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Ann Surg. 2015 Jun;261(6):1145-52. doi: 10.1097/SLA.0000000000000853.

Indeterminate Pulmonary Nodules in Colorectal Cancer: Follow-up Guidelines Based on a Risk Predictive Model.

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*Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Gwangju, Korea; and †Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.



Chest computed tomographic (CT) scans frequently detect indeterminate pulmonary nodules (IPNs) in patients with colorectal cancer. The discovery of such nodules creates a clinical dilemma.


This study was performed to identify clinical characteristics of IPNs and develop a predictive model to predict the risk of progression to pulmonary metastases in patients with colorectal cancer.


We analyzed data from a prospectively collected database involving 1195 patients with colorectal carcinoma who underwent curative surgery between January 2008 and June 2010. A predictive model was constructed on the basis of the probability risk score and validated in 115 patients collected from a separate treatment period.


Of the 1195 patients who underwent a baseline staging chest computed tomography, 326 (27.2%) had IPNs. During a median follow-up of 26.7 months (interquartile range: 18.0-37.2), 74 (28.1%) showed pulmonary metastases. Five variables maintained prognostic significance after multivariate analysis: metachronous nodule, bilateral involvement, positive perineural invasion, increased number of positive lymph nodes, and rectal location of cancer. The 2-year progression-free survival rates for the very low-, low-, intermediate-, and high-risk groups were 96%, 82%, 46%, and 16%, respectively (P < 0.001), with a concordance index of 0.81 (95% confidence interval, 0.75-0.86). This model was validated in a separate patient set (P < 0.001), with a C-index of 0.83 (95% confidence interval, 0.77-0.88).


A predictive model for progression of IPNs may be clinically useful in discriminating patients who might benefit from an aggressive surveillance program and early pulmonary metastasectomies.

[Indexed for MEDLINE]

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