ORIGINAL ARTICLE   

Minerva Surgery 2025 April;80(2):121-30

DOI: 10.23736/S2724-5691.25.10760-0

Copyright © 2025 EDIZIONI MINERVA MEDICA

language: English

Relevance of indeterminate pulmonary nodules in predicting distant metastasis in colorectal cancer

María SÁNCHEZ-RODRÍGUEZ ¹ ✉, María CAMARENA-GEA ², Lucía MARCOS-CORTÉS ¹, María FERNÁNDEZ-MARTÍNEZ ³, Luis M. JIMÉNEZ-GÓMEZ ⁴, Jaime ZORRILLA-ORTUZAR ⁴, Paula DUJOVNE-LINDENBAUM ⁴, Patricia TEJEDOR ⁴

¹ Department of General Surgery, Gregorio Marañón General University Hospital, Madrid, Spain; ² Department of Radiology, Gregorio Marañón General University Hospital, Madrid, Spain; ³ Department of Hepatobiliary, Pancreatic and Liver Transplantation Surgery, Gregorio Marañón General University Hospital, Madrid, Spain; ⁴ Department of Colorectal Surgery, Gregorio Marañón General University Hospital, Madrid, Spain

BACKGROUND: The detection of indeterminate pulmonary nodules (IPN) at diagnosis of colorectal cancer (CRC) has increased. However, there is limited information on predictive factors for its progression (pPF) to pulmonary metastases (PM). This study aims to identify these pPF to select appropriate management strategies.
METHODS: Single-center observational retrospective study including patients who underwent elective surgery for first non-metastatic CRC episode (January 2016- June 2019) with IPN at diagnosis. Patients were divided into those who developed PM in the same location as previous IPN (LM group) and those who did not (FM group).
RESULTS: One hundred twenty-one patients were included; 4.9% developed PM in the same location as previous IPN. Univariate analysis revealed a significant difference in IPN size between groups with 8 (5, 10) mm in LM versus 3 (1, 5) mm in FM (P=0.006). ROC curve showed a size of ≥5 mm as the best cutoff point to predict IPN progression. Multivariate analysis identified size ≥5mm as the only independent pPF (OR 11.9, 95%CI 1.3-105.8, P=0.026). The median time to diagnose PM in LM group was 13.8(SD 5.2) months.
CONCLUSIONS: We recommend a closer follow-up for patients with CRC and IPN ≥5 mm at diagnosis so they will have a higher risk of developing PM.

KEY WORDS: Colorectal neoplasms; Multiple pulmonary nodules; Neoplasm metastasis