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1
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Hooda Z, Eisenberg M, Antonoff MB. Role of Pulmonary Metastasectomy in Colorectal Cancer. Thorac Surg Clin 2025; 35:143-153. [PMID: 40246404 DOI: 10.1016/j.thorsurg.2024.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2025]
Abstract
Pulmonary metastasectomy serves as the most efficacious local therapeutic option for stage IV colorectal cancer that has spread to the lungs. In order to properly select patients who will benefit most from pulmonary metastasectomy over other therapeutic options, a multidisciplinary approach should be utilized. The ideal technique is parenchymal-sparing, especially given that there is a high recurrence rate with the most common location being the remainder of the lung. While benefits of pulmonary metastatsectomy are well-documented, further studies are warranted to continue to refine patient selection, timing of surgery, and interplay with other treatment modalities.
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Affiliation(s)
- Zamaan Hooda
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Michael Eisenberg
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
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2
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Guo Z, Zhang Z, Liu L, Zhao Y, Liu Z, Zhang C, Qi H, Feng J, Yao P. Explainable machine learning for predicting lung metastasis of colorectal cancer. Sci Rep 2025; 15:13611. [PMID: 40253427 PMCID: PMC12009389 DOI: 10.1038/s41598-025-98188-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2024] [Accepted: 04/09/2025] [Indexed: 04/21/2025] Open
Abstract
Patients with lung metastasis of colorectal cancer typically have a poor prognosis. Therefore, establishing an effective screening and diagnosis model is paramount. Our study seeks to construct and verify a predictive model utilizing machine learning (ML) that can evaluate the risk of lung metastasis with newly diagnosed colorectal cancer (CRC) using Shapley Additive exPlanations (SHAP). Using the Surveillance, Epidemiology, and End Results database, 39,674 were extracted for model development, all of whom had been pathologically diagnosed with CRC. The data spans from 2010 to 2015. Our study has constructed seven ML algorithms based on the data mentioned above, including Random Forest (RF), Decision Tree, Support Vector Machine, Naive Bayes, K-Nearest Neighbor, eXtreme Gradient Boosting, and Gradient Boosting Machine. We selected the best algorithm and visualized it using SHAP. We conducted a validation of the model utilizing data from a Chinese hospital to assess its practicality. Based on this, we have constructed an open web calculator. 39,674 patient data were included in our study, among whom 1369 (3.5%) presented with distant lung metastasis. The Random Forest (RF) algorithm demonstrated the highest predictive capability within the internal test set (AUC of 0.980, AUPR of 0.941). Furthermore, the random forest algorithm also exhibited excellent performance in external validation sets. Meanwhile, we have also established a web calculator ( http://121.43.117.60:8003/ ). The RF algorithm has demonstrated excellent predictive performance. It can assist clinicians in devising more personalized treatment plans.
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Affiliation(s)
- Zhentian Guo
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing, 100073, China
- China Clinical Medical Research Center for Hepatobiliary Diseases in General Surgery, China General Technology Group, Beijing, 100073, China
| | - Zongming Zhang
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing, 100073, China.
- China Clinical Medical Research Center for Hepatobiliary Diseases in General Surgery, China General Technology Group, Beijing, 100073, China.
