Efficacy of adjuvant chemotherapy after resection of pulmonary metastasis from colorectal cancer: a propensity score–matched analysis. (January 2019)

• Record Type: Journal Article
• Authors: Imanishi, Mamiko; Yamamoto, Yoshiyuki; Hamano, Yukako; Yamada, Takeshi; Moriwaki, Toshikazu; Gosho, Masahiko; Okumura, Takehiro; Boku, Narikazu; Kondo, Haruhiko; Hyodo, Ichinosuke
• Is Part Of: European journal of cancer. Volume 106(2019)
• Page Start: 69
• Page End: 77
• Publication Date: 2019-01
• Subjects: Pulmonary metastasis -- Colorectal cancer -- Adjuvant chemotherapy -- Propensity score matching; Cancer -- Periodicals; Neoplasms -- Periodicals; Cancer -- Périodiques; Cancer; Tumors; Electronic journals; Periodicals; Electronic journals; 616.994
• DOI: 10.1016/j.ejca.2018.10.003
• Languages: English
• ISSNs: 0959-8049

Abstract

Abstract: Background: Pulmonary metastases from colorectal cancer are resected due to the favourable 5-year overall survival rates of 30–60% reported in many studies. However, the efficacy of subsequent adjuvant chemotherapy remains unclear. Patient and methods: We retrospectively collected clinical data of 1237 patients who underwent surgical resection of pulmonary metastasis from colorectal cancer at 46 Japanese institutions between 2004 and 2008. Patients with non-curative resection, pre-operative chemotherapy, extra-thoracic metastasis, complications after surgery, and inadequate data were excluded. Then, a 1:1 propensity score nearest-neighbour matching between patients with and without adjuvant chemotherapy was performed, considering relevant co-variables, and survival of patients between groups was compared. Results: Data of 524 patients (surgery alone, 269 patients; surgery with adjuvant chemotherapy, 255 patients) were used for matching. From each group, 192 patients with similar background characteristics between groups were selected. Adjuvant chemotherapies included fluoropyrimidine alone (71%), an oxaliplatin-containing regimen (23%), or an irinotecan-containing regimen (6%). In the surgery alone and adjuvant chemotherapy groups, 5-year overall survival rates were 68% and 69%, and 5-year disease-free survival rates were 40% and 34%, respectively. There were no significant differences between the two groups in terms of overall survival (hazard ratio [HR]: 1.00, 95% confidence interval [CI]: 0.69–1.45, P = 1.00) and disease-free survival (HR: 1.07, 95% CI: 0.82–1.39, P = 0.62). Conclusions: Adjuvant chemotherapy after curative resection of lung-limited metastasis from colorectal cancer did not show a survival benefit in the propensity score–matched analysis and should not be recommended without further clinical trials. Highlights: Pulmonary metastases (PM) from colorectal cancer (CRC) are resected. Five-year survival rates after resection of PM from CRC are 30–60%. Efficacy of adjuvant chemotherapy after resection of PM is unclear. We used the propensity score nearest-neighbour matching method to minimise bias. Adjuvant chemotherapy showed no survival benefit after resection of PM.