Cancer Research and Treatment

Special Article

Korean Practical Guidelines for Geriatric Assessment and Management of Older Adults with Cancer: A Korean Cancer Association Guideline for Geriatric Oncology: Minsu Kang, Jeonghyun Kang, Changhoon Song, Heung-Kwon Oh, Hong Chung, Ilhak Lee, Jae Hung Jung, Jae Hyun Jeon, Eunjin Jeong, Jeong Rim Koh, Jung Hye Kwon, Jung-Yeon Choi, Kidong Kim, Kwangmin Kim, Kyung Hyun Moon, Minkyu Jung, Se Jin Hong, Su-Jin Koh, Sukki Cho, Suzy Kim, Yun-Gyoo Lee, Miyoung Choi, Dong Ah Park, Mi Ah Han, In Gyu Hwang, Jin Won Kim, Jee Hyun Kim; Received November 22, 2025 Accepted February 14, 2026 Published online February 19, 2026; DOI: https://doi.org/10.4143/crt.2025.1283 [Accepted]

Abstract PDF: The Korean Cancer Association’s clinical practice guidelines for geriatric oncology provide an evidence-based, multidisciplinary framework to optimize cancer care for the growing population of older adults. Geriatric Assessment (GA) identifies multidimensional vulnerabilities often missed by standard performance measures, providing critical information to guide individualized treatment planning. This guideline recommends using validated geriatric screening tools, life expectancy prediction models, and toxicity risk calculators to support risk stratification and decision-making. By integrating GA-based multidisciplinary interventions and shared decision-making into clinical practice, clinicians can avoid both overtreatment and undertreatment, reduce treatment-related toxicity, and potentially enhance quality of life. Although the certainty of evidence for most recommendations ranged from very low to low, the panel reached a consensus to provide conditional recommendations. This decision reflects the judgment that the clinical benefits—specifically in reducing treatment-related toxicity and identifying vulnerabilities—outweigh the limitations of current evidence, addressing the urgent need for standardized geriatric care in Korea. Ultimately, these guidelines aim to support individualized, patient-centered care and serve as a practical foundation for clinical and educational applications within the Korean healthcare system.

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Original Articles

Postoperative Radiotherapy May Improve Survival in Certain Patients with pN2 Non-Small Cell Lung Cancer Who Do Not Have Extranodal Extension: Seung Hyuck Jeon, Changhoon Song, Jae Hyun Jeon, Jin-Haeng Chung, Sukki Cho, Kwhanmien Kim, Sanghoon Jheon, Se Hyun Kim, Yu Jung Kim, Jae-Sung Kim; Received June 20, 2025 Accepted February 1, 2026 Published online February 3, 2026; DOI: https://doi.org/10.4143/crt.2025.644 [Accepted]

Abstract PDF: Purpose
The aim of this study was to identify subgroups of patients with pathologic N2 (pN2) non-small cell lung cancer (NSCLC) who may benefit from postoperative radiotherapy (PORT). Particular attention was given to evaluating whether extranodal extension (ENE) influences the therapeutic efficacy of PORT.
Materials and Methods
A total of 231 patients with pN2 NSCLC who underwent surgical resection followed by adjuvant chemotherapy at a single institution were analyzed retrospectively. Propensity score matching was performed to compare treatment outcomes according to the receipt of PORT.
Results
Propensity score matching yielded 99 matched pairs of patients with no significant differences in clinical parameters. There were no significant differences in the overall survival (OS; p=0.11) and disease-free survival (DFS; p=0.29) between the PORT and no PORT groups. However, PORT significantly improved the locoregional recurrence (LRR)-free rate (p=0.011), whereas the distant metastasis-free rate was comparable between groups (p=0.64). In subgroup analyses, PORT was associated with improved OS in patients with 1–3 positive N2 lymph nodes (p=0.013) and with significantly improved DFS among patients without ENE (p=0.046) or lymphatic invasion (p=0.032).
Conclusion
Although PORT did not improve OS or DFS in the matched overall cohort, it significantly reduced LRR. Subgroup analyses suggested potential benefits in patients with limited nodal burden and in those without ENE or lymphatic invasion. These findings, however, should be interpreted cautiously given small subgroup sizes and inherent limitations of retrospective design.