| | - Limin Liu
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing, 100073, China
- China Clinical Medical Research Center for Hepatobiliary Diseases in General Surgery, China General Technology Group, Beijing, 100073, China
| | - Yue Zhao
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing, 100073, China
- China Clinical Medical Research Center for Hepatobiliary Diseases in General Surgery, China General Technology Group, Beijing, 100073, China
| | - Zhuo Liu
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing, 100073, China
- China Clinical Medical Research Center for Hepatobiliary Diseases in General Surgery, China General Technology Group, Beijing, 100073, China
| | - Chong Zhang
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing, 100073, China
- China Clinical Medical Research Center for Hepatobiliary Diseases in General Surgery, China General Technology Group, Beijing, 100073, China
| | - Hui Qi
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing, 100073, China
- China Clinical Medical Research Center for Hepatobiliary Diseases in General Surgery, China General Technology Group, Beijing, 100073, China
| | - Jinqiu Feng
- China Clinical Medical Research Center for Hepatobiliary Diseases in General Surgery, China General Technology Group, Beijing, 100073, China
| | - Peijie Yao
- China Clinical Medical Research Center for Hepatobiliary Diseases in General Surgery, China General Technology Group, Beijing, 100073, China
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3
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Dong SC, Tang QY, Wang L, Fang F, Bai DS, Jin SJ, Zhou BH, Jiang GQ. Characteristics and risk differences of different tumor sizes on distant metastases of pancreatic neuroendocrine tumors: A retrospective study in the SEER database. Hepatobiliary Pancreat Dis Int 2025; 24:188-196. [PMID: 39019667 DOI: 10.1016/j.hbpd.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 07/02/2024] [Indexed: 07/19/2024]
Abstract
BACKGROUND The rate of distant metastasis in patients with pancreatic neuroendocrine tumors (PNETs) is 20%-50% at the time of initial diagnosis. However, whether tumor size can predict distant metastasis for PNETs remains unknown up to date. METHODS We used Surveillance, Epidemiology, and End Results (SEER) population-based data to collect 6089 patients with PNETs from 2010 to 2019. The optimal cut-off point of tumor size to predict distant metastasis was calculated by Youden's index. Multivariate logistic regression analysis was used to figure out the association between tumor size and distant metastasis patterns. RESULTS The most common metastatic site was liver (27.2%), followed by bone (3.0%), lung (2.3%) and brain (0.4%). Based on an optimal cut-off value of tumor size (25.5 mm) for predicting distant metastasis determined by Youden's index, patients were categorized into groups of tumor size < 25.5 mm and ≥ 25.5 mm. Multivariate logistic regression analyses showed that, compared with < 25.5 mm, tumor size ≥ 25.5 mm was an independent risk predictor of overall distant metastasis [odds ratio (OR) = 4.491, 95% confidence interval (CI): 3.724-5.416, P < 0.001] and liver metastasis (OR = 4.686, 95% CI: 3.886-5.651, P < 0.001). CONCLUSIONS Tumor size ≥ 25.5 mm was significantly associated with more overall distant and liver metastases. Timely identification of distant metastasis for tumor size ≥ 25.5 mm may provide survival benefit for timely and precise treatment.
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Affiliation(s)
- Song-Chen Dong
- Department of Hepatobiliary Surgery, Northern Jiangsu People's Hospital, Yangzhou 225000, China
| | - Qi-Yun Tang
- Department of Geriatric Gastroenterology, the First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China; Institute of Neuroendocrine Tumor, Nanjing Medical University, Nanjing 210029, China
| | - Lu Wang
- Center of Endoscopy, Northern Jiangsu People's Hospital, Yangzhou 225000, China
| | - Fang Fang
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital, Yangzhou 225000, China
| | - Dou-Sheng Bai
- Department of Hepatobiliary Surgery, Northern Jiangsu People's Hospital, Yangzhou 225000, China; Department of Hepatobiliary Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou 225000, China
| | - Sheng-Jie Jin
- Department of Hepatobiliary Surgery, Northern Jiangsu People's Hospital, Yangzhou 225000, China; Department of Hepatobiliary Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou 225000, China
| | - Bao-Huan Zhou
- Department of Hepatobiliary Surgery, Northern Jiangsu People's Hospital, Yangzhou 225000, China
| | - Guo-Qing Jiang
- Department of Hepatobiliary Surgery, Northern Jiangsu People's Hospital, Yangzhou 225000, China; Department of Hepatobiliary Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou 225000, China.
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Zhou FY, Song FH, Cheng ZH, Wu S. Discovery of primary lung cancer following resection of rectal cancer lung metastasis: A case report. World J Clin Oncol 2025; 16:99635. [PMID: 39995558 PMCID: PMC11686560 DOI: 10.5306/wjco.v16.i2.99635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Revised: 09/24/2024] [Accepted: 10/28/2024] [Indexed: 12/11/2024] Open
Abstract
BACKGROUND Colorectal cancer (CRC) ranks high among the most common types of malignant tumors. The primary cause of cancer-related mortality is metastasis, with lung metastases accounting for 32.9% of all cases of metastatic CRC (MCRC). However, cases of MCRC in the lungs, which present concurrently with primary peripheral lung adenocarcinoma, are exceptionally rare. CASE SUMMARY This report describes the case of a 52-year-old female patient who, following a colonoscopy, was diagnosed with moderately differentiated adenocarcinoma based on rectal mucosal biopsy findings. A preoperative chest computed tomography scan revealed a ground-glass nodule in the right lung and a small nodule (approximately 0.6 cm in diameter) in the extramural basal segment of the left lower lobe, which suggested multiple lung metastases from rectal cancer. Subsequent treatment and follow-up led to a diagnosis of rectal cancer with left lung metastasis and peripheral adenocarcinoma of the lower lobe of the right lung. CONCLUSION This case report describes the therapeutic journey of a patient with lung metastasis from rectal cancer in addition to primary peripheral adenocarcinoma, thus underscoring the critical roles of multidisciplinary collaboration, personalized treatment strategies, and comprehensive patient rehabilitation guidance.
