Prognosis associated with surgery for non-small cell lung cancer and synchronous brain metastasis

Kanou, Takashi; Okami, Jiro; Tokunaga, Tohru; Fujiwara, Ayako; Ishida, Daisuke; Kuno, Hidenori; Higashiyama, Masahiko

doi:10.1007/s00595-014-0895-3

Cited by 13 publications

(12 citation statements)

References 23 publications

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“…Factors affecting survival of synchronous oligometastatic NSCLC patients, such as performance status, N-stage, and thoracic stage, have been revealed in some reports (35)(36)(37). However, no study investigated factors predictive of survival specially for patients with ATT.…”

Section: Subgroup Analysesmentioning

confidence: 99%

Should aggressive thoracic therapy be performed in patients with synchronous oligometastatic non-small cell lung cancer? A meta-analysis

Li¹,

Zhu²,

Wang³

et al. 2017

J. Thorac. Dis.

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Background: We performed a meta-analysis to compare overall survival (OS) outcomes in patients with synchronous oligometastatic non-small cell lung cancer (NSCLC) who underwent aggressive thoracic therapy (ATT) with those who did not. Methods: A systematic review of controlled trials of ATT on survival in synchronous oligometastatic NSCLC was conducted. Hazard ratio (HR) for the main endpoint OS was pooled using a fixed-effects model. Subgroup analysis was performed in patients with single organ metastases, or with different numbers of brain metastases, or with different stages of thoracic disease. Pooled survival curves of OS were constructed. Results: Seven eligible retrospective observational cohort studies were identified including 668 synchronous oligometastatic NSCLC patients, of whom 227 (34.0%) received ATT. For patients with synchronous oligometastatic NSCLC, ATT was associated with a significant improvement of OS (HR, 0.48; 95% CI, 0.39-0.60; P<0.00001). In subgroup analysis, the association with OS was similar or even strengthened, with a HR of 0.42 (95% CI, 0.31-0.56) in single organ metastases group, 0.49 (95% CI, 0.31-0.75) in solitary brain metastasis group, and 0.38 (95% CI, 0.20-0.73) in thoracic stage I-II group, respectively. The pooled cumulative survival rates for patients received ATT were 74.9% at 1 year, 52.1% at 2 years, 23.0% at 3 years, and 12.6% at 4 years. The corresponding pooled survival for patients who did not receive ATT were 32.3%, 13.7%, 3.7%, and 2.0%, respectively. Conclusions: Survival benefit from ATT is common in synchronous oligometastatic patients. Selected patients with synchronous oligometastatic NSCLC could also achieve long-term survival with ATT. Targeted therapy have shown efficacy in the treatment of advanced NSCLC, however, most patients progress after a median survival of 12 months because of resistance (4-6).Hellman and Weichselbaum proposed the existence of a clinically recognisable state termed 'oligometastases', which is an intermediate state of metastases characterized by a limited number and site of metastatic tumors. In these selected patients, eradication of oligometastases could be curative (7,8). However, whether the aggressive thoracic therapy (ATT) could potentially improve overall survival (OS) in oligometastatic NSCLC remains unclear. Removal of the primary tumor was shown to improve OS in patients with metastatic renal cancer (9), by contrast, locoregional treatment of the primary tumor did not affect OS in patients with metastatic breast cancer (10). More and more studies reported favorable long-term survivals in oligometastatic NSCLC treated with aggressive local therapy (11-13). However, these studies are retrospective and the validity of the survival benefit are challenging due to patient selection.Recently, Ashworth et al. did a systematic review of literature considering NSCLC patients with 1-5 metastases treated with local therapy and found that definitive treatment of the primary tumor was a good prognostic factor for survival (14). Moreo...

