Department of Medicine, University of British Columbia.
Departments of Medical Oncology.
Am J Clin Oncol. 2019 Mar;42(3):292-297. doi: 10.1097/COC.0000000000000513.
Metastatic non-small cell lung cancer (NSCLC) has a poor prognosis. Most patients present with stage IV, and many patients treated curatively with stage I to III develop recurrent metastatic disease. It is unknown whether the natural history differs between patients with recurrent versus de novo metastatic NSCLC. We hypothesized that de novo metastatic status is associated with decreased overall survival compared with recurrent metastatic disease.
A retrospective review was completed of all patients with NSCLC referred to BC Cancer from 2005 to 2012. Two cohorts were created; de novo metastatic disease and patients treated with curative intent (surgery or radiotherapy) that developed recurrent, metastatic disease. Information was collected on known prognostic and predictive factors. Overall survival was calculated from the date of diagnosis of metastatic disease.
A total of 9651 patients were evaluated, 5782 (60%) with de novo stage IV disease, and 3869 (40%) with stage I to III disease. Of the 1658 patients who received curative therapy for stage I to III disease, 757 (46%) developed metastases. Patients in the de novo cohort versus recurrent cohort were more likely male (52% vs. 48%), have poorer performance status (Eastern Cooperative Oncology Group≥2 50% vs. 44%), and receive no palliative systemic therapy (67% vs. 61%). The median overall survival in the de novo cohort was 4.7 versus 6.9 m in the recurrent cohort (P<0.001). De novo status was associated with shorter overall survival and this remained significant in a multivariate model that incorporated known prognostic factors.
In a large population-based study of NSCLC, de novo metastatic status was independently associated with decreased overall survival from the time of metastatic disease diagnosis.
转移性非小细胞肺癌（NSCLC）预后较差。大多数患者为 IV 期，许多 I 期至 III 期接受治愈性治疗的患者会出现复发性转移性疾病。尚不清楚复发性与初发性转移性 NSCLC 之间的自然病史是否存在差异。我们假设与复发性转移性疾病相比，初发性转移性状态与总生存期缩短有关。
对 2005 年至 2012 年期间转诊至 BC 癌症中心的所有 NSCLC 患者进行了回顾性审查。创建了两个队列；初发性转移性疾病和接受治愈性治疗（手术或放疗）但出现复发性转移性疾病的患者。收集了已知的预后和预测因素信息。从转移性疾病诊断之日起计算总生存期。
共评估了 9651 例患者，其中 5782 例（60%）为初发性 IV 期疾病，3869 例（40%）为 I 期至 III 期疾病。在接受 I 期至 III 期疾病治愈性治疗的 1658 例患者中，有 757 例（46%）发生转移。初发性队列与复发性队列的患者更可能为男性（52%比 48%），体能状态较差（Eastern Cooperative Oncology Group≥2 为 50%比 44%），并且未接受姑息性全身治疗（67%比 61%）。初发性队列的中位总生存期为 4.7 个月，而复发性队列为 6.9 个月（P<0.001）。初发性状态与总生存期较短相关，在纳入已知预后因素的多变量模型中仍然显著。
在一项大型 NSCLC 基于人群的研究中，初发性转移性状态与转移性疾病诊断后总生存期缩短独立相关。