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Affiliation(s)
- Fei-Yan Zhou
- Department of Oncology II, Xinhua Hospital, Dalian University, Dalian 116000, Liaoning Province, China
| | - Fang-Hua Song
- Department of Oncology II, Xinhua Hospital, Dalian University, Dalian 116000, Liaoning Province, China
| | - Zhen-Hao Cheng
- Department of Oncology II, Xinhua Hospital, Dalian University, Dalian 116000, Liaoning Province, China
| | - Sen Wu
- Department of Oncology II, Xinhua Hospital, Dalian University, Dalian 116000, Liaoning Province, China
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Ma Z, Yang S, Yang Y, Luo J, Zhou Y, Yang H. Development and validation of prediction models for the prognosis of colon cancer with lung metastases: a population-based cohort study. Front Endocrinol (Lausanne) 2023; 14:1073360. [PMID: 37583430 PMCID: PMC10424923 DOI: 10.3389/fendo.2023.1073360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 04/20/2023] [Indexed: 08/17/2023] Open
Abstract
Background Current studies on the establishment of prognostic models for colon cancer with lung metastasis (CCLM) were lacking. This study aimed to construct and validate prediction models of overall survival (OS) and cancer-specific survival (CSS) probability in CCLM patients. Method Data on 1,284 patients with CCLM were collected from the Surveillance, Epidemiology, and End Results (SEER) database. Patients were randomly assigned with 7:3 (stratified by survival time) to a development set and a validation set on the basis of computer-calculated random numbers. After screening the predictors by the least absolute shrinkage and selection operator (LASSO) and multivariate Cox regression, the suitable predictors were entered into Cox proportional hazard models to build prediction models. Calibration curves, concordance index (C-index), time-dependent receiver operating characteristic (ROC) curves, and decision curve analysis (DCA) were used to perform the validation of models. Based on model-predicted risk scores, patients were divided into low-risk and high-risk groups. The Kaplan-Meier (K-M) plots and log-rank test were applied to perform survival analysis between the two groups. Results Building upon the LASSO and multivariate Cox regression, six variables were significantly associated with OS and CSS (i.e., tumor grade, AJCC T stage, AJCC N stage, chemotherapy, CEA, liver metastasis). In development, validation, and expanded testing sets, AUCs and C-indexes of the OS and CSS prediction models were all greater than or near 0.7, which indicated excellent predictability of models. On the whole, the calibration curves coincided with the diagonal in two models. DCA indicated that the models had higher clinical benefit than any single risk factor. Survival analysis results showed that the prognosis was worse in the high-risk group than in the low-risk group, which suggested that the models had significant discrimination for patients with different prognoses. Conclusion After verification, our prediction models of CCLM are reliable and can predict the OS and CSS of CCLM patients in the next 1, 3, and 5 years, providing valuable guidance for clinical prognosis estimation and individualized administration of patients with CCLM.
