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Title: Causal Model of Survival after Pulmonary Metastasectomy of Colorectal Cancer: A Nationwide Prospective Registry
Authors: Embun, Raul
De Andrés, Juan J.Rivas
Call, Sergi
De Olaiz Navarro, Beatriz
Freixinet, Jorge L. 
Bolufer, Sergio
Jarabo, Jose R.
Pajuelo, Nuria
Molins, Laureano
Rivas, Juan J.
Rivas-Doyague, Francisco
Hernández-Ferrández, Jorge
Heras, Félix
De La Cruz, Javier
Rubio, Matilde
Fernández, Esther
Carbajo, Miguel
Peñalver, Rafael
González-Rivas, Diego
Pagés, Carlos
Smith, David
Wins, Richard
Arnau, Antonio
Arroyo, Andrés
Marrón, Carmen
Tamura, Akiko
Blanco, Montse
De Olaiz, Beatriz
Muñoz, Gemma
García Prim, José M.
Rombolá, Carlos
García-Barajas, Santiago
Rodríguez-Fuster, Alberto
Ruiz-Zafra, Javier
Carriquiry, Guillermo
Rosenberg, Moisés
Canalís, Emilio
UNESCO Clasification: 32 Ciencias médicas
320713 Oncología
Keywords: Colorectal carcinoma
Prospective cohort study
Spanish Group of Lung Metastases of Colo-Rectal Cancer,
Issue Date: 2016
Journal: The annals of thoracic surgery 
Abstract: Background Although numerous existing studies have analyzed the prognostic factors of patients who have had surgical intervention for lung metastases of colorectal carcinoma (CRC), many of the results obtained until now have been contradictory. As a consequence, there is no established consensus about which group of prognostic factors could have a greater value when considered together. Methods This was a multicenter prospective cohort study that included all patients who underwent a first pulmonary metastasectomy of CRC, with radical intent, during a 2-year period (March 2008 to February 2010). The follow-up continued until March 2013, and an analysis of disease-specific survival (DSS), determined from the first pulmonary metastasectomy, was implemented. The selection of the best submodel was taken based on their coefficient of determination (R2) and how parsimonious they were depending on the number of variables included. Results The series, consisting of 522 patients, presented the following survival rates: median, 54.9 months; 3-year DSS, 69.4% (95% confidence interval [CI], 65% to 73.8%); and 5-year DSS, 46.1% (95% CI, 38.5% to 53.7%). The resulting survival model consisted of disease-free interval of 12 months or less (hazard ratio [HR], 1.76; 95% CI, 1.21 to 2.54; p = 0.003), carcinoembryonic antigen level exceeding 5 ng/mL (HR, 1.50; 95% CI, 1.04 to 2.17; p = 0.028), bilateral lung disease (HR, 1.81; 95% CI, 1.20 to 2.75; p = 0.005), and thoracic lymph node involvement (HR, 2.71; 95% CI, 1.44 to 5.12; p = 0.002). Conclusions According to these results from the Spanish Group of Lung Metastases of Colo-Rectal Cancer, the combination of these four variables—disease-free interval, carcinoembryonic antigen level, laterality, and thoracic lymph node involvement—constitutes the first-choice survival causal model based on the clinical and pathologic factors most frequently referenced in literature.
ISSN: 0003-4975
DOI: 10.1016/j.athoracsur.2015.12.017
Source: Annals of Thoracic Surgery[ISSN 0003-4975],v. 101(5), p. 1883-1890 (Mayo 2016)
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