanabe I, Arai T, Ono M et al (2003) Prognostic factors in resection of pulmonary metastasis from colorectal cancer. Br J Surg 90:1436–1440

    CAS  Article  PubMed  Google Scholar 

  11. Hattori A, Suzuki K, Aokage K et al (2014) Prognosis of lung cancer patients with a past history of colorectal cancer. Jpn J Clin Oncol 44:1088–1095

    Article  PubMed  Google Scholar 

  12. Cahan WG, Castro EB, Hajdu SI (1974) Proceedings: the significance of a solitary lung shadow in patients with colon carcinoma. Cancer 33:414–421

    CAS  Article  PubMed  Google Scholar 

  13. Collins J, Stern EJ (2008) Chest radiology: the essentials. Wolters Kluwer Health, Philadelphia

    Google Scholar 

  14. TNM Classification of Malignant Tumours, 7th edn (2009) Wiley

  15. Bishop JA, Sharma R, Illei PB (2010) Napsin a and thyroid transcription factor-1 expression in carcinomas of the lung, breast, pancreas, colon, kidney, thyroid, and malignant mesothelioma. Hum Pathol 41:20–25

    CAS  Article  PubMed  Google Scholar 

  16. Chhieng DC, Cangiarella JF, Zakowski MF et al (2001) Use of thyroid transcription factor 1, pe-10, and cytokeratins 7 and 20 in discriminating between primary lung carcinomas and metastatic lesions in fine-needle aspiration biopsy specimens. Cancer 93:330–336

    CAS  Article  PubMed  Google Scholar 

  17. Yatabe Y, Mitsudomi T, Takahashi T (2002) Ttf-1 expression in pulmonary adenocarcinomas. Am J Surg Pathol 26:767–773

    Article  PubMed  Google Scholar 

  18. Lindell RM, Hartman TE, Swensen SJ et al (2007) Five-year lung cancer screening experience: CT appearance, growth rate, location, and histologic features of 61 lung cancers. Radiology 242:555–562

    Article  PubMed  Google Scholar 

  19. Usuda K, Saito Y, Sagawa M et al (1994) Tumor doubling time and prognostic assessment of patients with primary lung cancer. Cancer 74:2239–2244

    CAS  Article  PubMed  Google Scholar 

  20. Sakurai H, Nakagawa K, Watanabe S et al (2015) Clinicopathologic features of resected subcentimeter lung cancer. Ann Thorac Surg 99:1731–1738

    Article  PubMed  Google Scholar 

  21. Watanabe K, Saito N, Sugito M et al (2013) Incidence and predictive factors for pulmonary metastases after curative resection of colon cancer. Ann Surg Oncol 20:1374–1380

    Article  PubMed  Google Scholar 

  22. Tanaka K, Shimizu K, Ohtaki Y et al (2013) Diagnosis and surgical resection of solitary pulmonary nodules in patients with breast cancer. Mol Clin Oncol 1:117–123

    Article  PubMed  Google Scholar 

  23. Gaeta M, Volta S, Scribano E et al (1996) Air-space pattern in lung metastasis from adenocarcinoma of the GI tract. J Comput Assist Tomogr 20:300–304

    CAS  Article  PubMed  Google Scholar 

  24. Okita R, Yamashita M, Nakata M et al (2005) Multiple ground-glass opacity in metastasis of malignant melanoma diagnosed by lung biopsy. Ann Thorac Surg 79:e1–e2

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors thank Ms. Kaori Takeshita for her support with the data collection.

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Authors and Affiliations

  1. Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Maebashi, Gunma, Japan

    Yoichi Ohtaki, Kimihiro Shimizu, Toshiteru Nagashima, Seshiru Nakazawa, Kai Obayashi, Yoko Azuma, Misaki Iijima, Takayuki Kosaka, Toshiki Yajima, Akira Mogi & Hiroyuki Kuwano

  2. Division of Digestive Surgery, Integrative Center of General Surgery, Gunma University Hospital, Maebashi, Gunma, Japan

    Hiroomi Ogawa, Soichi Tsutsumi & Hiroyuki Kuwano

  3. Clinical Department of Pathology, Gunma University Hospital, Maebashi, Gunma, Japan

    Motohiro Arai

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  1. Yoichi Ohtaki
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Correspondence to Kimihiro Shimizu.

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All authors participated in this study and agreed on the content of this paper. No author has any financial or other relationship that could lead to a conflict of interest.

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Ohtaki, Y., Shimizu, K., Nagashima, T. et al. Clinical and Radiological Discrimination of Solitary Pulmonary Lesions in Colorectal Cancer Patients. World J Surg 42, 1161–1170 (2018). https://doi.org/10.1007/s00268-017-4243-9

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  • DOI: https://doi.org/10.1007/s00268-017-4243-9