Looking forward lung metastasectomy—do we need a staging system for lung metastases?

The topic of pulmonary metastases has long been of high interest and ongoing controversy. There is a group of patients with pulmonary metastases who may benefit from curative resection. It remains unclear which among them will benefit from surgery in terms of survival. This work updates a previously proposed classification system for pulmonary metastases, similar in its essence to the tumor, nodes, metastasis (TNM) classification used for primary tumors and named pmTNM classification, where ‘pm' stands for ‘pulmonary metastasis’. The objective is to allow future studies to explore predictive and survival prognostic factors for pulmonary metastases and separate patients who will benefit from lung metastasectomy from those who will not. The secondary aim is to provide a classification system that will allow physicians, oncologists and surgeons to speak the same language in comparing their data and assessing the results of treatment of lung metastases.

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Results of lung metastasectomy from breast cancer: prognostic criteria on the basis of 467 cases of the international registry of lung metastases

European Journal of Cardio-Thoracic Surgery ◽

10.1016/s1010-7940(02)00331-7 ◽

2002 ◽

Vol 22 (3) ◽

pp. 335-344 ◽

Cited By ~ 152

Author(s):

G Friedel

Keyword(s):

Breast Cancer ◽

Lung Metastases ◽

Prognostic Criteria ◽

International Registry ◽

Lung Metastasectomy

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A practical nomogram for predicting cancer-specific survival in patients with clear-cell renal cell carcinoma

10.21203/rs.2.24343/v1 ◽

2020 ◽

Author(s):

Qian Wen ◽

Xinwen Wang ◽

Xiaoye Wang ◽

Tiao Bai ◽

Mei Tao

Keyword(s):

Prognostic Factors ◽

Lung Metastases ◽

Characteristic Curve ◽

Staging System ◽

Cox Proportional Hazards ◽

Cell Renal Cell Carcinoma ◽

Cancer Specific Survival ◽

Net Reclassification Improvement ◽

Ajcc Staging System ◽

Ajcc Staging

Abstract Background: It has limitations in predicting patient survival to use of the traditional American Joint Committee on Cancer (AJCC) staging system alone.Objectives: We aimed to establish and evaluate a comprehensive prognostic nomogram and compare its prognostic value with the AJCC staging system in adults diagnosed with ccRCC.Patients and Methods: We used the SEER database to identify 24477 cases of ccRCC between 2010 and 2015. The patients were randomly divided into two groups. In the development cohort, we used multivariate Cox proportional-hazards analyses to select significant variables, and used R software to establish a nomogram for predicting the 3-year and 5-year survival rates of ccRCC patients. In the development and validation cohorts, we compared our survival model with the AJCC prognosis model to evaluate the performance of the nomogram by calculating the concordance index (C-index), area under the receiver operating characteristic curve (AUC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI), and performing calibration plotting and decision curve analyses (DCAs). Results: Eleven identified independent prognostic factors were used to establish the nomogram. Age at diagnosis, being unmarried, higher grades, larger tumor size, higher AJCC stage, lymph node metastases, bone metastases, liver metastases, lung metastases, radiotherapy, and no surgery were risk factors for the survival of ccRCC. The C-index, AUC, NRI, IDI, and calibration plots demonstrated the good performance of the nomogram compared to the AJCC staging system. Moreover, the 3-year and 5-year DCA curves showed that the nomogram yielded net benefits that were greater than the traditional AJCC staging system.Conclusion: This study is the first to indicate that married status is an important prognostic parameter in ccRCC. Our results also demonstrate that the developed nomogram can predict survival more accurately than the AJCC staging system alone. The prognostic factors were easily obtained.

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Prognostic Analysis for Children with Hepatoblastoma with Lung Metastasis: A Single-Center Analysis of 98 Cases

10.21203/rs.3.rs-28324/v1 ◽

2020 ◽

Author(s):

Huimin Hu ◽

Weiling Zhang ◽

Yizhuo Wang ◽

Yi Zhang ◽

You Yi ◽

...

