EP1.15-13 Prognosis of Colorectal Cancer Cases That Underwent Lung and Liver Metastasectomy and Therapeutic Outcomes of Brain Metastasis

Abstract

The resectability is often debated in cases of lung and liver metastases. Further, we had reported previously that the incidence of brain metastasis is significantly higher in colorectal cancer with lung metastasis than cases with liver metastasis (lung: 7.7%, liver: 1.6%). We compared and investigated the therapeutic outcomes of cases of lung, liver and brain metastasis. Between 2002 and 2013, we retrospectively studied the prognosis of 90 cases of colorectal cancer cases that underwent lung metastasectomy, and 148 cases that underwent liver metastasectomy. The course of treatment in 8 cases of subsequent brain metastasis was also evaluated. The 5-year survival rate (5-SR)for 90 cases of lung metastasectomy overall was 66.7%. 63 cases were initial metastasis and the 5-SR was 66.7%. Out of these, there were 7 cases of synchronous metastasis with a 5-SR of 57.1%, and 56 cases of metachronous metastasis with a 5-SR of 67.9%, indicating no significant difference. The regions of secondary recurrence after lung resection were as follows: lung: 28 (cases), liver: 7, brain: 3, mediastinal lymph nodes: 5, other: 5. The 5-SR for 148 cases of liver metastasectomy overall was 54.7%. 141 cases were initial metastasis and the 5-SR was 55.3%. Cases who underwent lung metastasectomy had a significantly higher survival rate (p=0.0068). Out of these, 70 cases were synchronous metastasis with a 5-SR of 35.7%, and 71 cases were metachronous metastasis with a significantly higher 5-SR of 67.9% (p=0.011). The regions of secondary recurrence after liver resection were as follows: lung: 47 (cases), liver: 66,brain: 2, abdominal lymph nodes: 9, dissemination: 6, other: 7. While there were 5 cases of subsequent brain metastasis after lung resection, no subsequent brain metastasis was found after liver resection. All but one of the 8 cases of brain metastasis after lung resection were treated with surgery or CyberKnife. The total survival period was 1141 - 3848 days (median: 1913.5 days), and the survival period after detection of brain metastasis was 15 - 852 days (median: 401 days). In addition, all cases were experiencing associated symptoms when brain metastasis was detected, and only one patient was undergoing regular examinations to detect brain metastasis. While appropriate surgical intervention is recommended in cases of lung metastasis and metachronous liver metastasis,it is debatable in cases of synchronous liver metastasis. Cases of lung metastasis should give attention to brain metastasis and recieve early detection and intervention.