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Benefit of Adjuvant Chemotherapy After Curative Resection of Lung Metastasis in Colorectal Cancer

Annals of Surgical Oncology volume 23, pages 928–935 (2016)Cite this article

Abstract

Background

The survival benefit of adjuvant chemotherapy after colorectal cancer (CRC) lung metastasectomy is uncertain.

Methods

We enrolled 221 CRC patients who underwent pulmonary metastasectomy between October 2002 and July 2013, including those with previous liver metastasis that had been curatively resected. Disease-free survival (DFS) and overall survival (OS) were calculated from the day of lung metastasectomy.

Results

Among all patients, 176 (79.6 %) received adjuvant chemotherapy after lung metastasectomy. Median follow-up was 34.7 months from the time of lung metastasectomy [95 % confidence interval (95 % CI), 7.4–90.9 months]. Patients treated with adjuvant chemotherapy had longer DFS compared with surgery alone (median 32.7 vs 11.2 months respectively, P = 0.076). Multivariate analysis revealed previous liver metastasis, preoperative carcinoembryonic antigen ≥5 ng/mL, disease-free interval <24 months, and surgery without adjuvant chemotherapy as independent risk factors for recurrence. Low-risk patients who had 0–1 risk factors received a significant survival benefit from adjuvant chemotherapy [hazard ratio (HR) 0.54; 95 % CI 0.32–0.91, P = 0.020]; however, high-risk patients with ≥2 risk factors did not (HR 1.02; 95 % CI 0.48–2.14, P = 0.964). Patients treated with adjuvant chemotherapy showed no OS benefit compared with patients who received surgery alone (median 89.6 vs 86.8 months respectively, P = 0.833).

Conclusions

CRC patients received lung metastasectomy could have a DFS benefit from adjuvant chemotherapy, especially in low-risk patients. Larger, prospective studies are needed to evaluate the role of adjuvant chemotherapy after CRC lung metastasectomy.

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Acknowledgment

We thank Han Na Park (Yonsei Cancer Center, Yonsei University College of Medicine) for her help with data collection.

Conflict of Interest

The authors declare no conflicts of interest.

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Affiliations

  1. Department of Pharmacology and Brain Korea 21 Plus Project for Medical Sciences, Yonsei University College of Medicine, Seoul, South Korea

    Hyung Soon Park MD & Min Goo Lee MD, PhD

  2. Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea

    Minkyu Jung MD, Sang Joon Shin MD, PhD, Su Jin Heo MD, Chang Gon Kim MD, Seung Hoon Beom MD & Joong Bae Ahn MD, PhD

  3. Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, South Korea

    Chang Young Lee MD, Jin Gu Lee MD, PhD & Dae Joon Kim MD

Authors
  1. Hyung Soon Park MD
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  2. Minkyu Jung MD
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  3. Sang Joon Shin MD, PhD
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  4. Su Jin Heo MD
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  5. Chang Gon Kim MD
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  6. Min Goo Lee MD, PhD
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  8. Chang Young Lee MD
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  9. Jin Gu Lee MD, PhD
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Correspondence to Minkyu Jung MD.

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Park, H.S., Jung, M., Shin, S.J. et al. Benefit of Adjuvant Chemotherapy After Curative Resection of Lung Metastasis in Colorectal Cancer. Ann Surg Oncol 23, 928–935 (2016). https://doi.org/10.1245/s10434-015-4951-z

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  • DOI: https://doi.org/10.1245/s10434-015-4951-z

Keywords

  • Overall Survival
  • Liver Metastasis
  • Adjuvant Chemotherapy
  • Lung Metastasis
  • National Comprehensive Cancer Network