Keyword(s):

Survival Rate ◽

Survival Time ◽

Lung Metastasis ◽

Standard Treatment ◽

Lung Tumor ◽

Lung Metastases ◽

Factors Affecting ◽

Prognostic Analysis ◽

Standardized Treatment ◽

Lung Metastasectomy

Abstract Background To analyze the factors affecting prognosis of hepatoblastoma (HB) with lung metastasis in children.Patients and Methods: 98 HB patients with lung metastases admitted to Beijing Tongren Hospital, Capital Medical University were collected and analysed.Results 64 patients had lung metastases at diagnosis (median age, 22.3 months). 34 patients developed lung metastases whilst on treatment (median time, 6.5 months). The time of diagnosis of lung metastasis in patients with HB did not significantly affect survival time or 3-year survival rate (P = 0.37). The survival time and 5-year survival rate of patients with standard treatment was significantly longer than that of without standard treatment (P < 0.001). The survival time and 3-year survival rate of patients with lung metastasis alone or underwent lung metastasectomy was significantly longer than that of patients with extrapulmonary involvement or without lung metastasectomy (P = 0.007, P = 0.099). Lung metastasis accompanied with extrapulmonary involvement was risk factors affecting prognosis (HR = 0.460, 95% CI 0.239–0.888).Conclusions The overall prognosis of HB with lung metastasis in children was poor, and the prognosis of patients with lung metastasis alone was better than those with extrapulmonary involvement. Standardized treatment and resection of lung tumor may prolong the survival of HB patients with lung metastasis.

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Surgical Resection of Lung Metastases in Renal Cell Carcinoma

Urologia Journal ◽

10.1177/039156039205900615 ◽

1992 ◽

Vol 59 (6) ◽

pp. 57-59

Author(s):

A. Cozzoli ◽

S. Milano ◽

G. Cancarini ◽

T. Zanotelli ◽

S. Cosciani Cunico

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Surgical Resection ◽

Histological Examination ◽

Renal Cell ◽

Lung Metastases ◽

Surgical Removal ◽

Lung Metastasectomy ◽

Mean Time ◽

Unfavourable Prognostic Factor

The Authors report their experience with surgical treatment of lung metastases from renal cell carcinoma. From June 1986 to July 1991, 19 patients were submitted to contemporary or subsequent lung metastasectomy. Histological examination confirmed the presence of lung metastases due to renal cell carcinoma in 16 cases (6 synchronous and 10 metachronous with a mean disease-free interval of 23 months). In the other 3 cases, histological examination revealed tuberculomas, chondroid hamartoma and foci of anthracosis. To date, among the 6 patients with synchronous lung metastases, 3 have died, 2 are in progression and 1 is NED after a mean-time survival of 74 months. Among the 10 patients who underwent surgical resection of lung metachronous metastases, 1 has died, 3 are in progression and 6 are NED (mean-time survival of 43 months). In conclusion, while the presence of synchronous lung metastases is an unfavourable prognostic factor even after surgical removal (5 out of 6 patients died or are in progression shortly after metastasectomy), the results after surgery of metachronous lung metastases are encouraging, but the real efficacy of this treatment is still to be confirmed.

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The Assessment of Prognostic Factors for Lung Metastasectomy in Colorectal Cancer Patients With Previously Resected Liver Metastases

International Surgery ◽

10.9738/intsurg-d-15-00333.1 ◽

2019 ◽

Vol 104 (9-10) ◽

pp. 453-460

Author(s):

Ayumi Hachimaru ◽

Ryo Maeda ◽

Takashi Suda ◽

Yasushi Takagi

Keyword(s):

