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. 2023 Oct:184:107342.
doi: 10.1016/j.lungcan.2023.107342. Epub 2023 Aug 9.

Clinical score for colorectal cancer patients with lung-limited metastases undergoing surgical resection: Meta-Lung Score

Pina Ziranu  1 , Paolo Albino Ferrari  2 , Francesco Guerrera  3 , Pietro Bertoglio  4 , Alessandro Tamburrini  5 , Andrea Pretta  1 , Paraskevas Lyberis  3 , Giulia Grimaldi  6 , Eleonora Lai  1 , Massimiliano Santoru  6 , Fabio Bardanzellu  1 , Laura Riva  6 , Francesca Balconi  1 , Eleonora Della Beffa  3 , Marco Dubois  1 , Matteo Pinna-Susnik  6 , Clelia Donisi  1 , Enrico Capozzi  4 , Valeria Pusceddu  1 , Alessandro Murenu  6 , Marco Puzzoni  1 , Federico Mathieu  7 , Sabrina Sarais  6 , Aiman Alzetani  5 , Luca Luzzi  7 , Piergiorgio Solli  4 , Piero Paladini  7 , Enrico Ruffini  3 , Roberto Cherchi  6 , Mario Scartozzi  1
Affiliations

Clinical score for colorectal cancer patients with lung-limited metastases undergoing surgical resection: Meta-Lung Score

Pina Ziranu et al. Lung Cancer. 2023 Oct.

Abstract

Background: Radical resection of isolated lung metastases (LM) from colorectal cancer (CRC) is debated. Like Fong's criteria in liver metastases, our study was meant to assign a clinical prognostic score in patients with LM from CRC, aiming for better surgery selection.

Methods: We retrospectively analyzed data from 260 CRC patients who underwent curative LM resection from December 2002 to January 2022, verifying the impact of different clinicopathological features on the overall survival (OS).

Results: At the univariate analysis: higher baseline CEA levels (p = 0.0001), disease-free survival less than or equal to 12 months (m) (p = 0.0043), LM size larger than 2 cm (p = 0.0187), multiple resectable nodules (p = 0.0083), and positive nodal status of the primary tumor (p = 0.0011) were associated with worse prognosis. In a Cox regression model, these characteristics retained their independent role for OS (p < 0.0001) and were chosen as criteria to be assigned one point each for clinical risk score. The 5-year survival rate in patients with 0 points was 88%, while no patients with a 5-point score survived at 2 years. Based on the 0-1 vs. 2-5 score range, we obtained a significant difference in median OS: not reached vs. 40.8 months (95 %CI 36 to 87.5), respectively (p < 0.0001) stratifying patients into good and poor prognosis. The prognostic role of the score was also confirmed in terms of median RFS: not reached in 0-1 scored patients vs. 30.5 months (95 %CI 19.4 to 42) in patients with 2-5 scores (p = 0.0006).

Conclusions: When LM from CRC is resectable, the Meta-Lung Score provides valuable prognostic information. Indeed, while upfront surgery should be considered in patients with scores of 0 to 1, it should be cautiously suggested in patients with scores of 2 to 5, for whom a prognosis comparison between preventive surgery and other treatments should be investigated in prospective randomized clinical trials.

Keywords: Clinical score; Colorectal cancer; Lung metastasectomy; Lung-limited metastases.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.