Gössling Gustavo C L, Chedid Márcio F, Pereira Fernando S, da Silva Rafaela K, Andrade Leonardo B, Peruzzo Nícolas, Saueressig Maurício G, Schwartsmann Gilberto, Parikh Aparna R
Medical Oncology Department, Hospital de Clínicas de Porto Alegre, Brazil.
Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
Oncologist. 2021 Sep;26(9):e1581-e1588. doi: 10.1002/onco.13802. Epub 2021 May 5.
We aimed to identify clinicopathological and molecular features associated with progression-free survival (PFS) and overall survival (OS) after pulmonary metastasectomy for metastatic colorectal cancer in a retrospective cohort in Brazil.
We did a retrospective review of thoracic surgeries performed in a single large academic hospital in Brazil from January 1985 to September 2019. Demographics, previously described prognostic factors, and clinicopathological and molecular characteristics were abstracted. Univariate Cox regression was performed for each variable, and, when significant, data were dichotomized to provide clinically meaningful thresholds.
Records from 698 patients were reviewed. Fifty-eight patients underwent pulmonary metastasectomy with curative intent. Of those, 53.4% had a single metastatic lesion. The median size of the largest lesion was 1.5 cm. Results of RAS, RAF, and mismatch repair testing and of cytokeratin 20 (CK20) and CDX2 testing were available for 13.8% and 58.6% of the sample, respectively. Median PFS was 14 months, median OS was 58 months, and 5-year survival was 49.8%. Unfavorable prognostic factors for OS included disease-free interval (DFI) <24 months, synchronous presentation, size of the largest lesion ≥2 cm, and loss of CK20 expression. Presenting with more than one lesion was prognostic for PFS but not for OS.
In this Brazilian cohort, our findings corroborate existing data supporting DFI, synchronous presentation, and number and size of lesions as prognostic factors. Furthermore, we found that loss of CK20 expression may be associated with more aggressive disease and shorter OS. Additional molecular prognostic factors after pulmonary metastasectomy for colorectal cancer should be further explored.
This study consolidates disease-free interval, synchronous presentation, and number and size of lesions as clinically relevant data that may help guide therapy for patients with colorectal cancer and lung metastases who are candidates for curative-intent metastasectomy. Additionally, in this sample, lack of cytokeratin 20 expression in metastases was associated with shorter progression-free survival and overall survival, suggesting that biomarkers also may have a role in guiding therapy in this setting and that additional biomarkers should be further explored.
我们旨在在巴西的一项回顾性队列研究中，确定与转移性结直肠癌肺转移瘤切除术后无进展生存期（PFS）和总生存期（OS）相关的临床病理及分子特征。
我们对1985年1月至2019年9月在巴西一家大型学术医院进行的胸外科手术进行了回顾性研究。提取了人口统计学数据、先前描述的预后因素以及临床病理和分子特征。对每个变量进行单因素Cox回归分析，当结果有统计学意义时，将数据进行二分法处理以提供具有临床意义的阈值。
共回顾了698例患者的记录。58例患者接受了根治性肺转移瘤切除术。其中，53.4%有单个转移灶。最大病灶的中位大小为1.5厘米。RAS、RAF和错配修复检测以及细胞角蛋白20（CK20）和CDX2检测结果分别适用于13.8%和58.6%的样本。中位PFS为14个月，中位OS为58个月，5年生存率为49.8%。OS的不良预后因素包括无病间期（DFI）<24个月、同时性表现、最大病灶大小≥2厘米以及CK20表达缺失。存在多个病灶对PFS有预后意义，但对OS无预后意义。
在这个巴西队列中，我们的研究结果证实了现有数据支持DFI、同时性表现以及病灶数量和大小作为预后因素。此外，我们发现CK20表达缺失可能与疾病侵袭性更强和OS更短有关。结直肠癌肺转移瘤切除术后的其他分子预后因素应进一步探索。
本研究巩固了无病间期、同时性表现以及病灶数量和大小作为临床相关数据，这些数据可能有助于指导对有治愈性转移瘤切除术指征的结直肠癌和肺转移患者的治疗。此外，在这个样本中，转移灶中细胞角蛋白20表达缺失与无进展生存期和总生存期较短相关，这表明生物标志物在这种情况下也可能有助于指导治疗，并且应进一步探索其他生物标志物。