Colorectal Cancer ◽

Prognostic Factors ◽

Liver Metastases ◽

Carcinoembryonic Antigen ◽

Lung Metastases ◽

Univariate Analysis ◽

Antigen Level ◽

Resected Liver ◽

Serum Carcinoembryonic Antigen ◽

Lung Metastasectomy

The purpose of this study is to investigate the prognostic factors of lung metastasectomy in patients with previously resected liver metastases. Thirty-three patients underwent complete resection of lung metastases after previous liver metastasectomy from colorectal cancer between January 2004 and December 2013. In univariate analyses, all cumulative survival curves were estimated using the Kaplan-Meier method, and differences in variables were evaluated using the log-rank test. Multivariate analyses were performed using the Cox proportional hazards regression model. The 5-year survival rate of all 33 patients after lung metastasectomy was 31%. Univariate analysis identified 2 significant prognostic factors: preoperative serum carcinoembryonic antigen level (P = 0.035) and maximum tumor size (P = 0.029). Subgroup analysis with a combination of these 2 independent prognostic factors revealed 2-year survival rates of 100%, 92.3%, and 0% for patients with 0, 1, and 2 risk factors, respectively. We identified 2 independent poor prognostic factors for pulmonary metastasectomy in patients with previously resected liver metastases: high serum carcinoembryonic antigen level before lung metastasectomy, and maximum size of lung metastases. When these 2 factors are combined, higher- and lower-risk subgroups can be identified, which may help select patients with previously resected liver metastases who benefit most from lung metastasectomy.

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Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC): a multi-centre randomized clinical trial

10.21203/rs.2.11719/v1 ◽

2019 ◽

Author(s):

Tom Treasure ◽

Vern Farewell ◽

Fergus Macbeth ◽

Kathryn Monson ◽

Norman R Williams ◽

...

Keyword(s):

Colorectal Cancer ◽

Carcinoembryonic Antigen ◽

Lung Metastases ◽

Research Question ◽

Randomised Trial ◽

Primary Resection ◽

Pulmonary Metastasectomy ◽

Multidisciplinary Teams ◽

Survival Difference ◽

Lung Metastasectomy

Abstract Background: Lung metastasectomy in the treatment of advanced colorectal cancer has been adopted and established without control data. Our aim was to test its effectiveness in a randomised trial. Methods: Multidisciplinary teams in 13 hospitals recruited participants with potentially resectable lung metastases to a multicentre 2-arm randomised trial comparing active monitoring with or without metastasectomy. Other treatments were as decided by the local team. Randomization was centralised with stratification by site and minimisation for age, sex, primary cancer stage, interval since primary resection, prior liver involvement, the number of metastases, and carcinoembryonic antigen. The assigned arm was not disclosed to the trial management group until completion of analysis. Analysis was on intention to treat with a margin for non-inferiority of 10%. Findings: Between December 2010 and December 2016, 65 participants were randomised. Characteristics were well-matched in the two arms and similar to those in reported studies: age 35 to 86 (IQR 60 to 74); primary resection IQR 16 to 35 months previously; stage at resection T1, 2 or 3 in 3, 8 and 46; N1 or N2 in 31 and 26; unknown in 8. Lung metastases 1 to 5 (median 2); 16/65 had previous liver metastases; carcinoembryonic antigen normal in 55/65. There were no other interventions in the first 6 months, no cross overs from control to treatment, and no treatment related deaths or major adverse events. Hazard ratio for death within 5 years, comparing metastasectomy with control, was 0.82 (95%CI 0.43, 1.56). Interpretation: The small number (N=65) precludes a conclusive answer to the research question but the similar survival in metastasectomy and control arms challenges beliefs that there is a 35% survival difference that can be attributed to lung metastasectomy. Funding: Cancer Research UK funding Grant No. C7678/A11393 Name of the registry: Clintrial.gov Registration number: NCT01106261 Date 19th April 2010 https://clinicaltrials.gov/ct2/show/NCT01106261

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A practical nomogram for predicting cancer-specific survival in patients with clear-cell renal cell carcinoma

10.21203/rs.2.24343/v2 ◽

2020 ◽

Author(s):

Qian Wen ◽

Xinwen Wang ◽

Xiaoye Wang ◽

Tiao Bai ◽

Mei Tao

Keyword(s):