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Lung cancer

Genetic Alterations in Preinvasive Lung Synchronous Lesions: Soyeon Ahn, Jisun Lim, Soo Young Park, Hyojin Kim, Hyun Jung Kwon, Yeon Bi Han, Choon-Taek Lee, Sukki Cho, Jin-Haeng Chung; Cancer Res Treat. 2020;52(4):1120-1134. Published online June 5, 2020; DOI: https://doi.org/10.4143/crt.2020.307

Abstract PDF Supplementary Material PubReader ePub

Purpose
Despite advances in treatment, lung cancer remains the leading cause of cancer mortality. This study aimed to characterise genome-wide tumorigenesis events and to understand the hypothesis of the multistep carcinogenesis of lung adenocarcinoma (LUAD)
Materials and Methods
We conducted multiregion whole-exome sequencing of LUAD with synchronous atypical adenomatous hyperplasia (AAH), adenocarcinoma in situ, or minimally invasive adenocarcinoma of 19 samples from three patients to characterize genome-wide tumorigenesis events and validate the hypothesis of the multistep carcinogenesis of LUAD. We identified potential pathogenic mutations preserved in preinvasive lesions and supplemented the finding by allelic variant level from RNA sequencing.
Results
Overall, independent mutational profiles were observed per patient and between patients. Some shared mutations including epidermal growth factor receptor (EGFR , p.L858R) were present across synchronous lesions.
Conclusion
Here, we show that there are driver gene mutations in AAH, and they may exacerbate as a sequence in a histological continuum, supporting the Darwinian evolution model of cancer genome. The intertumoral and intratumoral heterogeneity of synchronous LUAD implies that multi-biomarker strategies might be necessary for appropriate treatment.

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Gene Expression Profiles of Multiple Synchronous Lesions in Lung Adenocarcinoma
Jisun Lim, Yeon Bi Han, Soo Young Park, Soyeon Ahn, Hyojin Kim, Hyun Jung Kwon, Choon-Taek Lee, Sukki Cho, Jin-Haeng Chung
Cells.2021; 10(12): 3484. CrossRef

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Clinical Significance of Pleural Attachment and Indentation of Subsolid Nodule Lung Cancer: Hyung-Jun Kim, Jun Yeun Cho, Yeon Joo Lee, Jong Sun Park, Young-Jae Cho, Ho Il Yoon, Jin-Haeng Chung, Sukki Cho, Kwhanmien Kim, Kyung Won Lee, Jae Ho Lee, Choon-Taek Lee; Cancer Res Treat. 2019;51(4):1540-1548. Published online March 25, 2019; DOI: https://doi.org/10.4143/crt.2019.057

Abstract PDF Supplementary Material PubReader ePub

Purpose
Lung cancers presenting as subsolid nodule commonly have peripheral location, making the cancer-pleura relationship noteworthy. We aimed to evaluate the effect of pleural attachment and/or indentation on visceral pleural invasion (VPI) and recurrence-free survival.
Materials and Methods
Patients who underwent curative resection of lung cancer as subsolid nodules from April 2007 to January 2016 were retrospectively evaluated. They were divided into four groups according to their relationship with the pleura. Clinical, radiographical, and pathological findings were analyzed.
Results
Among 404 patients with malignant subsolid nodule, 120 (29.7%) had neither pleural attachment nor indentation, 26 (6.4%) had attachment only, 117 (29.0%) had indentation only, and 141 (34.9%) had both. VPI was observed in nodules of 36 patients (8.9%), but absent in nonsolid nodules and in those without pleural attachment and/or indentation. Compared to subsolid nodules with concurrent pleural attachment and indentation, those with attachment only (odds ratio, 0.12; 95% confidence interval [CI], 0.02 to 0.98) and indentation only (odds ratio, 0.10; 95% CI, 0.03 to 0.31) revealed lower odds of VPI. On subgroup analysis, the size of the solid portion was associated with VPI among those with pleural attachment and indentation (p=0.021). Such high-risk features for VPI were associated with earlier lung cancer recurrence (adjusted hazard ratio, 3.31; 95% CI, 1.58 to 6.91).
Conclusion
Concurrent pleural attachment and indentation are risk factors for VPI, and the odds increase with larger solid portion in subsolid nodules. Considering the risk of recurrence, early surgical resection could be encouraged in these patients.

