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Pre-operative prognostic factors for 5-year survival following pulmonary metastasectomy from colorectal cancer. A systematic review and meta-analysis

Gkikas, Andreas; Kakos, Christos; Lampridis, Savvas; Godolphin, Peter J; Patrini, Davide; (2023) Pre-operative prognostic factors for 5-year survival following pulmonary metastasectomy from colorectal cancer. A systematic review and meta-analysis. European Journal of Cardio-Thoracic Surgery , 63 (3) , Article ezad059. 10.1093/ejcts/ezad059. Green open access

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Abstract

OBJECTIVES: We seek to identify pre-operative prognostic factors and measure their effect on 5-year survival following Pulmonary Metastasectomy (PM) for Colorectal Cancer (CRC). METHODS: We systematically reviewed the databases of Cochrane Library, MEDLINE, Embase and Google Scholar from January 2000-April 2021 to identify pre-operative factors that have been investigated for their prognostic effect on survival following PM. Quality assessment was performed using the QUIPS tool. The prognostic effect of each identified factor on 5-year survival post PM was estimated using random-effects meta-analyses. RESULTS: We identified 115 eligible articles which included 13,294 patients who underwent PM from CRC. The overall 5-year survival after resection of the lung metastasis was 54.1%. The risk of bias of the included studies was at least moderate in 93% (107/115). Seventy-seven pre-operative factors had been investigated for their prognostic effect. Our analysis showed that 11 factors had favorable and statistically significant prognostic effect on 5-year survival post-PM. These included solitary metastasis, size <2cm, unilateral location, N0 thoracic disease, no history of extra-thoracic or liver metastasis, normal carcinoembryonic antigen levels both before PM and CRC excision, no neo-adjuvant chemotherapy before PM, CRC T-stage < T4 and no p53 mutations on CRC. Disease free interval at 24 months did not appear to affect 5-year survival. CONCLUSION: Despite the considerable risk of bias in the literature, our study consolidates the available evidence on pre-operative prognostic factors for PM from CRC. These findings can complement both clinical practice and the design of future research on the field of PM.

Type: Article
Title: Pre-operative prognostic factors for 5-year survival following pulmonary metastasectomy from colorectal cancer. A systematic review and meta-analysis
Open access status: An open access version is available from UCL Discovery
DOI: 10.1093/ejcts/ezad059
Publisher version: https://doi.org/10.1093/ejcts/ezad059
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Pulmonary metastasectomy, Colorectal cancer, Prognostic factors, 5-year Survival, Meta-analysis
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology > MRC Clinical Trials Unit at UCL
URI: https://discovery.ucl.ac.uk/id/eprint/10165628
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