Prognostic Factors ◽

Proportional Hazards ◽

Lung Metastases ◽

Characteristic Curve ◽

Staging System ◽

Cox Proportional Hazards ◽

Youden Index ◽

Cell Renal Cell Carcinoma ◽

Cancer Specific Survival ◽

Net Reclassification Improvement

Abstract Background: It has limitations in predicting patient cancer-specific survival to use of the traditional American Joint Committee on Cancer (AJCC) staging system alone. Objectives: We aimed to establish and evaluate a comprehensive prognostic nomogram and compare its prognostic value with the AJCC-7th staging system in adults diagnosed with ccRCC.Methods: We used the SEER database to identify 24477 cases of ccRCC between 2010 and 2015. In the development cohort, we used multivariate Cox proportional-hazards analyses to select significant variables, and used R software to establish a nomogram for predicting the 3-year and 5-year cancer-specific survival rates of ccRCC patients. In the development and validation cohorts, we compared our cancer-specific survival model with the AJCC-7th prognosis model to evaluate the performance of the nomogram by calculating the concordance index (C-index), Youden Index, area under the receiver operating characteristic curve (AUC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI), and performing calibration plotting and decision curve analyses (DCAs). Results: Eleven identified independent prognostic factors were used to establish the nomogram. Age at diagnosis, being unmarried, higher grades, larger tumor size, higher AJCC-7th stage, lymph node metastases, bone metastases, liver metastases, lung metastases, radiotherapy, and no surgery were risk factors for the cancer-specific survival of ccRCC. The C-index, Youden Index, AUC, NRI, IDI, and calibration plots demonstrated the good performance of the nomogram compared to the AJCC-7th staging system. Moreover, the 3-year and 5-year DCA curves showed that the nomogram yielded net benefits that were greater than the traditional AJCC-7th staging system. Conclusion: This study is the first to indicate that married status is an important prognostic parameter in ccRCC. Our results also demonstrate that the developed nomogram can predict cancer-specific survival more accurately than the AJCC-7th staging system alone. The prognostic factors were easily obtained.

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Benign metastasizing leiomyoma (BML): A retrospective case series analysis of 8 patients (pts).

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e22525 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e22525-e22525 ◽

Cited By ~ 1

Author(s):

Vittoria Colia ◽

Angelo Paolo Dei Tos ◽

Elena Fumagalli ◽

Rossella Bertulli ◽

Domenica Lorusso ◽

...

Keyword(s):

Systemic Therapy ◽

Lung Metastases ◽

Case Series ◽

Hormonal Treatment ◽

High Dose ◽

Retrospective Case ◽

Benign Leiomyoma ◽

History Of ◽

Lung Metastasectomy

e22525 Background: BML is a rare entity marked by the presence of lung lesions in women with a history of surgery for a benign leiomyoma of the uterus. Optimal treatment strategy for BML is poorly defined. We report on the activity of systemic therapy in a retrospective series of pts with BML. Methods: Cases diagnosed with BML from June 1993 to January 2017 at Istituto Nazionale Tumori, Milan, were reviewed. Results: Eight pts were identified, with a median age of 43 yrs. Estrogen and progesteron receptors were positive in all cases. All pts underwent surgery (3 hysterectomy, 2 myomectomy, 2 hysteroannessiectomy and 1 left ovariectomy) for suspected uterine leiomyoma (1 leg; 1 thigh); 2 pts had concomitant lung disease. 8 pts developed lung metastases and 2 had also limb metastases. 2 pts underwent lung metastasectomy, followed by watchful waiting with CT every 6 mos and were disease-free at their last follow up after 132 mos and 84 mos from diagnosis. 6 pts received systemic therapy for progressing advanced disease (1-6 lines). Among 6 pts treated, 2 were in fertility age and underwent ovary-sparing hysterectomy, receiving GnRH agonist with 1 PR lasting 96 mos and 1 SD lasting 38 mos; 2 pts received an aromatase inhibitor with 1 PR lasting 24 mos and 1 SD lasting 12 mos; 2 pts received oral estrogens with 1 PR lasting 39 mos and 1 SD lasting 2 mos; 1 pt received oral progestins with a PR lasting 12 mos; 3 patients received antracyclin +/- ifosfamide obtaining 2 PR after 3 cycles (cys) and 1 SD after 3 cys lasting 6 mos; 1 pt received high-dose ifosfamide with a PR after 5 cys; 1 pt received ifosfamide+dacarbazine obtaining a CR after 6 cys; 2 pts received gemcitabine with 1 PR after 3 cys and 1 SD after 2 cys lasting 6 mos; 1 pt received oral etoposide with a PR lasting 21 mos; 1 pt received sorafenib with a SD lasting 6 mos; 1 pt received everolimus with a PR lasting 57 mos. In this case, everolimus was discontinued due to lung toxicity. No pts progressed during treatment. At a median follow-up of 55 mos, 6 pts are alive, while 2 are dead of disease. Conclusions: In a series of 8 pts, we confirm the activity of hormonal treatment in BML. mTOR inihibitors or chemotherapy also show to be active.

