Prognostic factors in 291 patients with pulmonary metastases submitted to thoracotomy

Pulmonary metastases are among the most common sites for the spread of cancer, particularly with mesenchymal tumors. Despite improvements in cancer therapy, the prognosis remains poor, except for the highly selective group of patients who are considered eligible for surgical treatment and those with chemosensitive tumors. The main objective of this study was to evaluate survival results of 291 patients who underwent thoractomy due to pulmonary metastases between 1953 and 1986. The number of metastases ranged from a minimum of 1 to as many as 30. The type of resection depended on site, size, and number of pulmonary lesions: 154 wedge resections, 49 lobectomies, and 9 pneumectomies. The tumor was not resectable in the remaining 79 patients. Of the prognostic factors analyzed, only type of pulmonary resection (wedge vs. lobectomy vs. pneumectomy vs. unresectable) and disease free interval (DFI) between primary treatment and pulmonary metastases diagnosis ( <=6 months vs. 7-12 months vs. >12 months) were selected as independent predictors of the risk of death in multivariate analysis. A reduced model for bone tumors included disease free interval, sex and histology.

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Prognostic factors for colorectal cancer patients with pulmonary metastases

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e15107 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e15107-e15107

Author(s):

W. Li ◽

W. Zhang ◽

S. Cai ◽

J. Yin ◽

J. Li

Keyword(s):

Multivariate Analysis ◽

Prognostic Factors ◽

Primary Tumor ◽

Pulmonary Metastases ◽

Good Survival ◽

Primary Tumor Site ◽

Disease Free Interval ◽

Metastatic Site ◽

Free Interval ◽

Disease Free

e15107 Background: Pulmonary is the second common metastastic site of CRC with a good survival after metastasectomy, however the general situation of pulmonary metastases from CRC has received little attention, especially for unresectable ones. The aim of this study was to determine factors that may influence survival and disease free interval from primary radical surgery to pulmonary metastases (DFI). Methods: From 01/2000 to 11/2008, a total of 206 pts with pulmonary metastases (colon72, rectal ca131, 3 unknown) were collected retrospectively and the clinical data were analyzed using Kaplan-Meier survival curves, univariate and multivariate analysis. Results: 128 pts (62.1%) had lung disease as the first metastatic site and 33 pts (26.7%) had synchronous liver involvement. Only 17 patients (8.3%) followed pulmonary metastatic resection, and others underwent palliative medical treatment including the chemotherapy and intervention. Median survival was 16.0 months (range 12.240–19.760) with a 18% 5-year survival. Of the totally 160 patients who had synchronous pulmonary metastases after radical primary tumor surgery, the mDFI was 20 months (range 16.738–23.262) months. Rectal cancer had a high chance (65%) for lung recurrence with longer DFI (21 vs 14 mo, P=0.02), but no difference of survival was shown compared to colon cancer. Factors that significantly predicted a poor prognosis on univariate analysis included vessel invasion (P=0.022) and high T stage (P=0.009), but neither of them was the independent prognostic factors after multivariate analysis. The factors influencing the DFI of metachronous pulmonary metastases included primary tumor site, pathological morphology, tumor infiltration stage and regional lymph node stage (P<0.05). There was a trend of better survival of patients receiving resection surgery after pulmonary metastases than receiving chemotherapy alone though no statistical significant was reached (mOS:34 vs 16 mo, P=0.125). But to patients who receiving metastatic site resection, chemotherapy after surgery improved the survival (P=0.042). Conclusions: No independent prognostic factors of survival had been found. The invasive tumor with high stage may have a shorter disease free interval of pulmonary metastases after primary surgery. No significant financial relationships to disclose.

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Prognostic factors and survival in patients with metastatic or recurrent carcinoma of the uterine cervix

International Journal of Gynecological Cancer ◽

10.1136/ijgc-00009577-200307000-00014 ◽

2003 ◽

Vol 13 (4) ◽

pp. 497-504 ◽

Cited By ~ 5

Author(s):

Y. Eralp ◽

P. Saip ◽

B. Sakar ◽

S. Kucucuk ◽

A. Aydiner ◽

...