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Predicting visceral pleural invasion in invasive adenocarcinoma with a maximum diameter ≤ 3 cm based on 18F-FDG PET/CT radiomics
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European Journal of Nuclear Medicine and Molecular Imaging.2026; 53(2): 1029. CrossRef
Predicting Visceral Pleural Invasion in Part-Solid and Solid Nodules Using CT Features: A Systematic Review, Meta-Analysis, and Independent Cohort Validation
Yu Long, Yong Li, Libo Lin, ChangJiu He, HaoMiao Qing, JieKe Liu, Peng Zhou
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Correlation Study between CT Manifestations and Pathological Features of Subsolid Pulmonary Nodules
仕怡周
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CT predictors of visceral pleural invasion in subsolid nodular pulmonary adenocarcinoma: differences between direct and indirect tumor-pleura contact
Yun Wang, Deng Lyu, Xiaoli Deng, Lei Hu, Junhong Wu, Xiuxiu Zhou, Yi Xiao, Li Fan, Shiyuan Liu
Cancer Imaging.2026;[Epub] CrossRef
Density homogeneity as a crucial CT indicator for differentiating malignant and benign subcentimeter solid pulmonary nodules: A retrospective multi-center study
Wen-tao Zhang, Hui Gan, Wei Luo, Min Zhao, Can Ding, Xue-feng Jiang, Ting Fu, Fa-jin Lv, Zhi-gang Chu
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Significance of the Lesion–Pleura Relationship in Differentiating Peripheral Inflammatory Lesions and Lung Cancers
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Radiomics analysis of 18F-FDG PET/CT for visceral pleural invasion in non-small cell lung cancer with pleural attachment
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Prognostic significance of visceral pleural changes in stage IA lung adenocarcinoma: a retrospective study
Yingding Ruan, Yuhe You, Jianwei Han, Hongsheng Xue, Wenjun Cao, Chuan Long, Peng Sun, Yaoyu Hu, Zhilong Zhao
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A CT-based deep learning model: visceral pleural invasion and survival prediction in clinical stage IA lung adenocarcinoma
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CT-Based Intratumoral and Peritumoral Radiomics Nomograms for the Preoperative Prediction of Spread Through Air Spaces in Clinical Stage IA Non-small Cell Lung Cancer
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The prognostic value of visceral pleural infiltration in ≤3 cm nonsmall cell lung cancer presenting with ground glass opacity: an inverse probability of treatment weighting study
Zhenyu Yang, Yiming Li, Chenglin Guo, Yikai Xing, Chengwu Liu, Jian Zhang, Qiang Pu, Lunxu Liu
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Tumour–pleura relationship on CT is a risk factor for occult lymph node metastasis in peripheral clinical stage IA solid adenocarcinoma
Chengzhou Zhang, Liping Wang, Xiaoting Cai, Mengfei Li, Dandan Sun, Ping Wang
European Radiology.2023; 33(5): 3083. CrossRef
Analysis of the relevance between computed tomography characterization and pathology of pulmonary ground-glass nodules with different pathology types
Zhang Youguo, Wang Chengye, Cheng Xiaofei, Zhang Xuefei, Liu Changhong
Turkish Journal of Thoracic and Cardiovascular Surgery.2023; 31(1): 95. CrossRef
Risk factors for loss of pulmonary function after wedge resection for peripheral ground-glass opacity dominant lung cancer
Tomohiro Miyoshi, Hiroyuki Ito, Masashi Wakabayashi, Tadayoshi Hashimoto, Yuta Sekino, Kenji Suzuki, Masahiro Tsuboi, Yasumitsu Moriya, Ichiro Yoshino, Tetsuya Isaka, Aritoshi Hattori, Takahiro Mimae, Mitsuhiro Isaka, Tomohiro Maniwa, Makoto Endo, Hiroshi
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Volumetric analysis of intravoxel incoherent motion diffusion-weighted imaging in preoperative assessment of non-small cell lung cancer
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A Nomogram Combined Radiomics and Clinical Features as Imaging Biomarkers for Prediction of Visceral Pleural Invasion in Lung Adenocarcinoma
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Radiologists with and without deep learning–based computer-aided diagnosis: comparison of performance and interobserver agreement for characterizing and diagnosing pulmonary nodules/masses
Tomohiro Wataya, Masahiro Yanagawa, Mitsuko Tsubamoto, Tomoharu Sato, Daiki Nishigaki, Kosuke Kita, Kazuki Yamagata, Yuki Suzuki, Akinori Hata, Shoji Kido, Noriyuki Tomiyama
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The value of CT radiomics features to predict visceral pleural invasion in ≤3 cm peripheral type early non-small cell lung cancer
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Lung-RADS Version 1.1: Challenges and a Look Ahead, From the AJR Special Series on Radiology Reporting and Data Systems
Lydia Chelala, Rydhwana Hossain, Ella A. Kazerooni, Jared D. Christensen, Debra S. Dyer, Charles S. White
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Predicting pathological lymph node status in clinical stage IA peripheral lung adenocarcinoma
Keiju Aokage, Kenji Suzuki, Masashi Wakabayashi, Tomonori Mizutani, Aritoshi Hattori, Haruhiko Fukuda, Shun-Ichi Watanabe
European Journal of Cardio-Thoracic Surgery.2021; 60(1): 64. CrossRef
Discriminating Small-Sized (2 cm or Less), Noncalcified, Solitary Pulmonary Tuberculoma and Solid Lung Adenocarcinoma in Tuberculosis-Endemic Areas
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Suk Ki Cho
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Radiology.2020; 297(3): 710. CrossRef

