Department of Thoracic Surgery, Paris Center University Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France; Department of Radiotherapy, Hopital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France.
Department of Thoracic Surgery, Paris Center University Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France.
Ann Thorac Surg. 2019 Apr;107(4):1053-1059. doi: 10.1016/j.athoracsur.2018.10.029. Epub 2018 Nov 23.
Oligometastatic stage IV non-small lung cancer (NSCLC) patients have a 5-year overall survival of 30% versus 4% to 6% in historical cohorts of stage IV NSCLC patients. We reviewed data and patterns of care of patients affected by oligometastatic NSCLC in our center between 2001 and 2017.
We retrospectively reviewed clinical and pathological files of all patients with lung cancer and synchronous isolated adrenal or brain metastases, or both, treated by locally ablative treatments (surgery or radiotherapy, or both) of both primary cancer and distant metastasis. Statistical analysis was performed to assess the effect on overall survival of patient- and tumor-related characteristics and therapeutic approaches. Overall survival was assessed by the Kaplan-Meier method. Survival rates were compared by log-rank test. Significance was accepted at a level of p of less than 0.05.
Our department treated 51 patients affected by NSCLC and synchronous brain metastasis (n = 41), adrenal metastasis (n = 9), or both (n = 1). Median survival was 42 months (95% confidence interval, 22.3 to 63.7). Overall survival was 62% at 2 years and 34.4% at 5 years. A univariate and multivariate analysis the positive prognostic factors for survival was cessation of smoking (p = 0.006) and lymphovascular and perineural spreading in the tissues (p = 0.024).
In selected oligometastatic synchronous NSCLC patients, a multimodality approach encompassing radical treatment of the primary tumor and ablative treatment of concurrent metastases is recommended, with encouraging results. Smoking cessation is a part of the treatment sequence.
寡转移 IV 期非小细胞肺癌（NSCLC）患者的 5 年总生存率为 30%，而在 IV 期 NSCLC 患者的历史队列中为 4%至 6%。我们回顾了 2001 年至 2017 年期间我们中心寡转移 NSCLC 患者的数据和治疗模式。
我们回顾性分析了所有肺癌患者的临床和病理资料，这些患者同时存在孤立性肾上腺或脑转移，或两者兼有，接受了局部消融治疗（手术或放疗，或两者联合），包括原发肿瘤和远处转移。统计分析评估了患者和肿瘤相关特征以及治疗方法对总生存率的影响。总生存率采用 Kaplan-Meier 法评估。通过对数秩检验比较生存率。p 值小于 0.05 被认为具有统计学意义。
我们科室治疗了 51 例 NSCLC 合并脑转移（n=41）、肾上腺转移（n=9）或两者（n=1）的患者。中位生存期为 42 个月（95%置信区间，22.3 至 63.7）。2 年生存率为 62%，5 年生存率为 34.4%。单因素和多因素分析显示，生存的阳性预测因素是戒烟（p=0.006）和组织中的血管淋巴管和神经周围扩散（p=0.024）。
在选择的寡转移同步 NSCLC 患者中，建议采用包括根治性治疗原发肿瘤和消融治疗同期转移的多模式治疗方法，结果令人鼓舞。戒烟是治疗序列的一部分。
