Morris Zachary S, Cannon Donald M, Morris Brett A, Bentzen Søren M, Kozak Kevin R
*Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; †St. Luke's Mountain States Tumor Institute, Twin Falls, Idaho; ‡Division of Biostatistics and Bioinformatics, University of Maryland Greenebaum Cancer Center, Baltimore, Maryland; §Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland; and ‖Department of Radiation Oncology, Mercy Regional Cancer Center, Janesville, Wisconsin.
J Thorac Oncol. 2015 Nov;10(11):1608-15. doi: 10.1097/JTO.0000000000000655.
Contralateral lung tumors in non-small-cell lung cancer (NSCLC) are classified as stage M1a yet may represent hematogenous metastases or synchronous primary tumors. The impact of these tumors on overall survival (OS) is poorly understood. Here, we aim to determine whether NSCLC patients with M1a disease due only to a contralateral tumor nodule exhibit a favorable prognosis relative to other M1a or M1b patients.
Retrospective evaluation of the impact of contralateral tumor nodules on OS in NSCLC stratified by primary tumor size and N stage attained from Surveillance, Epidemiology, and End Results database.
Of 173,640 patients, 5161 M1a-contra patients were identified. Median and 3-year OS for these patients exceeded that of patients with M1b (p < 0.0001) or other M1a disease (p < 0.0001). Primary tumor size and N stage were strongly associated with OS in M1a-contra patients. Three-year OS demonstrated a delayed convergence between M1a-contra and other M1a patients with primary tumors greater than or equal to 3 cm or mediastinal lymph node involvement. Proportional hazard modeling indicated that T1-2N0-1M1a-contra patients exhibit OS not significantly different (p = 0.258) from that predicted with comparable T and N stage disease plus a second early-stage primary.
Contralateral tumors in NSCLC carry a more favorable prognosis than other M1a or M1b disease. Primary tumor size and N stage may help distinguish M1a-contra patients with hematogenous metastasis from those with a synchronous, second primary.
非小细胞肺癌（NSCLC）中的对侧肺肿瘤被归类为M1a期，但可能代表血行转移或同步原发性肿瘤。这些肿瘤对总生存期（OS）的影响尚不清楚。在此，我们旨在确定仅因对侧肿瘤结节而患有M1a疾病的NSCLC患者相对于其他M1a或M1b患者是否具有良好的预后。
通过监测、流行病学和最终结果数据库，对原发性肿瘤大小和N分期分层的NSCLC患者中对侧肿瘤结节对OS的影响进行回顾性评估。
在173,640例患者中，确定了5161例M1a-对侧患者。这些患者的中位生存期和3年总生存期超过了M1b患者（p<0.0001）或其他M1a疾病患者（p<0.0001）。原发性肿瘤大小和N分期与M1a-对侧患者的总生存期密切相关。对于原发性肿瘤大于或等于3 cm或有纵隔淋巴结受累的M1a-对侧患者和其他M1a患者，3年总生存期显示出延迟趋同。比例风险模型表明，T1-2N0-1M1a-对侧患者的总生存期与具有可比T和N分期疾病加第二个早期原发性肿瘤所预测的总生存期无显著差异（p = 0.258）。
NSCLC中的对侧肿瘤比其他M1a或M1b疾病具有更良好的预后。原发性肿瘤大小和N分期可能有助于区分血行转移的M1a-对侧患者和同步第二个原发性肿瘤的患者。
