TY - JOUR
T1 - Occurrence and survival of synchronous pulmonary metastases in colorectal cancer
T2 - a nationwide cohort study
AU - Nordholm-Carstensen, Andreas
AU - Krarup, Peter-Martin
AU - Jorgensen, Lars N
AU - Wille-Jørgensen, Peer A
AU - Harling, Henrik
AU - Danish Colorectal Cancer Group
N1 - Copyright © 2013 Elsevier Ltd. All rights reserved.
PY - 2014/1
Y1 - 2014/1
N2 - Objective To investigate the occurrence of synchronous colorectal cancer metastases (SCCM) confined to the lungs, risk factors for these metastases and their impact on survival. Methods In a nationwide cohort study of 26,200 patients data were prospectively entered into the Danish Colorectal Cancer Group's (DCCG's) database between May 2001 and December 2011. The recorded data were merged with data from the Danish Pathology Registry and the National Patient Registry. Multivariable logistic- and extended Cox regression analyses were used to adjust for confounding variables. Results In total, 1970 patients (7.5%) had pulmonary SCCM of whom 736 (37%) had metastases exclusively in the lungs. Advanced age, recent years of diagnosis and a rectal index cancer were significantly associated with pulmonary SCCM. Adjustment for excess use of thoracic CT scans in rectal cancer patients did not alter this association (adjusted OR = 1.81 (95% CI: 1.46-2.25, P < 0.001)). Patients subjected to pulmonary metastasectomy, resection of primary tumour and chemotherapy had a superior overall survival compared with non-treated patients, especially when these therapeutic modalities were combined. Conclusions The occurrence of pulmonary SCCM was higher than previously reported and had a severe impact on survival. Our analyses suggest that pulmonary metastasectomy, resection of the primary tumour and chemotherapy may be a sound strategy in patients with confined pulmonary SCCM, but the risk of selection bias and consequent exaggeration of the treatment effect should be kept in mind. This study may serve as a reliable un-biased reference for future evaluation on detection strategies and potential therapeutic interventions.
AB - Objective To investigate the occurrence of synchronous colorectal cancer metastases (SCCM) confined to the lungs, risk factors for these metastases and their impact on survival. Methods In a nationwide cohort study of 26,200 patients data were prospectively entered into the Danish Colorectal Cancer Group's (DCCG's) database between May 2001 and December 2011. The recorded data were merged with data from the Danish Pathology Registry and the National Patient Registry. Multivariable logistic- and extended Cox regression analyses were used to adjust for confounding variables. Results In total, 1970 patients (7.5%) had pulmonary SCCM of whom 736 (37%) had metastases exclusively in the lungs. Advanced age, recent years of diagnosis and a rectal index cancer were significantly associated with pulmonary SCCM. Adjustment for excess use of thoracic CT scans in rectal cancer patients did not alter this association (adjusted OR = 1.81 (95% CI: 1.46-2.25, P < 0.001)). Patients subjected to pulmonary metastasectomy, resection of primary tumour and chemotherapy had a superior overall survival compared with non-treated patients, especially when these therapeutic modalities were combined. Conclusions The occurrence of pulmonary SCCM was higher than previously reported and had a severe impact on survival. Our analyses suggest that pulmonary metastasectomy, resection of the primary tumour and chemotherapy may be a sound strategy in patients with confined pulmonary SCCM, but the risk of selection bias and consequent exaggeration of the treatment effect should be kept in mind. This study may serve as a reliable un-biased reference for future evaluation on detection strategies and potential therapeutic interventions.
KW - Age Factors
KW - Aged
KW - Aged, 80 and over
KW - Cohort Studies
KW - Colorectal Neoplasms
KW - Combined Modality Therapy
KW - Denmark
KW - Female
KW - Follow-Up Studies
KW - Humans
KW - Kaplan-Meier Estimate
KW - Logistic Models
KW - Lung Neoplasms
KW - Male
KW - Middle Aged
KW - Multivariate Analysis
KW - Outcome Assessment (Health Care)
KW - Proportional Hazards Models
KW - Registries
KW - Risk Factors
U2 - 10.1016/j.ejca.2013.10.009
DO - 10.1016/j.ejca.2013.10.009
M3 - Journal article
C2 - 24215844
SN - 0959-8049
VL - 50
SP - 447
EP - 456
JO - European Journal of Cancer, Supplement
JF - European Journal of Cancer, Supplement
IS - 2
ER -