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Landscape of Actionable Genetic Alterations Profiled from 1,071 Tumor Samples in Korean Cancer Patients: Se-Hoon Lee, Boram Lee, Joon Ho Shim, Kwang Woo Lee, Jae Won Yun, Sook-Young Kim, Tae-You Kim, Yeul Hong Kim, Young Hyeh Ko, Hyun Cheol Chung, Chang Sik Yu, Jeeyun Lee, Sun Young Rha, Tae Won Kim, Kyung Hae Jung, Seock-Ah Im, Hyeong-Gon Moon, Sukki Cho, Jin Hyoung Kang, Jihun Kim, Sang Kyum Kim, Han Suk Ryu, Sang Yun Ha, Jong Il Kim, Yeun-Jun Chung, Cheolmin Kim, Hyung-Lae Kim, Woong-Yang Park, Dong-Young Noh, Keunchil Park; Cancer Res Treat. 2019;51(1):211-222. Published online April 23, 2018; DOI: https://doi.org/10.4143/crt.2018.132

Abstract PDF Supplementary Material PubReader ePub

Purpose
With the emergence of next-generation sequencing (NGS) technology, profiling a wide range of genomic alterations has become a possibility resulting in improved implementation of targeted cancer therapy. In Asian populations, the prevalence and spectrum of clinically actionable genetic alterations has not yet been determined because of a lack of studies examining high-throughput cancer genomic data.
Materials and Methods
To address this issue, 1,071 tumor samples were collected from five major cancer institutes in Korea and analyzed using targeted NGS at a centralized laboratory. Samples were either fresh frozen or formalin-fixed, paraffin embedded (FFPE) and the quality and yield of extracted genomic DNA was assessed. In order to estimate the effect of sample condition on the quality of sequencing results, tissue preparation method, specimen type (resected or biopsied) and tissue storage time were compared.
Results
We detected 7,360 non-synonymous point mutations, 1,164 small insertions and deletions, 3,173 copy number alterations, and 462 structural variants. Fifty-four percent of tumors had one or more clinically relevant genetic mutation. The distribution of actionable variants was variable among different genes. Fresh frozen tissues, surgically resected specimens, and recently obtained specimens generated superior sequencing results over FFPE tissues, biopsied specimens, and tissues with long storage duration.
Conclusion
In order to overcome, challenges involved in bringing NGS testing into routine clinical use, a centralized laboratory model was designed that could improve the NGS workflows, provide appropriate turnaround times and control costs with goal of enabling precision medicine.

