Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex.
Department of General Surgery, Baylor University, Houston, Tex.
J Thorac Cardiovasc Surg. 2024 Mar;167(3):814-819.e2. doi: 10.1016/j.jtcvs.2023.07.017. Epub 2023 Jul 24.
Appropriately selected patients clearly benefit from resection of colorectal cancer (CRC) pulmonary metastases (PMs). However, there remains equipoise surrounding optimal chest surveillance strategies following pulmonary metastasectomy. We aimed to identify risk factors that may inform chest surveillance in this population.
Patients who underwent CRC pulmonary metastasectomy were identified from a single institution's prospectively maintained surgical database. Clinicopathologic and genomic characteristics were collected. Patients were stratified by diagnosis of subsequent PM within 6 months of the index lung resection. Multivariate modeling was used to evaluate risk factors.
A total of 197 patients met the study's inclusion criteria, of whom 52.3% (n = 103) developed subsequent PM, at a median of 9.51 months following the index metastasectomy. Patients with KRAS alterations (odds ratio [OR], 3.073; 95% confidence interval [CI], 1.363-6.926; P = .007), TP53 alterations (OR, 3.109; 95% CI, 1.318-7.341; P = .010) were found to be at risk of PM diagnosis within 6 months of the index metastasectomy, while those with an APC alteration (OR, .218; 95% CI, 0.080-0.598; P = .003) were protected. Moreover, patients who received systemic therapy within 3 months of the initial PM diagnosis also were more likely to develop early lung recurrence (OR, 2.105; 95% CI, 0.971-4.563; P = .059).
Patients with KRAS alterations, TP53 alterations, and no APC alterations developed early recurrence in the lung following pulmonary metastasectomy, as did those who received chemotherapy after their initial PM diagnosis. As such, these groups benefit from early lung imaging after metastasectomy, as chest surveillance protocols should be based on patient-centered clinicopathologic and genomic risk factors.
适当选择的患者显然可以从结直肠癌（CRC）肺转移瘤（PMs）的切除术获益。然而，在肺转移瘤切除术后，对于最佳的胸部监测策略仍存在争议。我们旨在确定可能为该人群提供胸部监测信息的危险因素。
从单机构前瞻性维护的手术数据库中确定接受 CRC 肺转移瘤切除术的患者。收集临床病理和基因组特征。根据指数肺切除术后 6 个月内是否诊断出 PM 将患者分层。多变量建模用于评估危险因素。
共有 197 名患者符合研究纳入标准，其中 52.3%（n=103）在指数转移瘤切除术 9.51 个月后发生了后续 PM。KRAS 改变（比值比 [OR]，3.073；95%置信区间 [CI]，1.363-6.926；P=0.007）、TP53 改变（OR，3.109；95%CI，1.318-7.341；P=0.010）的患者有在指数转移瘤切除术后 6 个月内诊断为 PM 的风险，而 APC 改变（OR，0.218；95%CI，0.080-0.598；P=0.003）的患者则有保护作用。此外，在初始 PM 诊断后 3 个月内接受系统治疗的患者也更有可能早期发生肺部复发（OR，2.105；95%CI，0.971-4.563；P=0.059）。
在肺转移瘤切除术后，KRAS 改变、TP53 改变且无 APC 改变的患者以及初始 PM 诊断后接受化疗的患者，肺部早期复发。因此，这些患者在转移瘤切除术后需要进行早期肺部影像学检查，因为胸部监测方案应基于患者为中心的临床病理和基因组危险因素。
