Distribution and prognosis of uncommon metastases from non-small cell lung cancer

Abstract

BackgroundAccording to the literature and our experience, the most common sites of non-small cell lung cancer (NSCLC) metastases include the brain, bone, liver, adrenal glands, contralateral lung and distant lymph nodes. Metastases to other organs are relatively rare. There have been numerous case reports and a few small case series of uncommon metastases derived from NSCLC.MethodsWe defined all organs except the common metastatic sites mentioned above as uncommon sites of metastasis. Patients with uncommon metastases among 2,872 consecutive NSCLC patients with stage IV disease at the Guangdong Lung Cancer Institute (GLCI) from 2006 to 2012 were included in this study. The diagnosis of uncommon metastases was based on pathology or imaging studies.ResultsUncommon metastases were diagnosed in 193 cases at anatomical sites such as the soft tissue, kidney, pancreas, spleen, peritoneum, intestine, bone marrow, eye, ovary, thyroid, heart, breast, tonsil and nasal cavity. Uncommon metastases were identified as independent poor prognostic factors through a multivariate analysis with a HR (hazard ratio) of 1.29 [95 % confidence interval (CI) 1.09–1.52, P < 0.01]. Those patients who received systemic therapy plus local treatment had a better survival rate than did those who received systemic therapy only (P < 0.01); all patients received best supportive care.ConclusionsMetastases to the above mentioned sites are infrequent. The presentation of uncommon metastases tends to indicate a poor outcome, and selected patients may benefit from local treatment.

Prognostic factors in patients with skeletal-related events at non-small-cell lung cancer diagnosis

“…In accordance with our findings, several reports demonstrated that a surgical approach to metastatic NSCLC may improve prognosis (25)(26)(27). There is a possibility that surgery was performed only on patients who were expected to have better prognosis.…”

Patient with Three EGFR Mutations – Gradual Development of Resistance to Previous Targeted Treatment

“…nění [21,22]. Jejich přítomnost je spojena s horší prognózou pa cientů [21] a stejně jako u naší nemocné jsou obvykle spojeny s pohrudničními maligními výpotky [14].…”

“…Jejich přítomnost je spojena s horší prognózou pa cientů [21] a stejně jako u naší nemocné jsou obvykle spojeny s pohrudničními maligními výpotky [14]. Kazuisticky byla doložena regrese tohoto typu metastáz po erlotinibu, který navíc dle jiné práce dokládal slibnou účinnost po léčbě afatinibem se získanou mutací C797S a delecí na exonu 19 [23,24].…”

“…Peritoneální metastázy, které se objevily u naší pa cientky po podání osimertinibu, jsou poměrně vzácným místem šíření plicních tumorů [21]. Jejich čet-nost je uváděna do 1 % případů, kdy obvykle vznikají až v průběhu onemocrován obvyklý výskyt těchto mutací na stejné alele genu EGFR [8].…”

Bladder Metastases from Lung Cancer: Clinical and Pathological Implications: A Systematic Review

“…According to the seminal study by Quint et al [6], the main metastatic sites for LC, apart from lymph nodes, are the brain, bone, liver, adrenal glands, body wall and lung (47, 36, 22, 15, 13 and 11%, respectively). All other locations are defined as “uncommon metastases,” which have been reported as independent predictors of poorer overall survival compared to common ones [7]. Such worse outcome may be explained by 2 hypotheses: (i) tumor cells spreading and surviving in a “hostile” anlage, such as an uncommon organ, may develop a more aggressive phenotype, and (ii) treatment of metastatic cancer in uncommon sites is challenging, especially when there is only one distant localization of disease [7].…”