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Micronodular Thymic Carcinoma With Lymphoid Hyperplasia: A Case Report and Next Generation Sequencing Analysis With its Benign Counterpart Multinodular Thymoma With Lymphoid Stroma
Min Gyoung Pak, Seung Yeon Ha, Mee Sook Roh
International Journal of Surgical Pathology.2026; 34(1): 207. CrossRef
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Jin Won Kim, Hee Young Na, Sejoon Lee, Ji-Won Kim, Koung Jin Suh, Se Hyun Kim, Yu Jung Kim, Keun-Wook Lee, Jong Seok Lee, Jaihwan Kim, Jin-Hyeok Hwang, Kihwan Hwang, Chae-Yong Kim, Yong Beom Kim, Soomin Ahn, Kyu Sang Lee, Hyojin Kim, Hye Seung Lee, So Yeo
Scientific Reports.2025;[Epub] CrossRef
High clinical actionability of a pan-cancer tissue-based combined DNA and RNA next generation sequencing assay in a diverse Asian population
Jing Yi Lee, Aya El Helali, Donavan Jia Jie Tan, Zi Yi Wan, Donald Poon, Jens Samol, Tsz Him So, Su Pin Choo, Ravindran Kanesvaran, Cheng-Vai Hui, Joseph Siu-Kie Au, Timothy Yip, Ross A. Soo, Michelle Pek, Ruifen Weng, Bin Tean Teh, Min-Han Tan, Jonathan
npj Precision Oncology.2025;[Epub] CrossRef
Clinical significance of concurrent TP53 mutations in KRAS-mutant invasive mucinous adenocarcinoma patients undergoing curative-intent lung surgery
Dong Woog Yoon, Soohyun Hwang, Boram Lee, Yeong Jeong Jeon, Junghee Lee, Dong Wook Shin, Byeong-Ho Jeong, Seong Yong Park, Hong Kwan Kim, Yong Soo Choi, Jong Ho Cho
Cancer Treatment and Research Communications.2025; 45: 101014. CrossRef
Evaluation of false positive and false negative errors in targeted next generation sequencing
Youngbeen Moon, Young-Ho Kim, Jong-Kwang Kim, Chung Hwan Hong, Eun-Kyung Kang, Hye Won Choi, Dong‑eun Lee, Tae-Min Kim, Seong Gu Heo, Namshik Han, Kyeong-Man Hong
Genome Biology.2025;[Epub] CrossRef
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Fabio Canino, Antonio Tornincasa, Stefania Bettelli, Samantha Manfredini, Monica Barbolini, Luca Moscetti, Claudia Omarini, Angela Toss, Fabio Tamburrano, Giuseppina Antonelli, Federica Baglio, Lorenzo Belluzzi, Giulio Martinelli, Salvatore Natalizio, Orn
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Exploring the DNA methylome of Korean patients with colorectal cancer consolidates the clinical implications of cancer-associated methylation markers
Sejoon Lee, Kil-yong Lee, Ji-Hwan Park, Duck-Woo Kim, Heung-Kwon Oh, Seong-Taek Oh, Jongbum Jeon, Dongyoon Lee, Soobok Joe, Hoang Bao Khanh Chu, Jisun Kang, Jin-Young Lee, Sheehyun Cho, Hyeran Shim, Si-Cho Kim, Hong Seok Lee, Young-Joon Kim, Jin Ok Yang,
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Jiwon Koh, Ha Young Park, Jeong Mo Bae, Jun Kang, Uiju Cho, Seung Eun Lee, Haeyoun Kang, Min Eui Hong, Jae Kyung Won, Youn-La Choi, Wan-Seop Kim, Ahwon Lee
