Clinical and Radiological Discrimination of Solitary Pulmonary Lesions in Colorectal Cancer Patients

• Published in: World journal of surgery 2018-04, Vol.42 (4), p.1161-1170
• Main Authors: Ohtaki, Yoichi, Shimizu, Kimihiro, Nagashima, Toshiteru, Nakazawa, Seshiru, Obayashi, Kai, Azuma, Yoko, Iijima, Misaki, Kosaka, Takayuki, Yajima, Toshiki, Ogawa, Hiroomi, Tsutsumi, Soichi, Arai, Motohiro, Mogi, Akira, Kuwano, Hiroyuki
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Cancer; Cardiac Surgery; Colorectal cancer; Colorectal carcinoma; General Surgery; Lung cancer; Medicine; Medicine & Public Health; Metastases; Metastasis; Multivariate analysis; Opacity; Organs; Original Scientific Report; Patients; Pulmonary lesions; Solid tumors; Surgery; Thoracic Surgery; Tumors; Vascular Surgery
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-017-4243-9

Objectives The lung is one of the most common organs of metastasis from colorectal cancer (CRC), and we have encountered lung cancer patients with a history of CRC. There have been few studies regarding methods used to discriminate between primary lung cancer (PLC) and pulmonary metastasis from CRC (PM-CRC) based only on preoperative findings. We retrospectively investigated predictive factors discriminating between these lesions in patients with a history of CRC. Methods Between 2006 and 2015, 117 patients with a history of CRC (44 patients with 47 PLC and 73 patients with 102 PM-CRC) underwent subsequent or concurrent resection of pulmonary lesions. We compared the clinical and radiological characteristics of 100 patients with solitary lesions (43 PLC and 57 PM-CRC). Using univariate and multivariate analyses, we examined predictive factors for discrimination of these two lesions. Results All tumors with findings of ground-glass opacity (GGO) were PLC ( n  = 19). In a multivariate analysis of 81 radiologically solid tumors, two factors were found to be significant independent predictors of PLC: a history of stage I CRC and presence of pleural indentation. All tumors in 26 patients with either GGO or both a stage I CRC history and pleural indentation were PLC, while most tumors in patients without all three factors were PM-CRC (43/44; 97.7%). Conclusions The presence or absence of GGO, pathological CRC stage, and pleural indentation could be useful factors to distinguish between PLC and PM-CRC.