Number of metastatic sites is a strong predictor of survival in patients with nonsmall cell lung cancer with or without brain metastases

Abstract

BACKGROUND: The staging system for non–small cell lung cancer (NSCLC) does not consider tumor burden or number of metastatic sites, although oligometastases are more favorable. METHODS: Using log‐rank testing, the authors analyzed overall survival (OS) in 1284 patients newly presenting with metastatic NSCLC by number of metastatic organ sites and the presence of brain metastases. RESULTS: OS for patients without brain metastases was found to be correlated with the number of metastatic sites (P = .0009). Brain metastases conferred an inferior OS (median of 7 months vs 9 months; 95% confidence interval, 7‐8 months vs 8‐10 months [P = .00,002]). To evaluate the influence of tumor burden on OS, the authors considered subsets of patients in whom the brain (n = 135) or lung (n = 137) was the solitary metastatic organ site. In patients with brain metastases, OS was found to be correlated inversely with the volume of all metastases or the largest lesion (hazards ratio, 1.04 or 1.03, respectively; P = .01). For patients with lung metastases, OS was better for those with a maximum tumor size below the median of 40 mm (P = .0004). CONCLUSIONS: Staging of NSCLC and clinical trial patient stratification should include quantitation of tumor burden. The prognostic impact of brain metastases is small and partly dependent on tumor volume, which indicates the need for aggressive therapy for patients with NSCLC brain metastasis and their inclusion in clinical trials. Cancer 2009. © 2009 American Cancer Society.

Mini Nutritional Assessment (MNA) and biochemical markers of cachexia in metastatic lung cancer patients: Interrelations and associations with prognosis

“…With regard to age, this is in accordance with extensive previous work [38][39][40]. The number of metastatic sites was another strong, independent predictor of survival in lung cancer patients as evidenced by our results and those of previous studies [41,42]. MNA retained its importance in multivariate analysis probably due to its inputs related to weight loss and patient's mobility (PS).…”

Baseline Insulin-Like Growth Factor-I Plasma Levels, Systemic Inflammation, Weight Loss and Clinical Outcome in Metastatic Non-Small Cell Lung Cancer Patients

“…This was highly expected based on the extensive pre-existing literature [19,20,21,22,23]. IGF-I failed to retain its importance in the multivariate model probably due to its previously described correlation with PS.…”

18F-FDOPA PET for Differentiating Recurrent or Progressive Brain Metastatic Tumors from Late or Delayed Radiation Injury After Radiation Treatment

“…Prognosis is poor, with reported median survival times of 7-9 mo for metastatic lung cancer (4), 2-9 mo for breast cancer (5), and 2-5 mo for melanoma (6). Patients with solitary lesions have longer survival times than those with multiple lesions (4)(5)(6).…”