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IC Uzoma, IA Taiwo, NI Ugwu, MA Durosinmi, O Akinloye
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Recommendations for the Use of Next-Generation Sequencing and the Molecular Tumor Board for Patients with Advanced Cancer: A Report from KSMO and KCSG Precision Medicine Networking Group
Shinkyo Yoon, Miso Kim, Yong Sang Hong, Han Sang Kim, Seung Tae Kim, Jihun Kim, Hongseok Yun, Changhoon Yoo, Hee Kyung Ahn, Hyo Song Kim, In Hee Lee, In-Ho Kim, Inkeun Park, Jae Ho Jeong, Jaekyung Cheon, Jin Won Kim, Jina Yun, Sun Min Lim, Yongjun Cha, Se
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Gelareh Sadigh, Hilary Gee Goeckner, Ella A. Kazerooni, Bruce E. Johnson, Robert A. Smith, Devon V. Adams, Ruth C. Carlos
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Koung Jin Suh, Se Hyun Kim, Yu Jung Kim, Heechul Shin, Eunyoung Kang, Eun-Kyu Kim, Sejoon Lee, Ji Won Woo, Hee Young Na, Soomin Ahn, Bum-Sup Jang, In Ah Kim, So Yeon Park, Jee Hyun Kim
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Real‐world utility of next‐generation sequencing for targeted gene analysis and its application to treatment in lung adenocarcinoma
Jwa Hoon Kim, Shinkyo Yoon, Dae Ho Lee, Se Jin Jang, Sung‐Min Chun, Sang‐We Kim
Cancer Medicine.2021; 10(10): 3197. CrossRef
Actionability evaluation of biliary tract cancer by genome transcriptome analysis and Asian cancer knowledgebase
Yuki Okawa, Nobutaka Ebata, Nayoung K.D. Kim, Masashi Fujita, Kazuhiro Maejima, Shota Sasagawa, Toru Nakamura, Woong-Yang Park, Satoshi Hirano, Hidewaki Nakagawa
Oncotarget.2021; 12(15): 1540. CrossRef
Development and Validation of Targeted Gene Sequencing Panel Based Companion Diagnostic for Korean Patients with Solid Tumors
Byung-Joo Min, Woo Seung Lee, Myung-Eui Seo, Kye-Hwa Lee, Seung-Yong Jeong, Ja-Lok Ku, Yeul Hong Kim, Sang-Won Shin, Ju Han Kim
Cancers.2021; 13(20): 5112. CrossRef
Junction Location Identifier (JuLI)
Hyun-Tae Shin, Nayoung K.D. Kim, Jae Won Yun, Boram Lee, Sungkyu Kyung, Ki-Wook Lee, Daeun Ryu, Jinho Kim, Joon Seol Bae, Donghyun Park, Yoon-La Choi, Se-Hoon Lee, Myung-Ju Ahn, Keunchil Park, Woong-Yang Park
The Journal of Molecular Diagnostics.2020; 22(3): 304. CrossRef
Simple prediction model for homologous recombination deficiency in breast cancers in adolescents and young adults
Tomoko Watanabe, Takayuki Honda, Hirohiko Totsuka, Masayuki Yoshida, Maki Tanioka, Kouya Shiraishi, Yoko Shimada, Eri Arai, Mineko Ushiama, Kenji Tamura, Teruhiko Yoshida, Yae Kanai, Takashi Kohno
Breast Cancer Research and Treatment.2020; 182(2): 491. CrossRef