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Affiliation(s)
| | | | | | | | | | - Huiyong Yang
- School of Medicine, Huaqiao University, Quanzhou, China
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6
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Qian L, Chen Y, Peng M, Xia Y, Zhou T, Hong J, Ding S. The Importance of Marital Status in the Morbidity and Prognosis of Lung Metastasis in Newly Diagnosed Ovarian Cancer. J Cancer 2023; 14:1024-1038. [PMID: 37151400 PMCID: PMC10158508 DOI: 10.7150/jca.83017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/25/2023] [Indexed: 05/09/2023] Open
Abstract
Objective: The study aimed to evaluate the risk factors for the morbidity and prognosis of lung metastases (LM) in patients with newly diagnosed ovarian cancer (OC), and further explore the important role of marital status. Materials and methods: Based on the Surveillance, Epidemiology, and End Results (SEER) dataset, OC patients from 2010 and 2019 were retrospectively analyzed. Logistic regression analysis and Kaplan-Meier method were applied to evaluate the vital factors of incidence and survival outcome in LM population. Cox regression analysis was performed to identify risk factors for the prognosis of OC patients with LM. The predictive potential was showed by two established nomograms and examined by the concordance index (C-index), calibration curves, the area under the curve (AUC), decision curve analyses (DCAs) and clinical impact curves (CICs). Results: There are 25,202 eligible OC patients were enrolled in the study, the morbidity of LM at 5.61%. Multivariable logistic regression models illustrated that chemotherapy (P<0.01), surgical treatment of bilateral or more areas (P<0.01), T stage (P<0.01), N1 stage (P<0.01), bone metastasis (P<0.01), brain metastasis (P<0.01) and liver metastasis (P<0.01) were all significantly connected with LM in OC. Multivariable Cox regression analyses illustrated that unmarried, radiotherapy, elder people and positive cancer antigen 125 (CA-125) were significantly associated with shorter survival time, while chemotherapy made contributions to improve survival. Our study found that marital relationships promoted LM and was associated with the better prognosis, while unmarried patients had the opposite results. With the further development of our research, the cross-action of social, economic and psychological factors together determined the great impact of marital status on the morbidity and prognosis of OC patients combined with LM. Finally, the stability of the models was proved by internal verification. Conclusion: The population-based cohort study provides references for guiding clinical screening and individualized treatment of OC patients with LM. Under the influence of society and economy, marital status is closely related to the morbidity and prognosis of OC, which can be an important direction to explore the risk of OC lung metastasis in the future.
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Affiliation(s)
- Lihui Qian
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Yixin Chen
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Mingying Peng
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Yuwei Xia
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Tianye Zhou
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Jiana Hong
- Department of Nursing, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou 310006, China
- ✉ Corresponding authors: Shuning Ding, ; Jiana Hong,
| | - Shuning Ding
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou 310053, China
- ✉ Corresponding authors: Shuning Ding, ; Jiana Hong,
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Cheng P, Chen H, Huang F, Li J, Liu H, Zheng Z, Lu Z. Nomograms predicting cancer-specific survival for stage IV colorectal cancer with synchronous lung metastases. Sci Rep 2022; 12:13952. [PMID: 35977984 PMCID: PMC9385743 DOI: 10.1038/s41598-022-18258-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 08/08/2022] [Indexed: 12/24/2022] Open
Abstract
This study aimed to establish a nomogram for the prediction of cancer-specific survival (CSS) of CRC patients with synchronous LM. The final prognostic nomogram based on prognostic factors was evaluated by concordance index (C-index), time-dependent receiver operating characteristic curves, and calibration curves. In the training and validation groups, the C-index for the nomogram was 0.648 and 0.638, and the AUC was 0.793 and 0.785, respectively. The high quality of the calibration curves in the nomogram models for CSS at 1-, 3-, and 5-year was observed. The nomogram model provided a conventional and useful tool to evaluate the 1-, 3-, and 5-year CSS of CRC patients with synchronous LM.
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Affiliation(s)
- Pu Cheng
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haipeng Chen
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fei Huang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiyun Li
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hengchang Liu
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhaoxu Zheng
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Zhao Lu
- Department of Gastrointestinal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.
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Zuo L, Cao L, Ding C, Tu H, Wei C, Yuan L, Wang H, Zhang B. Strategy to small intestine obstruction caused by Crohn's disease on the basis of transnasal ileus tube insertion. BMC Surg 2022; 22:183. [PMID: 35568851 PMCID: PMC9107679 DOI: 10.1186/s12893-022-01632-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/05/2022] [Indexed: 02/20/2025] Open
Abstract
Background Previous studies reported that transnasal ileus tube was a new and useful method for rapid relief of small intestinal obstruction. However, no study reported the impacts of the transnasal ileus tube for Crohn’s disease combined with intestinal obstruction. We aimed to describe the strategy to the small intestine obstruction caused by Crohn’s disease on the basis of transnasal ileus tube insertion. Methods From November 2019 to November 2021, the data of 6 hospitalized patients with CD, diagnosed and conservatively treated in The Second Hospital of Nanjing, were not relived and retrospectively collected. After the insertion of transnasal ileus tube, demographic information, clinical features and treatment data were extracted from medical records. Results Six Crohn’s disease patients with intestinal obstruction were included. Half of them were male. The patients aged from 29 to 70 years. Five patients had chronic intestinal obstruction more than one year. Three patients had intestinal surgery history. One patient had colonic abdominal fistula and anastomotic fistula, when she took intermittent usage of sulfsalazine and steroid. On admission, all the patients had abdominal pain, distention and mass. Five patients had anemia, low albumin and cholinesterase. All CDAI scores were more than 400. Compared to 19 patients with incomplete intestinal obstruction improved by nasogastric decompression tube, 6 patients with intestinal obstruction catheter had significant difference in time for relieving abdominal pain and distension (p = 0.003), time for alleviating abnormal mass (p ≤ 0.01), drainage volume (p = 0.004), and preoperative CDAI score (p = 0.001). Compared with X-ray image before insertion, complete remission of obstruction of 5 patients were observed in intestinal cavity after insertion. After 1–2 months nutrition, all the patients had small intestine resection and ileostomy, half of them underwent colectomy and fistula repair, and 4 patients were performed enterolysis at the same time, the residual small intestine length ranging from 250 to 400 cm. 1 patient had permanent ileostomy;1 patient had abdominal infection after operation. The typical manifestations of acute and chronic inflammation, transmural inflammation, pseudopolyps and serous fiber hyperplasia could be seen in pathological findings of patients 1 to 5. All the patients continued enteral nutrition after surgery. Four patients were treated with infliximab or vedolizumab. Conclusion The current intestinal obstruction catheter which is used to treat patients with Crohn's combined obstruction can afford quick clinical remission, longer nutrition time, and suitable preoperative CDAI score for operation, which is worthy of wildly being used.