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Liver and/or lung metastasectomy after cetuximab or bevacizumab+FOLFIRI chemotherapy in patients (pts) with metastatic colorectal cancer (mCRC).

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.4_suppl.843 ◽

2018 ◽

Vol 36 (4_suppl) ◽

pp. 843-843

Author(s):

Sang-A Kim ◽

Ji-Won Kim ◽

Koung Jin Suh ◽

Jin Won Kim ◽

Heung-Kwon Oh ◽

...

Keyword(s):

Lung Metastases ◽

Disease Free Survival ◽

Progression Free Survival ◽

R0 Resection ◽

Targeted Agents ◽

Free Survival ◽

Improved Outcomes ◽

Lung Metastasectomy ◽

Limited Metastasis

843 Background: Some mCRC pts who have liver and/or lung metastases (LLMs) could achieve cure after palliative chemotherapy and conversion surgery (CS) including metastasectomy. Though targeted agents including bevacizumab and cetuximab significantly improved outcomes in mCRC pts, the effect of targeted agents on cure rate after CS has not yet been thoroughly investigated. Methods: We analyzed clinical data of mCRC pts who initially had unresectable LLMs regardless of their size and number and underwent first-line cetuximab or bevacizumab+FOLFIRI. Pts who had metastasis other than liver and lung were excluded. Results: From January 2013 to May 2016, 87 pts (male, 56) were consecutively enrolled: liver-limited metastasis in 42 pts (48.3%), lung-limited metastasis in 17 pts (19.5%), and both liver and lung metastases in 28 pts (32.2%). Median age was 62 years (range, 37-85). K-RAS or N-RAS mutation was detected in 39 pts (46.4%) and B-RAF in 2 pts (3.1%) among mutation evaluated pts. Among them, 35 pts (40.2%) received cetuximab+FOLFIRI and the others (N = 52, 59.8%), bevacizumab+FOLFIRI. Median follow-up time was 20.0 months (range, 1.9-49.1). Response rate was 65.7% in the cetuximab group (CET) and 42.3% in the bevacizumab group (BEV) ( p= 0.032). Median progression-free survival was 19.1 months (95% confidence interval [CI], 11.2-27.1) in CET and 14.1 months (95% CI, 11.5-16.8) in BEV ( p= 0.249). CS was performed in 24 pts (27.6%) after median 8.7 months (range, 2.5-27.3) after initiation of chemotherapy. In CET, 11 pts (31.4%) including 8 pts with partial response (PR) and 3 pts with stable disease (SD) underwent CS and all (100%) attained R0. In BEV, 13 pts (25%) including 6 pts with PR and 7 pts with SD received CS and 11 of them (84.6%) achieved R0. Among pts with R0 resection, median disease-free survival (DFS) was 8.8 months (95% CI, 4.9-12.7) in CET and 3.2 months (95% CI, 0.0-7.4) in BEV ( p= 0.326). Conclusions: A substantial proportion of pts could receive CS after cetuximab or bevacizumab+FOLFIRI chemotherapy. CET tended to show higher rate of CS. However, the median DFS after R0 resection was not significantly different between the two groups.

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