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

Chao, Ce; Qian, Yongxiang; Li, Xihao; Sang, Chen; Wang, Bin; Zhang, Xiaoying

doi:10.1177/15330338211033064

Cited by 6 publications

(7 citation statements)

References 39 publications

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“…Consistent with previous studies, surgical resection can prolong the survival of patients with metastatic NSCLC ( 24 , 25 ). Yang et al reported that the median OS was 18 months in patients with M1 NSCLC treated with surgery ( 24 ).…”

Section: Discussionsupporting

confidence: 89%

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Optimal therapeutic strategy for non-small cell lung cancer with thoracic extrathoracic metastasis: a study based on SEER database

He,

Sun,

et al. 2024

J Thorac Dis

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Background Non-small cell lung cancer (NSCLC) patients with extrathoracic metastasis (EM) are a highly heterogeneous cohort. Some of these patients could benefit from primary tumor surgery. This study aimed to identify potential NSCLC patients with EM suitable for primary tumor resection and to determine the optimal therapeutic strategy. Methods NSCLC patients with EM were extracted from the Surveillance, Epidemiology and End Results database between 2010 and 2015. They were stratified into subgroups with single and multi-EMs. Cox regression analysis was adopted to identify prognostic factors for overall survival (OS). The Kaplan-Meier method was used to compare the OS among patients who received different treatment modalities. Results The univariate Cox regression analysis demonstrated that advanced age, male sex, race (black), married status, squamous cell carcinoma, higher histological grade, advanced T or N stage, contralateral lung metastasis, multi-EMs, tumor size >2 cm, and lack of treatment were associated with poorer OS in patients with NSCLC (P<0.05). Multivariate Cox regression analysis revealed that the number of EM and treatment modalities were independent prognostic factors affecting OS (P<0.001). For patients with single EM, those who did not receive treatment and those who underwent single-agent chemotherapy, single-agent surgery, surgery combined with chemotherapy, surgery combined with radiotherapy, or surgery combined with chemoradiotherapy had median OS times of 3.0, 11.0, 12.0, 26.0, 11.0, and 25.0 months, respectively. Compared to monotherapy, combination therapy showed significant benefits for patients with single EM in NSCLC. Furthermore, patients with single EM who underwent lobectomy, bilobectomy, or pneumonectomy had significantly longer survival than those who underwent sublobar resection, even when the primary tumor size was ≤2 cm (P=0.04). Conclusions Primary tumor surgery could benefit NSCLC patients with single EM; lobectomy was at least warranted to improve survival even for primary tumors with size ≤2 cm.

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Section: Discussionsupporting

confidence: 89%

“…Yang et al reported that the median OS was 18 months in patients with M1 NSCLC treated with surgery ( 24 ). Surgery could prolong the survival time of NSCLC patients with EM by eight months ( 25 ). These studies, however, did not specify whether primary or metastatic sites were treated with resection.…”

Section: Discussionmentioning

confidence: 99%

Optimal therapeutic strategy for non-small cell lung cancer with thoracic extrathoracic metastasis: a study based on SEER database

He,

Sun,

et al. 2024

J Thorac Dis

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“…Chao et al compared the OS of patients with stage IV extrathoracic metastatic NSCLC receiving surgery or not. They demonstrated that surgery could improve the survival of patients with single organ metastasis, while surgery showed no significant survival benefits in patients with multiple organ metastases (15). Lastly, the metastasis sites were included in the multivariate model.…”

Section: Discussionmentioning

confidence: 99%

Development and validation of a dynamic survival nomogram for metastatic non-small cell lung cancer based on the SEER database and an external validation cohort

