Opitz Isabelle, Patella Miriam, Payrard Loic, Perentes Jean Yannis, Inderbitzi Rolf, Gelpke Hans, Schulte Sandra, Diezi Maja, Gonzalez Michel, Krueger Thorsten, Weder Walter
Department of Thoracic Surgery, University Hospital of Zurich, Zurich, Switzerland.
Department of Thoracic Surgery, University Hospital of Vaudois, Lausanne, Switzerland.
Eur J Cardiothorac Surg. 2020 Jun 1;57(6):1166-1172. doi: 10.1093/ejcts/ezz384.
Patients with oligometastatic non-small-cell lung cancer (NSCLC) may benefit from therapy with curative intent. Our goal was to identify prognostic factors related to better prognosis in a multicentre analysis of patients who underwent surgery of primary tumours in combination with radical treatment of all metastatic sites.
We retrospectively reviewed the records of oligometastatic patients who underwent resection of primary tumours at 4 centres (August 2001-February 2018). Oligometastasis was defined as ≤5 synchronous metastases in ≤2 organs. Radical metastatic treatment was surgery, radiotherapy or a combination. The Cox proportional hazards model was used for identification of prognostic factors on overall survival.
We treated 124 patients; 72 (58%) were men, mean age 60 ± 9.8 years, with 87 (70%) adenocarcinoma. Sixty-seven (54%) patients had positive pathologic-N stage (pN). Brain metastases were most common (n = 76; 61%) followed by adrenal (n = 13; 10%) and bone (n = 12; 10%). Systemic therapy was administered in 101 (82%) patients. Median follow-up was 60 months [95% confidence interval (CI) 41-86]. Thirty- and 90-day mortality rates were 0 and 2.4%, respectively. One-, 2-, and 5-year overall survival were 80%, 58% and 36%, respectively. Cox regression analysis showed that patients ≤60 years [hazard ratio (HR) 0.41, 95% CI 0.24, 0.69; P = 0.001] and patients with pN0 (HR 0.38, 95% CI 0.21-0.69; P = 0.002) had a significant survival benefit. The presence of bone metastases negatively affected survival (HR 2.53, 95% CI 1.05-6.09; P = 0.04).
Treatment with curative intent of selected oligometastatic NSCLC, including resection of the primary tumour, can be performed safely and with excellent 5-year survival rates, especially in younger patients with pN0 disease.
寡转移非小细胞肺癌（NSCLC）患者可能从根治性治疗中获益。我们的目标是在一项多中心分析中，确定与接受原发性肿瘤手术联合所有转移部位根治性治疗的患者预后较好相关的预后因素。
我们回顾性分析了4个中心（2001年8月至2018年2月）接受原发性肿瘤切除的寡转移患者的记录。寡转移定义为≤2个器官中≤5个同步转移灶。根治性转移治疗为手术、放疗或联合治疗。采用Cox比例风险模型确定总生存的预后因素。
我们治疗了124例患者；72例（58%）为男性，平均年龄60±9.8岁，87例（70%）为腺癌。67例（54%）患者病理N分期（pN）为阳性。脑转移最为常见（n = 76；61%），其次是肾上腺转移（n = 13；10%）和骨转移（n = 12；10%）。101例（82%）患者接受了全身治疗。中位随访时间为60个月[95%置信区间（CI）41 - 86]。30天和90天死亡率分别为0和2.4%。1年、2年和5年总生存率分别为80%、58%和36%。Cox回归分析显示，年龄≤60岁的患者[风险比（HR）0.41，95%CI 0.24，0.69；P = 0.001]和pN0患者（HR 0.38，95%CI 0.21 - 0.69；P = 0.002）有显著的生存获益。骨转移的存在对生存有负面影响（HR 2.53，95%CI 1.05 - 6.09；P = 0.04）。
对选定的寡转移NSCLC进行根治性治疗，包括切除原发性肿瘤，可以安全地进行，且5年生存率良好，尤其是在pN0疾病的年轻患者中。
