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Ann Thorac Surg 2006;81:1547-1548
© 2006 The Society of Thoracic Surgeons

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Correspondence

Limited Value of Histopathologic Prognostic Factors for Resected Colorectal Lung Metastases

Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, 1441 Eastlake Ave, Suite 7418, Los Angeles, CA 90033

(Email: akaiser{at}usc.edu).

To the Editor:

I have read the article by Shiono and colleagues [1] about histopathologic prognostic factors in resected colorectal lung metastases with great interest. We all agree that a nihilistic approach to recurrent or metastatic colorectal cancer is often not in the patient's best interest. In that sense, an aggressive approach to resect pulmonary metastases is indicated in suitable candidates. However, it is important to keep the overall context in mind and to mention that only 2% of the total patient population with pulmonary metastases will undergo a surgical resection. Therefore the study population of 87 patients describes a diminutive fraction of all patients with colorectal cancer (unknown denominator) and thus a highly selected group with an overall better survival. Comparison has to be made with data from the national surveillance, epidemiology, and end results (SEER) program of the National Cancer Institute, which reports an overall survival of 60% to 65% survival for all stages of colorectal cancer, but definitively a lot lower chance for stage IV disease with distant metastases, typically in the range of 5% to 8% [2].

However, in the current article the authors report that their patients with lung metastases (stage IV colorectal cancer) had a 5-year survival of 61.4%, and even the worst subgroup with vascular invasion still had a fantastic 5-year survival of 39.9%. Both numbers are much better than the 37.4% median overall 5-year survival in 26 pulmonary metastasectomy studies from 1986 through 2001, as summarized by Ike and colleagues [3]. This illustrates that whatever positive or negative finding there is in this selected subgroup, it cannot be extrapolated on the overall tumor characterization. In other words, "these patients did better than the ones that did worse." Unfortunately and from a practical standpoint, the mentioned parameters are of no help in reliably determining an individual patient's prognosis or identifying patients who will benefit from one or the other treatment. In order to study this latter question, a parameter comparison of the primary tumors and the respective metastases should be made between patients with resectable metastases on one hand and non-resectable metastases on the other. Furthermore, we will never know how those 87 patients or a similarly favorable set of patients would have done without surgery because such a prospective randomized study would be impossible to conduct, but it is not be unreasonable to assume that they would still have outlived the majority of their co-patients with pulmonary metastases.

	References

Top References

 

1. Shiono S, Ishii G, Nagai K, et al. Histopathologic prognostic factors in resected colorectal lung metastases Ann Thorac Surg 2005;79:278-283.[Abstract/Free Full Text]
2. O'Connell JB, Maggard MA, Ko CY. Colon cancer survival rates with the new American Joint Committee on Cancer sixth edition staging JNCI 2004;96:1420-1425.[Abstract/Free Full Text]
3. Ike H, Shimada H, Ohki S, et al. Results of aggressive resection of lung metastases from colorectal carcinoma detected by intensive follow-up Dis Colon Rectum 2002;45:468-473.[Medline]

This article has been cited by other articles:

				S. Shiono, G. Ishii, A. Ochiai, and K. Nagai Reply Ann. Thorac. Surg., April 1, 2006; 81(4): 1548 - 1548. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kaiser, A. M. Search for Related Content PubMed PubMed Citation Articles by Kaiser, A. M. Related Collections Lung - other Related Article