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Affiliation(s)
- Lingyun Zuo
- Department of Gastroenterology, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, 1 Zhongfu Road, Nanjing, Jiangsu, China
| | - Lei Cao
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Chengliang Ding
- Department of Gastroenterology, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, 1 Zhongfu Road, Nanjing, Jiangsu, China
| | - Hongfei Tu
- Department of Gastroenterology, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, 1 Zhongfu Road, Nanjing, Jiangsu, China
| | - Cheng Wei
- Department of Gastroenterology, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, 1 Zhongfu Road, Nanjing, Jiangsu, China
| | - Lili Yuan
- Department of Radiology, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Huali Wang
- Department of Gastroenterology, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, 1 Zhongfu Road, Nanjing, Jiangsu, China
| | - Bin Zhang
- Department of Gastroenterology, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, 1 Zhongfu Road, Nanjing, Jiangsu, China.
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Zhou Y, Wang D, Tan F, Zhou Z, Zhao L, Güngör C, Pei Q, Li Y, Liu W. The survival impact of radiotherapy on synchronous metastatic rectal cancer: metastatic site can serve for radiotherapy-decision. J Cancer 2022; 13:2171-2178. [PMID: 35517420 PMCID: PMC9066223 DOI: 10.7150/jca.70894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/19/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose: The metastatic site seems to represent a malignancy with a different biological characteristic. Radiotherapy, as a successful, well-tolerated, cost-effective and time-efficient intervention, is able to provide clear benefits for the treatment of locally advanced rectal cancer and has become an essential component of palliative oncology care. The real-world effect of radiotherapy on the survival outcomes of metastatic rectal cancer (mRC) patients might do exist and was worth exploring. Patients and methods: Data were extracted from the Surveillance, Epidemiology, and End Results (SEER) database in this retrospective analysis. The statistical methods included Pearson's chi-square test, Log-rank test, Cox regression model and propensity score matching (PSM). Results: The multivariable Cox regression displayed that radiotherapy may not be used as a prognostic factor for mRC (p=0.057). However, radiotherapy may be associated with the prognosis if the metastatic site was excluded from the multivariate analysis (p<0.001). Radiotherapy seemed to fail to improve OS before PSM (p<0.001) and after PSM without the metastatic site as a matching factor (p<0.001). Nevertheless, there was no significant survival difference between radiotherapy and non-radiotherapy cohort after PSM with the metastatic site as a matching factor (p=0.057). All of M1a rectal cancer patients appear to obtain survival benefit from radiotherapy without the impact of PSM (p<0.001). Notwithstanding, radiotherapy was associated with improved OS of patients with rectal liver-limited metastasis (p=0.023) and did not appear to provide survival benefit for rectal lung-limited (p=0.386) and other-limited metastasis (p=0.385). Both of M1b mRC with and without liver metastasis did not seem to obtain survival benefit from radiotherapy. Conclusions: Carefully selected data from the SEER database suggested that radiotherapy appears to improve overall survival only in patients with rectal liver-limited metastasis.