Wang¹,

Wang²,

Wang³

et al. 2022

Transl Lung Cancer Res

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Background: Limited efficacy and poor prognosis are common in patients with metastatic non-small cell lung cancer (NSCLC). An accurate and useful nomogram helps the clinician predict the prognosis of the patients. However, there has been no previous report on the nomogram specially for predicting the overall survival (OS) of metastatic NSCLC patients. Methods: A total of 18,343 patients diagnosed with metastatic NSCLC in the Surveillance, Epidemiology, and End Results (SEER) database were included and divided into the training cohort (n=12,840) and the internal validation cohort (n=5,503), and 242 patients in Renji Hospital were additionally enrolled as the external validation cohort. Demographical, clinical, and OS data were collected. A Cox proportional hazards regression model was used to develop a nomogram based on the training cohort. To validate the nomogram, we applied C-indexes, calibration curves, receiver operating characteristic (ROC) curve, decision curve analysis (DCA), and a Kaplan-Meier survival curve. Results:The multivariate Cox regression model found that there were a total of 16 independent risk factors for OS of the patients (all 16 factors showed P<0.001), which were integrated into the nomogram with a C-index of 0.702 [95% confidence interval (CI): 0.684-0.720]. The nomogram also exhibited good prognostic value in the internal validation cohort (C-index =0.699, 95% CI: 0.673-0.725) and external validation cohort (C-index =0.695, 95% CI: 0.653-0.737). The ROC and Kaplan-Meier survival curve analyses demonstrated a high discriminative ability. High-risk patients had significantly less favorable OS than low-risk patients in the SEER population and external validation cohort (both P<0.001). The DCA analysis showed that the nomogram provided better prognosis prediction than the tumor-node-metastasis (TNM) staging system. Conclusions:We constructed and validated a dynamic nomogram with 16 variables based on a large-scale population of SEER database to predict the prognosis of metastatic NSCLC patients. The nomogram is expected to provide higher predictive ability and accuracy than the TNM staging system.

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“…The metastatic pattern of liver, bone, and brain had a significantly higher HR for death compared to other clinicopathological variables by multivariate regression analysis (HR = 1.562, 95%CI: 1.400-1.742, P < 0.001). Several studies have explored the association between the number of metastatic sites and the prognosis of NSCLC patients and reported that multiple organ involvement was significantly associated with poorer survival[ 5 , 19 ]. Therefore, we further divided multiple organ involvement into different metastatic patterns, and then investigated the effect of the metastatic patterns on survival time.…”

Section: Discussionmentioning

confidence: 99%

“…Patients presenting with distant organ involvement account for 40% to 65% of the diagnosed NSCLC cases[ 3 ]. Their five-year survival rate is as low as 5%[ 4 , 5 ]. Bone, brain, liver, and the adrenal glands are commonly affected extrapulmonary sites of metastasis in NSCLC patients[ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical characteristics and prognosis of non-small cell lung cancer patients with liver metastasis: A population-based study

Wang¹,

Lu²,

Wang³

et al. 2022

World J Clin Cases

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BACKGROUND The presence of liver metastasis (LM) is an independent prognostic factor for shorter survival in non-small cell lung cancer (NSCLC) patients. The median overall survival of patients with involvement of the liver is less than 5 mo. At present, identifying prognostic factors and constructing survival prediction nomogram for NSCLC patients with LM (NSCLC-LM) are highly desirable. AIM To build a forecasting model to predict the survival time of NSCLC-LM patients. METHODS Data on NSCLC-LM patients were collected from the Surveillance, Epidemiology, and End Results database between 2010 and 2018. Joinpoint analysis was used to estimate the incidence trend of NSCLC-LM. Kaplan-Meier curves were constructed to assess survival time. Cox regression was applied to select the independent prognostic predictors of cancer-specific survival (CSS). A nomogram was established and its prognostic performance was evaluated. RESULTS The age-adjusted incidence of NSCLC-LM increased from 22.7 per 1000000 in 2010 to 25.2 in 2013, and then declined to 22.1 in 2018. According to the multivariable Cox regression analysis of the training set, age, marital status, sex, race, histological type, T stage, metastatic pattern, and whether the patient received chemotherapy or not were identified as independent prognostic factors for CSS ( P < 0.05) and were further used to construct a nomogram. The C-indices of the training and validation sets were 0.726 and 0.722, respectively. The results of decision curve analyses (DCAs) and calibration curves showed that the nomogram was well-discriminated and had great clinical utility. CONCLUSION We designed a nomogram model and further constructed a novel risk classification system based on easily accessible clinical factors which demonstrated excellent performance to predict the individual CSS of NSCLC-LM patients.

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

Cited by 6 publications

References 39 publications

Optimal therapeutic strategy for non-small cell lung cancer with thoracic extrathoracic metastasis: a study based on SEER database

Optimal therapeutic strategy for non-small cell lung cancer with thoracic extrathoracic metastasis: a study based on SEER database

Development and validation of a dynamic survival nomogram for metastatic non-small cell lung cancer based on the SEER database and an external validation cohort

Clinical characteristics and prognosis of non-small cell lung cancer patients with liver metastasis: A population-based study

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