Patient outcomes post-pulmonary resection for synchronous bone-metastatic non-small cell lung cancer

Takahashi, Yuki; Adachi, Hirofumi; Mizukami, Yasushi; Yokouchi, Hiroshi; Oizumi, Satoshi; Watanabe, Atsushi

doi:10.21037/jtd.2019.09.17

Cited by 11 publications

(13 citation statements)

References 19 publications

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“… 23 Recently, Takahashi and colleagues found that primary lung cancer resection improved the survival rates of patients with synchronous isolated bone metastasis. 24 The above research findings are consistent with our findings; however, distant lymph node metastasis as a vital metastatic site has often been overlooked and it was discovered to be difficult to benefit from primary surgery in single and multiple organ metastases. Therefore, surgical management for patients with distant lymph node metastasis is required to consider other risk factors, including age, physical state, and lymph node status.…”

Section: Discussionsupporting

confidence: 91%

Surgical Survival Benefits With Different Metastatic Patterns for Stage IV Extrathoracic Metastatic Non-Small Cell Lung Cancer: A SEER-Based Study

Chao

Qian

et al. 2021

Technol Cancer Res Treat

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Background: With the knowledge of oligometastases, primary surgery plays an increasingly vital role in metastatic non-small cell lung cancer. We aimed to evaluate the survival benefit of primary surgery based on metastatic patterns. Materials and Methods: The selected patients with stage IV extrathoracic metastatic (m1b) non-small cell lung cancer between 2010 and 2015 were included in a retrospective cohort study from the Surveillance, Epidemiology, and End Results (SEER) database. Multiple imputation was used for the missing data. Patients were divided into 2 groups depending on whether surgery was performed. After covariate balancing propensity score (CBPS) weighting, multivariate Cox regression models and Kaplan-Meier survival curve were built to identify the survival benefit of different metastatic patterns. Results: Surgery can potentially increase the overall survival (OS) (adjusted HR: 0.68, P < 0.001) of non-small cell lung cancer. The weighted 3-year OS in the surgical group was 16.9%, compared with 7.8% in the nonsurgical group. For single organ metastasis, surgery could improve the survival of metastatic non-small cell lung cancer. Meanwhile, no significant survival improvements in surgical group were observed in patients with multiple organ metastases. Conclusion: The surgical survival benefits for extrathoracic metastatic non-small cell lung cancer could be divided by metastatic pattern.

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Section: Discussionsupporting

confidence: 91%

Surgical Survival Benefits With Different Metastatic Patterns for Stage IV Extrathoracic Metastatic Non-Small Cell Lung Cancer: A SEER-Based Study

Chao

Qian

et al. 2021

Technol Cancer Res Treat

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“…Patients with clinical N0-1 NSCLC with simultaneous bone metastasis may obtain a longer survival rate after primary lung tumor resection. The radically curativeintent surgical resection of the primary lung tumor includes pneumonectomy, systemic decomposition of hilar and mediastinal lymph node dissection (92,93).…”

Section: Surgerymentioning

confidence: 99%

Current progress and mechanisms of bone metastasis in lung cancer: a narrative review

Wu¹,

Pan²,

Mao³

et al. 2021

Transl Lung Cancer Res

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Lung cancer is a kind of malignant tumor with rapid progression and poor prognosis. Distant metastasis has been the main cause of mortality among lung cancer patients. Bone is one of the most common sites. Among all lung cancer patients with bone metastasis, most of them are osteolytic metastasis. Some serious clinical consequences like bone pain, pathological fractures, spinal instability, spinal cord compression and hypercalcemia occur as well. Since the severity of bone metastasis in lung cancer, it is undoubtedly necessary to know how lung cancer spread to bone, how can we diagnose it and how can we treat it. Here, we reviewed the process, possible mechanisms, diagnosis methods and current treatment of bone metastasis in lung cancer. We divided the process of bone metastasis in lung cancer into three steps: tumor invasion, tumor cell migration and invasion in bone tissue. It may be influenced by genetic factors, microenvironment and other adhesion-related factors. Imaging examination, laboratory examination, and pathological examination are used to diagnose lung cancer metastasis to bone. Surgery, radiotherapy, targeted therapy, bisphosphonate, radiation therapy and chemotherapy are the common clinical treatment methods currently. We also found some problems remained to be solved. For example, drugs for skeletal related events mainly target on osteoclasts at present, which increase the ratio of patients in osteoporosis and fractures in the long term. In all, this review provides the direction for future research on bone metastasis in lung cancer.

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“…Nonetheless, a handful of retrospective series on metastatic NSCLC patients with bone metastases unfortunately suggest poor outcomes for these patients with a 2-year survival of only 13% (58)(59)(60)(61). The discrepancy between these good local control rates and poor outcomes is presumably due to the limited amount of data available for this specific population, making treatment recommendations difficult (58)(59)(60)(61).…”

Section: Outcome Per Location: An Intricate Interplay Of Dose Volume and Primary Tumormentioning

confidence: 99%

Radiotherapy for oligometastatic non-small cell lung cancer: a narrative review

Sundahl

Lievens

2021

Transl Lung Cancer Res

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Preclinical and early clinical evidence suggest that radical radiotherapy of oligometastatic disease in non-small cell lung cancer (NSCLC) patients can impact outcomes with relatively limited toxicity. Whilst data from phase 2 randomized trials suggesting an improved overall survival (OS) with this treatment is promising, it has also illustrated the heterogeneity in this patient population and treatment.Oligometastatic disease in itself comprises a broad spectrum of patients, in terms of tumor load and location, stage of the disease and treatment history. This real-life variety in patient characteristics is often reflected in studies to a certain extent, hinting to the fact that all might benefit from radical radiotherapy to limited metastatic disease, yet leaving the question unanswered as to whom the ideal candidate is. Furthermore, differences between and within studies with regards to treatment modality, timing, radiation technique, and radiation dose are substantial. Also, preclinical and early clinical trials suggest that radiotherapy can work synergistically with checkpoint inhibitors by acting as an in situ cancer vaccine, therefore the combination of these two treatments in oligometastatic patients might entail the largest benefit. Ongoing randomized controlled phase 3 trials and prospective registry trials will further elucidate the true extent of benefit of this local treatment strategy and aid in identifying the ideal patient population and therapy. The current narrative review summarizes the clinical evidence on radiotherapy for oligometastatic NSCLC and highlights the remaining unknowns.

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Patient outcomes post-pulmonary resection for synchronous bone-metastatic non-small cell lung cancer

Cited by 11 publications

References 19 publications

Surgical Survival Benefits With Different Metastatic Patterns for Stage IV Extrathoracic Metastatic Non-Small Cell Lung Cancer: A SEER-Based Study

Surgical Survival Benefits With Different Metastatic Patterns for Stage IV Extrathoracic Metastatic Non-Small Cell Lung Cancer: A SEER-Based Study

Current progress and mechanisms of bone metastasis in lung cancer: a narrative review

Radiotherapy for oligometastatic non-small cell lung cancer: a narrative review

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