Prognostic factors of oligometastatic non-small-cell lung cancer following radical therapy: a multicentre analysis

Abstract

OBJECTIVES Patients with oligometastatic non-small-cell lung cancer (NSCLC) may benefit from therapy with curative intent. Our goal was to identify prognostic factors related to better prognosis in a multicentre analysis of patients who underwent surgery of primary tumours in combination with radical treatment of all metastatic sites. METHODS We retrospectively reviewed the records of oligometastatic patients who underwent resection of primary tumours at 4 centres (August 2001–February 2018). Oligometastasis was defined as ≤5 synchronous metastases in ≤2 organs. Radical metastatic treatment was surgery, radiotherapy or a combination. The Cox proportional hazards model was used for identification of prognostic factors on overall survival. RESULTS We treated 124 patients; 72 (58%) were men, mean age 60 ± 9.8 years, with 87 (70%) adenocarcinoma. Sixty-seven (54%) patients had positive pathologic-N stage (pN). Brain metastases were most common (n = 76; 61%) followed by adrenal (n = 13; 10%) and bone (n = 12; 10%). Systemic therapy was administered in 101 (82%) patients. Median follow-up was 60 months [95% confidence interval (CI) 41–86]. Thirty- and 90-day mortality rates were 0 and 2.4%, respectively. One-, 2-, and 5-year overall survival were 80%, 58% and 36%, respectively. Cox regression analysis showed that patients ≤60 years [hazard ratio (HR) 0.41, 95% CI 0.24, 0.69; P = 0.001] and patients with pN0 (HR 0.38, 95% CI 0.21–0.69; P = 0.002) had a significant survival benefit. The presence of bone metastases negatively affected survival (HR 2.53, 95% CI 1.05–6.09; P = 0.04). CONCLUSIONS Treatment with curative intent of selected oligometastatic NSCLC, including resection of the primary tumour, can be performed safely and with excellent 5-year survival rates, especially in younger patients with pN0 disease.

Management of Synchronous Extrathoracic Oligometastatic Non-Small Cell Lung Cancer

“…In our study, pathologic tumor size was independently associated with both EFS and OS. Nodal disease was also indicative of poor EFS and OS in our study, as has been observed in numerous other studies [ 5 , 17 , 24 , 25 ]. However, in our cohort, specific patterns of recurrence were associated with pathologic nodal status, with pN0 patients having seemingly higher proportions of intrathoracic recurrence than pN1 or pN2 patients on exploratory analysis.…”

“…However, this trial was limited by the overall low number of patients who received LCT ( n = 25). Although no subsequent prospective studies have included surgical patients [ 10 , 11 ], larger, more-recent retrospective studies have reiterated the survival benefit in patients whose oligometastasis management included primary tumor resection [ 17 , 18 , 19 ]. Single-institution studies have observed five-year OS in the range of 32 to 48% in patients who underwent primary tumor resection and LCT for all disease sites, compared with 24% in patients who underwent radiotherapy for local disease control [ 18 , 19 ].…”

“…Single-institution studies have observed five-year OS in the range of 32 to 48% in patients who underwent primary tumor resection and LCT for all disease sites, compared with 24% in patients who underwent radiotherapy for local disease control [ 18 , 19 ]. A multi-institutional collaboration from Switzerland that included 124 patients with oligometastatic NSCLC who underwent primary tumor resection observed a median PFS of 11 months, with an encouraging five-year OS of 36% [ 17 ]. Despite these findings, surgical management of the primary tumor is utilized in a fraction of cases of oligometastatic NSCLC [ 5 , 20 , 21 ], and rates of primary tumor resection in this population have actually decreased during the past decade [ 12 , 22 ].…”

In Spite of Curative Radical Pulmonary Procedures, Lesser Pulmonary Resection Shows More Favorable Prognosis in Surgically Treated NSCLC With Synchronous Isolated Cranial Oligometastases

“…In studies investigating prognostic factors in oligometastatic disease, it was reported that the presence of mediastinal lymph node metastasis was one of the criteria for poor prognosis (21). In our study, there was no statistically significant difference between the survival rates of 4 patients with incidental mediastinal lymph node metastasis (N2) and 24 patients with N0-N1 disease (p = 0.413).…”

Clinical prognostic factors in surgically treated oligometastatic non-small cell lung cancer: a systematic review

“…Median overall survival (OS) was 51.8 months and varied from 21.1 months (20) to 60 months ( 16), but results were not statistically significant. The disease-free survival (DFS) was reported only by two studies recently published (14,18). The first reported a 21% 5-year DFS and the second 23%.…”