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Effect of Adjuvant Chemotherapy after Complete Resection for Pathologic Stage IB Lung Adenocarcinoma in High-Risk Patients as Defined by a New Recurrence Risk Scoring Model: Hyo Joon Jang, Sukki Cho, Kwhanmien Kim, Sanghoon Jheon, Hee Chul Yang, Dong Kwan Kim; Cancer Res Treat. 2017;49(4):898-905. Published online January 18, 2017; DOI: https://doi.org/10.4143/crt.2016.312

Abstract PDF PubReader ePub

Purpose
We conducted a retrospective analysis to determine if adjuvant chemotherapy prolongs overall survival in patients with pathologic stage IB lung adenocarcinoma who had undergone complete resection and were defined as high-risk by a newly developed recurrence risk scoring model.
Materials and Methods
Patientswho underwent curative resection for stage IB lung adenocarcinomawere analyzed with a newly developed recurrence risk scoring model and divided into a low-risk group and a high-risk group. The patients in the high-risk group were retrospectively divided into two groups based on whether they underwent adjuvant chemotherapy or observation. Recurrence-free survival and overall survival were compared between these two groups.
Results
A total of 328 patients who underwent curative resection between 2000 and 2009 were included in this study, of whom 110 (34%) received adjuvant chemotherapy and 218 (67%) underwent observation without additional treatment. According to our risk model, 167 patients (51%) were high-risk and 161 (49%) were low-risk. The 5-year recurrence-free survival rates and overall survival were 84.4% and 91.5% in low-risk patients and 53.9% and 74.7% in high-risk patients (p < 0.001). In high-risk patients, the 5-year overall survival rates were 77% among patients who underwent observation and 87% among those who underwent adjuvant chemotherapy (p=0.019).
Conclusion
Adjuvant chemotherapy prolonged overall survival among high-risk patients who had undergone complete resection for stage IB lung adenocarcinoma.

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Curative Resection for Metachronous Pulmonary Metastases from Colorectal Cancer: Analysis of Survival Rates and Prognostic Factors: Myong Hoon Ihn, Duck-Woo Kim, Sukki Cho, Heung-Kwon Oh, Sanghoon Jheon, Kwhanmien Kim, Eun Shin, Hye Seung Lee, Jin-Haeng Chung, Sung-Bum Kang; Cancer Res Treat. 2017;49(1):104-115. Published online May 9, 2016; DOI: https://doi.org/10.4143/crt.2015.367

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Purpose
Prognostic factors in patients with pulmonary metastases (PM) from colorectal cancer (CRC) are still controversial. This study assessed oncologic outcomes and prognostic factors in patients with metachronous PM from CRC.
Materials and Methods
Between June 2003 and December 2011, 122 patients with CRC underwent curative resection of PM detected at least 4 months after CRC resection. Clinico-pathological factors selected from the prospectively maintained database were analyzed retrospectively.
Results
The median disease-free interval (DFI) between resection of the primary tumor and detection of PM was 22.0 months (range, 4 to 85 months). Solitary PM were detected in 77 patients (63.1%), with a median maximal tumor diameter of 12.0 mm (range, 2 to 70 mm). Of 52 patients who underwent mediastinal lymph node (LN) dissection, eight patients had LN involvement. Five-year overall survival and disease-free survival (DFS) rates after initial pulmonary metastasectomy were 66.4% and 50.9%, respectively. DFI, mediastinal LN involvement, and the number and distribution of PM were significantly prognostic factors for DFS. In multivariable analysis DFI ≥ 12 months, solitary lesion, and absence of mediastinal LN involvement were independently prognostic for DFS. Of the 122 patients, 48 patients (39.3%) developed recurrent PM a median 13.0 months after initial pulmonary metastasectomy. Recurrent DFI was independently prognostic of DFS in patients who underwent repeated pulmonary metastasectomy.
Conclusion
There is a potential survival benefit for patients with metachronous PM from CRC who undergo pulmonary metastasectomy, even those with recurrent PM. Pulmonary metastasectomy should be considered in selected patients, particularly those with longer DFI, solitary lesions, and absence of mediastinal LN involvement.

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