Keyword(s):

Prognostic Factors ◽

Progression Free Survival ◽

Primary Treatment ◽

Initial Diagnosis ◽

Survival Duration ◽

Disease Free Interval ◽

Free Survival ◽

Free Interval ◽

Response To Chemotherapy ◽

Disease Free

The aim of this study is to identify the impact of various prognostic factors on survival in patients with recurrent carcinoma of the uterine cervix. Fifty-two patients who were treated with platinum-based chemotherapy for recurrent or metastatic disease were retrospectively evaluated. Twenty-seven patients (90%) had received pelvic radiation as primary treatment.Out of 45 evaluable patients, two (4.4%) had complete response (CR), three (6.7%) had a continuous CR after additional surgical treatment and irradiation. Five patients (11.1%) had partial response (PR). The majority of patients had progressive response to treatment (22 patients, 48.9%). After a median follow-up period of 19 months, 31 patients (60%) had died. Progression-free survival after initial diagnosis was observed to have a significant association with response to chemotherapy for recurrent disease (Fisher two-sided P = 0.027). The median survival duration for relapsed disease was 11.8 months. Those with a longer disease-free interval (8 months vs. ≤ 8 months) from initial diagnosis to first recurrence and reponse to chemotherapy had a tendency for a longer survival duration after relapse by univariate analysis. Multivariate analysis revealed that progressive response to chemotherapy (P = 0.002, HR = 4.6) and recurrence within the previously irradiated field (P = 0.04, HR = 2.7) were significant independent prognostic factors for a shorter time to progression after recurrence. Furthermore, advanced stage at presentation (P = 0.001, HR = 3.0) and a short disease-free interval after primary treatment (<8 months, P = 0.003, HR = 3.4) were determined as independent prognostic factors with a significant negative influence on progression-free survival and overall survival from initial diagnosis, respectively.The use of toxic and expensive combinations for the treatment of recurrent cervical cancer patients should be well balanced against potential hazards. Based on our data, less toxic regimens would be more feasible in patients who present with advanced disease at initial diagnosis, or those that experience recurrence within the previously irradiated field after a progression-free interval of less than 8 months.

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Metastasectomy of Pulmonary Metastases from Osteosarcoma: Prognostic Factors and Indication for Repeat Metastasectomy

Journal of Respiratory Medicine ◽

10.1155/2015/570314 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Eri Matsubara ◽

Takeshi Mori ◽

Takamasa Koga ◽

Hidekatsu Shibata ◽

Koei Ikeda ◽

...

Keyword(s):

Prognostic Factors ◽

Pulmonary Metastases ◽

Pulmonary Metastasectomy ◽

Repeat Surgery ◽

Disease Free Interval ◽

Potential Predictor ◽

Free Interval ◽

Maximal Diameter ◽

Metastatic Osteosarcoma ◽

Disease Free

Purpose. To identify prognostic factors for metastatic osteosarcoma patients and establish indication for repeat metastasectomy. Methods. Data from 37 patients with pulmonary metastasis from osteosarcoma who underwent metastasectomy in our institute from 1979 to 2013 were retrospectively reviewed. Results. Prognostic factors analyzed were age, sex, maximal diameter of the tumor at first pulmonary metastasectomy, total number of resected pulmonary metastases at first metastasectomy, number of surgeries, and disease free interval. In our analysis, characteristics associated with an increased overall survival were age > 15 years and fewer metastases (≤3). Of the 37 patients, 13 underwent repeat metastasectomy after the first metastasectomy. Of the 7 patients that underwent only two metastasectomies, three remained disease-free. In contrast, all six patients that underwent three or more metastasectomies died of relapse. Patients who had five or less lesions at second metastasectomy showed better survival compared to those who had six or more lesions. Conclusion. Age > 15 years and number of metastases at first metastasectomy were independent prognostic factors. Metastasectomy may provide curative treatment even in cases requiring repeat surgery. The number of metastases at second metastasectomy may be a potential predictor of the need for repeat surgery.

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Analysis of the immunohistochemical expressions of p53, bcl-2 and Ki-67 in colorectal adenocarcinoma and their correlations with the prognostic factors

Arquivos de Gastroenterologia ◽

10.1590/s0004-28032010000200005 ◽

2010 ◽

Vol 47 (2) ◽

pp. 141-147 ◽

Cited By ~ 19

Author(s):

Hunaldo Lima de Menezes ◽

Mário Jorge Jucá ◽

Edmundo Guilherme de A. Gomes ◽

Benício L. Bulhões B. P. Nunes ◽

Henrique Oliveira Costa ◽

...

