Thorac Cardiovasc Surg 2015; 63(07): 577-582
DOI: 10.1055/s-0034-1396666
Original Thoracic
Georg Thieme Verlag KG Stuttgart · New York

Survival of M1a Non-Small Cell Lung Cancer Treated Surgically: A Retrospective Single-Center Study

Tieqin Liu
1   Department of Thoracic Surgery, First Hospital, China Medical University, Shenyang, China
,
Hongxu Liu
1   Department of Thoracic Surgery, First Hospital, China Medical University, Shenyang, China
,
Gebang Wang
1   Department of Thoracic Surgery, First Hospital, China Medical University, Shenyang, China
,
Chenlei Zhang
1   Department of Thoracic Surgery, First Hospital, China Medical University, Shenyang, China
,
Bingbing Liu
2   Department of Infection, First Hospital, China Medical University, Shenyang, China
› Author Affiliations
Further Information

Publication History

14 September 2014

23 October 2014

Publication Date:
20 April 2015 (online)

Abstract

Background Stage IV non-small cell lung cancer (NSCLC) is always associated with a poor outcome and is rarely treated with surgical resection. The aim of this study was to retrospectively analyze the effectiveness of surgical treatments.

Methods We have retrospectively analyzed the records of NSCLC patients with local thoracic metastatic disease (M1a) who had been treated with surgical resection. The impact on survival of eight variables (age, gender, smoking status, current drinking status, site of metastasis, pathology classifications, resection status, and presence of adjuvant treatment) were further assessed.

Results Eighty patients (49 males, 61%) with a median age of 58 (range, 38–80) were included. Metastatic sites included: pleural nodules with or without effusion metastasis (51, 63.8%), pleural effusion without nodules (7, 8.8%), contralateral lung (9, 11.3%), diaphragm nodules metastasis (5, 6.3%), and pericardium nodules metastasis (8, 10%). Histology was adenocarcinoma in 55, squamous-cell carcinoma in 16, large cell in 5 and other in 4 patients. Types of lung resection performed for primary tumors were complete resection in 43 and limited resection in 37 patients. Survival at 5 years for the overall population reached 31% (95% confidence interval, 19.4–43%). The median overall survival time was 34.3 months. Ten (12.5%) patients survived for more than 5 years. Smoking status and postoperative adjuvant treatment were independent prognostic factors (p = 0.006 and 0.013). There was no impact on survival for the other six variables.

Conclusion Surgical treatments in M1a NSCLC seem to be associated with improved survival than published results and might be considered in the management of selected cases. Selected patients, including good performance status and nonsmoking histology, may predict for improved survival in these patients.