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Section: Subgroup Analysesmentioning

confidence: 99%

Should aggressive thoracic therapy be performed in patients with synchronous oligometastatic non-small cell lung cancer? A meta-analysis

Li¹,

Zhu²,

Wang³

et al. 2017

J. Thorac. Dis.

View full text Add to dashboard Cite

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“…Thirty-eight patients received aggressive thoracic therapy, and the latter was associated with prolonged median OS (26.4 vs. 10.5 months; p < 0.001). In NSCLC patients with synchronous brain metastases treated with lung surgery, five-year survival rates of approximately 20–25% have been reported [15, 16]. Taken together, several retrospective studies suggest that aggressive management of thoracic disease may be associated with improved OS.…”

Section: Discussionmentioning

confidence: 99%

Presence of Brain Metastases at Initial Diagnosis of Cancer: Patient Characteristics and Outcome

Nieder

Haukland

Mannsåker

et al. 2019

Cureus

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Objective To describe the characteristics of patients who present with brain metastases already at first diagnosis of cancer and to evaluate overall survival (OS) and long-term survival. Methods Retrospective uni- and multivariate analyses in a group of 84 patients treated with different approaches. Results With respect to primary cancer type, the largest entities were adenocarcinoma non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) (34.5 and 21.4%, respectively). The most common diagnostic setting was symptomatic brain metastases (64 patients, 76.2%). Median OS was 7.2 months (one-year survival rate 31%). Four patients survived for at least three years, all had solitary metastases. The best survival was observed in the group managed with neurosurgical resection, median 17.7 months. Systemic treatment was also associated with better survival (median 9.7 vs. 2.8 months, p = 0.0001). Multivariate analysis revealed two prognostic baseline factors for OS, Karnofsky performance status (KPS) and number of brain metastases. Neurologic cause of death was uncommon (n = 14, 17%). Conclusion Long-term survival was limited and observed exclusively in the setting of a solitary brain metastasis. In patients with good KPS and limited number of brain metastases, systemic treatment as well as effective local treatment, such as resection and/or radiotherapy with sufficiently high equivalent dose, is warranted.

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“…Additionally, compared with the standard diet, this formula food provides energy, high-quality protein and balanced nutrition, which would be expected to improve the nutritional status, as was suggested by the higher serum albumin level. Although there have been major advances in the treatment of various cancers, postoperative recurrence and metastasis remain a problem [21][22][23]. There is evidence that even after surgery, dormant tumor cells can remain in the body for a long time [24].…”

Section: Discussionmentioning

confidence: 99%

The Efficacy of a Formula Food for Preventing Postoperative Recurrence in a Tumor Dormancy Model

Zhang¹,

Chen²,

Miao³

et al. 2019

Journal of Nutritional Oncology

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Objective To establish a lung cancer dormancy mouse model and verify the effects of Wushen (WS), a formula food, on postoperative recurrence. Methods We established a Lewis cell tumor dormancy model system that definitively links surgery and the subsequent wound-healing response to the outgrowth of lung cancer cells. We used this model to observe the effects of WS on the postoperative recurrence and the nutritional status of the mice. Finally, the immunocyte subtypes and cytokine levels in the serum and spleens of mice were detected by flow cytometry and ELISA. Results The recurrence rate in the WS group was obviously lower than that in the control group. Wushen increased the body weights and serum albumin levels of the mice. The levels of NK, Gr1 + CD11b + CD3 + CD8 + and CD3 + CD4 + T cells in the spleens of mice in the WS group were also increased. Compared with the control group, the levels of CD4 + IFN-γ + , CD4 + IL-2 and CD4 + /IL-10 + in the spleens of mice in the WS group were decreased. Wushen also seemed to decrease the levels of IL-6 and TNF-α, but the decrease was not significant. Conclusion The postoperative lung cancer recurrence model was successfully established. Wushen inhibited postoperative recurrence, apparently by regulating the level of immune cell subtypes and cytokines in the serum and spleen.

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Prognosis associated with surgery for non-small cell lung cancer and synchronous brain metastasis

Abstract: Although the survival of patients with brain metastasis from non-small cell lung cancer remains poor, surgical resection may benefit a select group of patients, particularly those with a normal CEA level, small tumor size, and node-negative status.

Cited by 13 publications

References 23 publications

Should aggressive thoracic therapy be performed in patients with synchronous oligometastatic non-small cell lung cancer? A meta-analysis

Should aggressive thoracic therapy be performed in patients with synchronous oligometastatic non-small cell lung cancer? A meta-analysis

Presence of Brain Metastases at Initial Diagnosis of Cancer: Patient Characteristics and Outcome

The Efficacy of a Formula Food for Preventing Postoperative Recurrence in a Tumor Dormancy Model

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