LONG-TERM SURVIVAL OF PATIENTS WITH RESECTION OF PULMONARY METASTASES FROM COLORECTAL NEOPLASMS AS COMPARED TO NOT RESECTED ONES. A RETROSPECTIVE STUDY ON PATIENTS FOLLOWED FROM THE TIME OF FIRST RECURRENCE

Background: there are several published papers describing the beneficial effects of the resection of lung mts (RLM) from colorectal cancer. However, all these studies enrolled series of pts referred to surgeons comparing outcomes with those described in historical studies, and thus with an evident selection bias. No randomized study has been proposed to state the real advantage of surgery as this will not be considered as ethical. We selected from a large database of mCRC patients followed and treated from the time of the first appearance of metastatic disease those patients with lung recurrence in order to obtain comparative data from a more homogeneous setting. Methods: We collected data from 1411 mCRC pts treated in 3 different institutions. We extracted data of 409 pts (29.0%) with lung mts at first diagnosis of mCRC (144/417 with rectal cancer, 34.5%; 265/994 with colon cancer, 26.7%) which were grouped as follows: G1) 255 pts with lung and extra-lung mts; G2) 104 pts with lung as unique site of mts not submitted to RML; G3) 50 pts submitted to RML (19 pts operated after neoadjuvant chemotherapy and 31 pts submitted to RML upfront). Results: Patients’ characteristics were: median age (range) yrs: 64.3 (26.4-80.6); male/female 241/168; stage at diagnosis A/B/C/D/UNKN) 3/58/131/203/14; site of primitive: rectum/left colon/right colon 144/154/111; site of mts: liver/lung/ other: 227/409/86. Chemotherapy administered were: 1 pts Triplet, 286 pts Doublets (LOHP-based 237, CPT11-based 49); 64 pts 5FU or oral fluoropyrimidines only. Response rates were: overall 141/378 (37.3%); G1 90/255 (35.3%); G2 37/104 (35.6%); G3 14/19 (73.7%). Surgery was performed in 50/409 pts (12.2%). No surgery mortality was recorded. Time to progressions (TTP) were (mos): 11.3, 10.3, 10.5, 26.2 Overall, G1, G2, and G3, respectively (p<0.0001). Considering only pts with lung as unique site of mts (G2 non resected vs G3 resected), TTPs were 10.5 vs 26.2 mos (p<0.001). Overall survivals (OS) were (mos): 29.4, 24.2, 31.5, 72.4+ for Overall, G1, G2, and G3, respectively (p<0.0001). Considering only pts with unresected lung mts (G2) vs resected lung mts (G3), OSs were 31.5 vs 72.4+mos (p<0.0001). At the time of data computation 14/50 resected patients (G3) have died (28.0%), 17 are alive more than 5 years and three more than 10 years from diagnosis of mCRC, whereas only four of those pts in G2 are alive after five years. Conclusions: Although in the presence of pts selection bias typical of retrospective studies, our data showed that: 1) lung metastases as first site of recurrence are a frequent occurrence even in colon neoplasms when studied with CT scan; 2) resection of lung mts is safe, confirming previous reports; 3) resected patients presented a longer TTP and OS than non resected ones; 4) long-term survivors (5- and 10-year survivors) are more frequently observed in resected patients.