Survival and prognostic factors in patients with non-small cell lung cancer presenting with synchronous oligometastatic disease
Metastatic non-small cell lung cancer is considered incurable and is typically treated in a palliative fashion. As new chemotherapies become more effective at eliminating systemic disease, local control or eradication of clinically detectable disease is likely to play a more prominent role in the therapeutic paradigm. The purpose of this work was to determine whether there is a subset of patients with synchronous, oligometastatic non-small cell lung cancer who may derive survival benefit from aggressive local therapy in the form of either radiation or surgery to all sites of disease. In this retrospective study, 256 patients met inclusion criteria, and at a median follow up of 46.5 months, patients who received local therapy to all sites of disease had a median overall survival from the time of initial diagnosis of 23.4 months compared to 13.3 months for those who did not (P value<0.05). In multivariate analysis, local therapy to all sites of disease, treatment with induction chemotherapy, and chemotherapy after locoregional therapy to the primary tumor were each significantly associated with improved overall survival, while squamous cell carcinoma histology and male sex were significantly associated with a worse overall survival (P value<0.05). Notably the organ distribution of the metastases and number of metastatic lesions (1 vs. 2-3) were not significant prognosticators. These findings suggest that the subpopulations of patients who may benefit from aggressive, comprehensive local therapy may be broader than previously thought. Specifically, further consideration of aggressive therapy may be warranted in those presenting with relatively stable oligometastatic disease regardless of the organ distribution of the metastases at presentation. This is an important consideration in the design of future clinical trials as well as current treatment approaches.
Sheu, Tommy, "Survival and prognostic factors in patients with non-small cell lung cancer presenting with synchronous oligometastatic disease" (2014). Texas Medical Center Dissertations (via ProQuest). AAI1565865.