Patterns of Extrathoracic Metastases in Different Histological Types of Lung Cancer

Abstract

Lung cancer is the leading cause of cancer-related deaths mainly attributable to metastasis, especially extrathoracic metastasis. This large-cohort research is aimed to explore metastatic profiles in different histological types of lung cancer, as well as to assess clinicopathological and survival significance of diverse metastatic lesions. Lung cancer cases were extracted and enrolled from the Surveillance, Epidemiology, and End Results (SEER) database. χ 2 -tests were conducted to make comparisons of metastatic distribution among different histological types and odds ratios were calculated to analyze co-occurrence relationships between different metastatic lesions. Kaplan-Meier methods were performed to analyze survival outcomes according to different metastatic sites and Cox regression models were conducted to identify independent prognostic factors. In total, we included 159,241 lung cancer cases with detailed metastatic status and complete follow-up information. In order to understand their metastatic patterns, we elucidated the following points in this research: (1) Comparing the frequencies of different metastatic lesions in different histological types. The frequency of bone metastasis was highest in adenocarcinoma, squamous cell carcinoma, LCLC and NSCLC/NOS, while liver was the most common metastatic site in SCLC. (2) Elaborating the tendency of combined metastases. Bi-site metastases occurred more common than tri-site and tetra-site metastases. And several metastatic sites, such as bone and liver, intended to co-metastasize preferentially. (3) Clarifying the prognostic significance of single-site and bi-site metastases. All single-site metastases were independent prognostic factors and co-metastases ended up with even worse survival outcomes. Thus, our findings would be beneficial for research design and clinical practice.

The landscape of small cell lung cancer metastases: Organ specificity and timing

“…Next, in order to assess the clinical relevance of metastasis pattern in SCLC, we investigated the timing and co‐occurrence of organ metastases. With regards to the incidence of distant metastases, the most common metastatic sites were the liver, brain, bone, and adrenal glands, which is in line with the findings of others 5,10,25 . Importantly, we also found that the onset of bone, brain, and pericardial metastases tended to be late, whereas the development of adrenal gland and liver metastases were usually early events during SCLC progression.…”

“…Our group previously found that in lung adenocarcinoma patients bone metastases tend to appear together with adrenal gland and liver metastases, while pleural and pericardial, and skin and adrenal gland metastasis pairs also appear more frequently together than expected if metastatic events occurred independently 9 . Of note, a very recent large population‐based study on unselected Asian lung cancer patients also suggested that bone metastases tended to onset together with liver metastases 10 . To date, however, no metastasis pattern‐specific analyses have been conducted in Caucasian SCLC patients.…”

The role of surgery on the primary tumor site in bladder cancer with distant metastasis: significance of histology type and metastatic pattern

“…Similarly, Bianchi et al 13 found a higher bone metastasis rate than to lung and liver for bladder cancer with distant metastasis. Histology types are associated with the metastasis pattern in lung cancer; 23 however, studies about the relationship between histology types and metastatic pattern are deficient for bladder cancer. Our research suggested that the metastasis pattern depended on histology type.…”

Mechanisms of small cell lung cancer metastasis

“…Small cell lung cancer tumors commonly metastasize to the brain, liver, bones, and distant lymph nodes, but also metastasize at lower frequencies in many other organs (Froudarakis, 2012; Nakazawa et al , 2012; Ryu et al , 2016; Bütof et al , 2017; Wang et al , 2020a) (Fig 1). Little is known about the molecular and cellular mechanisms that allow SCLC cells to home to, seed, and grow into micro‐ and macro‐metastases in specific organ environments.…”