Characteristics of clinical N0 metastatic non-small cell lung cancer

Tamura, Tomohide; Kurishima, Koichi; Watanabe, Hiroko; Shiozawa, Toshihiro; Nakazawa, Kensuke; Ishikawa, Hiroichi; Hizawa, Nobuyuki

doi:10.1016/j.lungcan.2015.04.002

Cited by 18 publications

(14 citation statements)

References 32 publications

(28 reference statements)

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“…In stage IV NSCLC patients undergoing surgery, those with clinical N0 disease had an 18 month median 5-year survival compared to 11 months in those with any nodal disease, highlighting the importance of neoadjuvant chemoradiation in diminishing nodal disease in surgical candidates with advanced stage NSCLC (p<0.001). 37 In a study by Collaud et al, a similar trend is seen with tumor size, with T1–2 stage IV NSCLC patients who undergo resection having a median 5-year survival of 26 months compared to only 8 months in T3–4 patients (p=0.007). 38 Additionally, data suggest that the timing of metastatic disease development may affect survival, with metachronous oligometastatic stage IV NSCLC patients having improved survival as opposed to synchronous oligometastatic disease.…”

Section: Resultsmentioning

confidence: 75%

The Role of Thoracic Surgery in the Therapeutic Management of Metastatic Non–Small Cell Lung Cancer

David

Clark

Cooke

et al. 2017

Journal of Thoracic Oncology

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Introduction The majority of non-small cell lung cancer (NSCLC) patients are diagnosed with advanced stage disease for whom the prognosis is poor and survival is typically measured in months. Standard therapeutic treatment regimens for patients with stage IV NSCLC typically include chemotherapy and palliative radiation. Despite newer regimens that may include molecularly targeted therapy and immunotherapy, the overall 5-year survival for stage IV disease remains low at 4–6%. Although therapeutic surgery is performed in a minority of cases, accumulating data suggest that thoracic surgery may play several beneficial roles for these patients. Methods In this narrative review, we summarize the literature on surgical intervention in the multimodality management of stage IV NSCLC; focusing on the potential evidence for and against therapeutic/curative intent procedures to impact outcomes for patients with oligometastatic disease and pleural metastasis. Results In selected patients, surgical resection can result in a 5-year survival of 30–50%, but this is heavily influenced by the presence of mediastinal nodal disease, which should be evaluated before therapeutic surgical procedures are undertaken. Additionally, diagnostic or palliative surgical procedures can play an important role in the personalized management of stage IV disease. These data suggest that for carefully selected patients with advanced stage NSCLC, surgical intervention can be an important component of combined modality treatment. Conclusions Given advances in molecular targeted therapy and immunotherapy, further studies should focus on the possible use of surgery as a strategy of therapeutic “consolidation” for appropriately selected patients with stage IV NSCLC receiving combined modality care.

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Section: Resultsmentioning

confidence: 75%

The Role of Thoracic Surgery in the Therapeutic Management of Metastatic Non–Small Cell Lung Cancer

David

Clark

Cooke

et al. 2017

Journal of Thoracic Oncology

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“…As reported in the majority of the series, one of the keys for a favorable outcome is the absence of mediastinal lymph node involvement. A recently published retrospective study including 761 patients collected over a 13-year period (10), reported that cN0 stage IV patients had statistically significant longer survival (11.9 months) compared to 7.2 months for cN1-3 (P<0.001). This survival difference was maintained also in the group of patients who received active treatment including surgery in 2.4% of the patients (18.3 months for the cN0 versus 11.4 months for the rest; P<0.001) but did not reached a significant statistical difference when EGFR mutation was present (37.9 months for cN0 versus 27.0 months for cN1-3).…”

Section: The Role For a Proper Selection Of Patientsmentioning

confidence: 98%

“…Tamura et al (10) suggested that certain type of adrenal metastasis may result from a lymphatic spread as adrenal metastasis are more frequent in those with cN1-3. On the contrary to the brain metastasis, for synchronous adrenal metastasis, the treatment strategy is to operate the primary tumor in the lung first and after, the adrenal lesion (15).…”

Section: Adrenal Metastasismentioning

confidence: 99%

Surgical management of oligometastatic non-small cell lung cancer

2016

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“…Other prognostic factors are: N-stage disease, tumor size, organ site, disease free-interval greater than 6 months, RPA classification, the presence of extracranial metastases, type of pulmonary surgical resection, primary tumor histology, age, number of secondary lesions, previous adjuvant regimens. Concerning with N-stage, Tamura et al (27), in a retrospective cohort study involving 761 stage IV NSCLC patients, reported N0 patients presented a significant increased survival when compared to N1-3 ones (11.9 vs. 7.2 months, P<0.001), thus suggesting lymph node metastases were independent prognostic factors. Similarly, tumor size seems to strongly influence prognosis, as reported by Collaud et al (28) in a small retrospective single-centre study.…”

Section: Oligometastatic Disease: State Of Artmentioning

confidence: 98%

Surgical approach in the oligometastatic patient

Divisi¹,

Barone²,

Zaccagna³

et al. 2018

Ann. Transl. Med.

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In the setting of a stage IV non-small cell lung cancer (NSCLC), oligometastatic patients represent a heterogeneous group whose incidence is increasing as far as with the adoption of new therapeutic regimens, the improvement of the molecular characterization assays and the increasing number of longsurvivor patients. The oligometastatic state undergone a major revision with the introduction of the new TNM lung cancer staging system, being characterized by a different prognosis compared to multimetastatic patients. Furthermore, the presence of a limited number of metastases imposes a local control especially when clonal selections occur during adjuvant therapy. In this regard, the review seeks to clarify the indications for surgical treatment by organ according to recent guidelines, by analyzing prognostic factors and outcome of patients. Although accurate patient stratification is mandatory, aggressive local control strategies represent a valid therapeutic approach in patients with oligometastatic NSCLC. At the same time, persevering with ablative strategies raises both medical and ethical issues about limits and reiteration, which certainly requires a deep reflection, being, on the other hand, in front of a metastatic disease.

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Characteristics of clinical N0 metastatic non-small cell lung cancer

Cited by 18 publications

References 32 publications

The Role of Thoracic Surgery in the Therapeutic Management of Metastatic Non–Small Cell Lung Cancer

The Role of Thoracic Surgery in the Therapeutic Management of Metastatic Non–Small Cell Lung Cancer

Surgical management of oligometastatic non-small cell lung cancer

Surgical approach in the oligometastatic patient

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