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Affiliation(s)
- Yuan Zhou
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Dan Wang
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,Department of General Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fengbo Tan
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Zhongyi Zhou
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Lilan Zhao
- Department of Thoracic surgery, Fujian Provincial Hospital, Fuzhou, China
| | - Cenap Güngör
- Department of General Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Qian Pei
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yuqiang Li
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,Department of General Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Wenxue Liu
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,Department of Cardiology, Xiangya Hospital, Central South University, Changsha, China
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10
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Chiappetta M, Salvatore L, Congedo MT, Bensi M, De Luca V, Petracca Ciavarella L, Camarda F, Evangelista J, Valentini V, Tortora G, Margaritora S, Lococo F. Management of single pulmonary metastases from colorectal cancer: State of the art. World J Gastrointest Oncol 2022; 14:820-832. [PMID: 35582100 PMCID: PMC9048528 DOI: 10.4251/wjgo.v14.i4.820] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/26/2021] [Accepted: 03/04/2022] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer (CRC) is one of the most common causes of death from cancer. Lung seeding occurs in approximately 10% of patients surgically treated for primary CRC with radical intent: the lung is the most common site of metastases after the liver. While surgical treatment of liver metastases is widely accepted to affect long-term outcomes, more controversial and not standardized is the therapy for CRC patients developing lung metastases. Experience suggests the potential curative role of pulmonary metastasectomy, especially in oligometastatic disease. However, the optimal strategy of care and the definition of prognostic factors after treatment still need to be defined. This review focused on the uncommon scenario of single pulmonary metastases from CRC. We explored pertinent literature and provide an overview of the epidemiology, clinical characteristics and imaging of single pulmonary metastases from CRC. Additionally, we identified the best available evidence for overall management. In particular, we analyzed the role and results of locoregional approaches (surgery, radiotherapy or ablative procedures) and their integration with systemic therapy.
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Affiliation(s)
- Marco Chiappetta
- Department of Thoracic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Lisa Salvatore
- Oncologia Medica Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Maria Teresa Congedo
- Department of Thoracic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Maria Bensi
- Oncologia Medica Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Viola De Luca
- Department of Radiation Therapy, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Leonardo Petracca Ciavarella
- Department of Thoracic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Floriana Camarda
- Oncologia Medica Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Jessica Evangelista
- Department of Thoracic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Vincenzo Valentini
- Department of Radiation Therapy, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Giampaolo Tortora
- Oncologia Medica Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Stefano Margaritora
- Department of Thoracic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Filippo Lococo
- Department of Thoracic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
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Cipriani F, Ratti F, Fiorentini G, Reineke R, Aldrighetti L. Systematic review of perioperative and oncologic outcomes of minimally-invasive surgery for hilar cholangiocarcinoma. Updates Surg 2021; 73:359-377. [PMID: 33615423 DOI: 10.1007/s13304-021-01006-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/10/2021] [Indexed: 12/12/2022]
Abstract
Most surgeons have traditionally been reluctant toward minimally-invasive surgery for bile duct tumors. This study aimed to perform a systematic literature review on perioperative and oncologic results of pure laparoscopic and robotic curative-intent surgery for hilar cholangiocarcinoma. According to the PRISMA statement, a systematic review was conducted into Pubmed, EMBASE and Cochrane. A critical appraisal of study was performed according to the Joanna Briggs Institute tools. Nineteen studies (12 on pure laparoscopy and 7 on robotics) were included: 7 case reports, 9 case series, 3 case-control (193 patients). The pooled conversion, morbidity, biliary leak and mortality rates were 5.5%, 43%, 16.4% and 4%. The weighted mean of operative time, blood loss and postoperative stay were 388 min, 446 mL and 14 days. For pure laparoscopy, the pooled R0 rate was 86%; overall survival and disease-free survival rates ranged from 85 to 100% and from 80 to 100% (median observation time 6-18 months). For robotic surgeries, the pooled R0 rate was 69% and overall survival rates ranged from 90 to 100% (median observation time 5-15 months). Case reports were overall of high quality, case series of moderate / high-quality, case-control studies ranged from low to high quality. In selected patients, minimally-invasive surgery for Klatskin tumors appears feasible, safe, satisfactory for perioperative outcomes and adequate for oncologic results. However, the results are based on few studies, limited in patient numbers and with allocation criteria more restrictive than open, reporting short follow-up and mainly with non-comparative design: evidence of higher quality is recommended.
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Affiliation(s)
- Federica Cipriani
- Hepatobiliary Surgery Division, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
| | - Francesca Ratti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Guido Fiorentini
- Hepatobiliary Surgery Division, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Raffaella Reineke
- Department of Anesthesiology and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca Aldrighetti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
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