Keyword(s):

Prognostic Factors ◽

Cell Differentiation ◽

Colorectal Adenocarcinoma ◽

Sao Paulo ◽

Immunohistochemical Expression ◽

Ki 67 ◽

Disease Free Interval ◽

Free Interval ◽

Specific Mortality ◽

Disease Free

CONTEXT: Search of tumors markers that allow treatment with higher survival rates, and indicate the response to treatment and recurrence of cancer OBJECTIVE: To analyze the immunoexpression of the proteins p53, bcl-2 and Ki-67 in colorectal adenocarcinoma and correlate them with the clinical-pathological prognostic factors. METHOD: Tissue microarray paraffin blocks were made from colorectal adenocarcinoma tissue resected from 82 patients who had undergone surgery but not chemotherapy or radiotherapy, at "Hospital São Paulo", São Paulo, SP, Brazil, between 2002 and 2005. Thin sections (4 µm) were subjected to immunohistochemical reactions, and immunoexpression staining scores were obtained. The scores were correlated with the degree of cell differentiation, staging, disease-free interval, recurrence, survival and specific mortality. The study variables were analyzed using the chi-square and Kaplan-Meier tests to investigate associations with the markers. The significance of the differences between the curves of the disease-free interval and survival was analyzed using the Logrank and Wilcoxon tests. RESULTS: The immunohistochemical expression of p53 was positive in 70 tumors (85.4%) and negative in 12 (14.6%). The expression of bcl-2 was positive in 26 (31.7%) and negative in 56 (68.3%). The expression of Ki-67 was positive in 62 (75.6%) and negative in 20 (24.4%). There was no statistically significant correlation between the expressions of these markers separately or in conjunction, in relation to the degree of cell differentiation, staging, disease-free interval, survival and specific mortality. In relation to recurrence, there was a statistically significant correlation with positive expression of Ki-67 (P = 0.035). CONCLUSION: The immunohistochemical expression of Ki-67 in colorectal cancer is associated with recurrence of this disease.

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Pulmonary resection and systemic lymph node dissection in a patient with breast cancer who had a 33-year disease-free interval

World Journal of Surgical Oncology ◽

10.1186/s12957-015-0565-y ◽

2015 ◽

Vol 13 (1) ◽

Author(s):

Degang Yin ◽

Guofei Zhang ◽

Lufeng Zhao ◽

Ying Chai

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Lymph Node Dissection ◽

Pulmonary Resection ◽

Node Dissection ◽

Disease Free Interval ◽

Free Interval ◽

Disease Free

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Outcomes after resection of synchronous or metachronous hepatic and pulmonary colorectal metastases

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.4059 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 4059-4059

Author(s):

G. Miller ◽

P. Biernacki ◽

N. Kemeny ◽

M. Gonen ◽

R. Downey ◽

...

Keyword(s):

Surgical Resection ◽

Cox Regression ◽

Pulmonary Metastases ◽

Hepatic Metastases ◽

Colorectal Metastases ◽

Patient Treatment ◽

Disease Free Interval ◽

Free Interval ◽

Disease Free ◽

Pulmonary Colorectal Metastases

4059 Background: Surgical resection of isolated hepatic or pulmonary colorectal metastases prolongs survival in selected patients. However, the benefits of resection and appropriate selection criteria in patients who develop both hepatic and pulmonary metastases are ill-defined. Methods: Data were prospectively collected from 131 patients with colorectal cancer who underwent resection of both hepatic and pulmonary metastases over a 20-year period. Median follow-up was 6.6 years from the time of resection of the primary tumor. Patient, treatment, and outcome variables were analyzed using log-rank, Cox regression, and Kaplan-Meier methods. Results: The site of first metastasis was the liver in 65% of patients, lung in 11%, and both simultaneously in 24%. Multiple hepatic metastases were present in 51% of patients and multiple pulmonary metastases were found in 48%. Hepatic lobectomy or trisegmentectomy was required in 61% of patients while most lung metastases (80%) were treated with wedge excisions. Median survival from resection of the primary disease, first site of metastasis, and second site of metastasis was 6.9, 5.0, and 3.3 years, respectively. After resection of disease at the second site of metastasis, the 1, 3, 5, and 10 year disease-specific survival rates were 91, 55, 31 and 19%, respectively. An analysis of prognostic factors revealed that survival was significantly longer when the disease-free interval between the development of the first and second sites of metastases exceeded one year, in patients with a single liver metastasis, and in patients younger than 55 years. Conclusions: Surgical resection of both hepatic and pulmonary colorectal metastases is associated with prolonged survival in selected patients. Patients with a longer disease free interval between metastases and those with single liver lesions had the best outcomes. [Table: see text] No significant financial relationships to disclose.