 
  • References

  • 1 Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin 2010; 60 (5) 277-300
  • 2 Ramalingam S, Belani C. Systemic chemotherapy for advanced non-small cell lung cancer: recent advances and future directions. Oncologist 2008; 13 (Suppl. 01) 5-13
  • 3 Pastorino U, Buyse M, Friedel G , et al. Longterm results of lung metastasectomy: prognostic analyses based on 5206 cases. The International Registry of Lung Metastases. J Thorac Cardiovasc Surg 1997; 113 (1) 37-49
  • 4 Hellman S, Weichselbaum RR. Importance of local control in an era of systemic therapy. Nat Clin Pract Oncol 2005; 2 (2) 60-61
  • 5 Alexander BM, Othus M, Caglar HB, Allen AM. Tumor volume is a prognostic factor in non-small-cell lung cancer treated with chemoradiotherapy. Int J Radiat Oncol Biol Phys 2011; 79 (5) 1381-1387
  • 6 Pfannschmidt J, Dienemann H. Surgical treatment of oligometastatic non-small cell lung cancer. Lung Cancer 2010; 69 (3) 251-258
  • 7 Congedo MT, Cesario A, Lococo F , et al. Surgery for oligometastatic non-small cell lung cancer: long-term results from a single center experience. J Thorac Cardiovasc Surg 2012; 144 (2) 444-452
  • 8 Hanagiri T, Takenaka M, Oka S , et al. Results of a surgical resection for patients with stage IV non—small-cell lung cancer. Clin Lung Cancer 2012; 13 (3) 220-224
  • 9 Calman L, Beaver K, Hind D, Lorigan P, Roberts C, Lloyd-Jones M. Survival benefits from follow-up of patients with lung cancer: a systematic review and meta-analysis. J Thorac Oncol 2011; 6 (12) 1993-2004
  • 10 Parikh RB, Cronin AM, Kozono DE , et al. Definitive primary therapy in patients presenting with oligometastatic non-small cell lung cancer. Int J Radiat Oncol Biol Phys 2014; 89 (4) 880-887
  • 11 Goldstraw P, Crowley J, Chansky K , et al; International Association for the Study of Lung Cancer International Staging Committee; Participating Institutions. The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM Classification of malignant tumours. J Thorac Oncol 2007; 2 (8) 706-714
  • 12 UyBico SJ, Wu CC, Suh RD, Le NH, Brown K, Krishnam MS. Lung cancer staging essentials: the new TNM staging system and potential imaging pitfalls. Radiographics 2010; 30 (5) 1163-1181
  • 13 Schiller JH, Harrington D, Belani CP , et al; Eastern Cooperative Oncology Group. Comparison of four chemotherapy regimens for advanced non-small-cell lung cancer. N Engl J Med 2002; 346 (2) 92-98
  • 14 Sandler A, Gray R, Perry MC , et al. Paclitaxel-carboplatin alone or with bevacizumab for non-small-cell lung cancer. N Engl J Med 2006; 355 (24) 2542-2550
  • 15 Janjigian YY, Park BJ, Zakowski MF , et al. Impact on disease-free survival of adjuvant erlotinib or gefitinib in patients with resected lung adenocarcinomas that harbor EGFR mutations. J Thorac Oncol 2011; 6 (3) 569-575
  • 16 D'Angelo SP, Janjigian YY, Ahye N , et al. Distinct clinical course of EGFR-mutant resected lung cancers: results of testing of 1118 surgical specimens and effects of adjuvant gefitinib and erlotinib. J Thorac Oncol 2012; 7 (12) 1815-1822
  • 17 Kim YT, Seong YW, Jung YJ , et al. The presence of mutations in epidermal growth factor receptor gene is not a prognostic factor for long-term outcome after surgical resection of non-small-cell lung cancer. J Thorac Oncol 2013; 8 (2) 171-178
  • 18 Liu HP, Isaac Wu HD, Chang JWC , et al. Prognostic implications of epidermal growth factor receptor and KRAS gene mutations and epidermal growth factor receptor gene copy numbers in patients with surgically resectable non-small cell lung cancer in Taiwan. J Thorac Oncol 2010; 5 (8) 1175-1184
  • 19 Izar B, Sequist L, Lee M , et al. The impact of EGFR mutation status on outcomes in patients with resected stage I non-small cell lung cancers. Ann Thorac Surg 2013; 96 (3) 962-968
  • 20 Nakata M, Sawada S, Yamashita M , et al. Surgical treatments for multiple primary adenocarcinoma of the lung. Ann Thorac Surg 2004; 78 (4) 1194-1199
  • 21 Rea F, Zuin A, Callegaro D, Bortolotti L, Guanella G, Sartori F. Surgical results for multiple primary lung cancers. Eur J Cardiothorac Surg 2001; 20 (3) 489-495
  • 22 Liu T, Liu H, Li Y. Systematic lymph node dissection is necessary for T1a non-small cell lung cancer. Asia Pac J Clin Oncol 2014;
  • 23 Trousse D, Barlesi F, Loundou A , et al. Synchronous multiple primary lung cancer: an increasing clinical occurrence requiring multidisciplinary management. J Thorac Cardiovasc Surg 2007; 133 (5) 1193-1200
  • 24 De Leyn P, Moons J, Vansteenkiste J , et al. Survival after resection of synchronous bilateral lung cancer. Eur J Cardiothorac Surg 2008; 34 (6) 1215-1222
  • 25 Varela G, Thomas PA. Surgical management of advanced non-small cell lung cancer. J Thorac Dis 2014; 6 (Suppl. 02) S217-S223
  • 26 Postmus PE, Brambilla E, Chansky K , et al; International Association for the Study of Lung Cancer International Staging Committee; Cancer Research and Biostatistics; Observers to the Committee; Participating Institutions. The IASLC Lung Cancer Staging Project: proposals for revision of the M descriptors in the forthcoming (seventh) edition of the TNM classification of lung cancer. J Thorac Oncol 2007; 2 (8) 686-693
  • 27 Ou SH, Zell JA. Validation study of the proposed IASLC staging revisions of the T4 and M non-small cell lung cancer descriptors using data from 23,583 patients in the California Cancer Registry. J Thorac Oncol 2008; 3 (3) 216-227
  • 28 Mordant P, Arame A, Foucault C, Dujon A, Le Pimpec Barthes F, Riquet M. Surgery for metastatic pleural extension of non-small-cell lung cancer. Eur J Cardiothorac Surg 2011; 40 (6) 1444-1449
  • 29 Sardari Nia P, Weyler J, Colpaert C, Vermeulen P, Van Marck E, Van Schil P. Prognostic value of smoking status in operated non-small cell lung cancer. Lung Cancer 2005; 47 (3) 351-359