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Short disease-free interval is a significant risk factor for intrapulmonary recurrence after resection of pulmonary metastases in colorectal cancer

Colorectal Disease ◽

10.1111/j.1463-1318.2009.02070.x ◽

2009 ◽

Cited By ~ 2

Author(s):

Yuji Takakura ◽

Yoshihiro Miyata ◽

Masazumi Okajima ◽

Morihito Okada ◽

Hideki Ohdan

Keyword(s):

Colorectal Cancer ◽

Risk Factor ◽

Pulmonary Metastases ◽

Significant Risk ◽

Significant Risk Factor ◽

Disease Free Interval ◽

Free Interval ◽

Disease Free

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The Significance of Metastasectomy in Patients with Metastatic Renal Cell Carcinoma in the Era of Targeted Therapy

BioMed Research International ◽

10.1155/2015/176373 ◽

2015 ◽

Vol 2015 ◽

pp. 1-8 ◽

Cited By ~ 15

Author(s):

Xiaoteng Yu ◽

Bing Wang ◽

Xuesong Li ◽

Gang Lin ◽

Cuijian Zhang ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Overall Survival ◽

Prognostic Factors ◽

Targeted Therapy ◽

Renal Cell ◽

Complete Resection ◽

Disease Free Interval ◽

Free Interval ◽

Metastatic Sites ◽

Disease Free

Objective. To investigate the efficacy of surgery in the treatment of metastatic renal cell carcinoma (mRCC) and to identify prognostic factors. Methods. A single center retrospective study of 96 patients with mRCC from December 2004 to August 2013. Results. The median follow-up time was 45 months. Thirty-one (32.3%) of the patients received complete resection of metastatic sites, 11 (11.5%) of the patients underwent incomplete resection of metastatic sites, and 54 (56.3%) of the patients received no surgery. In the univariate Kaplan-Meier analysis, the median overall survival times of the three groups were 52 months, 16 months, and 22 months, respectively (p<0.001). The difference in the overall survival time was statistically significant between complete resection and no surgery groups (HR = 0.43, p=0.009), while there was no significant difference between the incomplete metastasectomy and no surgery groups (HR = 1.80, p=0.102). According to the multivariate Cox regression analysis, complete metastasectomy (HR = 0.49, p=0.033), T stage > 3 (HR = 1.88, p=0.015), disease free interval <12 months (HR = 2.34, p=0.003), and multiorgan involvement (HR = 2.00, p=0.011) were significant prognostic factors. Conclusion. In the era of targeted therapy, complete metastasectomy can improve overall survival. Complete metastasectomy, T stage > 3, disease free interval <12 months, and multiorgan involvement are independent prognostic factors.

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Melanoma ganglionic metastasis 30 years after treatment of the primary tumor: a case report

Sao Paulo Medical Journal ◽

10.1590/s1516-31801996000200005 ◽

1996 ◽

Vol 114 (2) ◽

pp. 1131-1133

Author(s):

Alfio José Tincani ◽

Antonio Santos Martins ◽

Henriette de Toledo Lage ◽

Lincoln Santos Souza

Keyword(s):

Case Report ◽

Primary Tumor ◽

Primary Treatment ◽

Disease Free Interval ◽

Free Interval ◽

Number Of Factors ◽

Disease Free

The recurrence of melanoma in patients is well-documented, and is dependent on a number of factors. We report a case in which a patient had a case of ganglionar metastasis in the neck after a 30-year disease-free interval following primary treatment.

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