Department of Surgery, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.
Department of Thoracic Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.
Lung Cancer. 2021 Nov;161:141-151. doi: 10.1016/j.lungcan.2021.09.019. Epub 2021 Sep 27.
Patients with advanced stage non-small cell lung cancer (NSCLC) are generally considered incurable. The mainstay of treatment for these patients is systemic therapy. The addition of local treatment, including surgery, remains controversial. Oligoprogression is defined as advanced stage NSCLC with limited progression of disease after a period of prolonged disease stabilisation or after a partial or complete response on systemic therapy. In this retrospective study we evaluated outcome and survival of patients who underwent a resection for oligoprogression after systemic therapy for advanced stage NSCLC.
Patients with oligoprogression after systemic treatment for advanced NSCLC who were operated in the Antoni van Leeuwenhoek Hospital were included. Patient and treatment characteristics were collected in relation to progression free survival (PFS) and overall survival (OS).
Between January 2015 and December 2019, 28 patients underwent surgery for an oligoprogressive lesion (primary tumor lung (n = 12), other metastatic site (n = 16)). Median age at time of resection was 60 years (39-86) and 57% were female. Postoperative complications were observed in 2 patients (7%). Progression of disease after resection of the oligoprogressive site was observed in 17 patients (61%). Median PFS was 7 months since date of resection (95% CI 6.0-25.0) and median OS was not reached. Seven patients (25%) died during follow-up. Age was predictive for OS and clinical T4 stage was predictive for PFS. M1 disease at initial presentation was predictive for better PFS compared to patients who were diagnosed with M0 disease initially. Patients who underwent resection because of oligoprogression of the primary lung tumour had a better PFS, when compared to oligoprogression of another metastastic site.
Surgical resection of an oligoprogressive lesion in patients with advanced NSCLC treated with systemic treatment is feasible and might be considered in order to achieve long term survival.
晚期非小细胞肺癌（NSCLC）患者通常被认为无法治愈。这些患者的主要治疗方法是系统治疗。局部治疗的加入，包括手术，仍然存在争议。寡进展是指在系统治疗后疾病稳定期延长或部分或完全缓解后，疾病仍有限进展的晚期 NSCLC。在这项回顾性研究中，我们评估了接受系统治疗后寡进展的晚期 NSCLC 患者接受手术切除的结果和生存情况。
纳入在 Antoni van Leeuwenhoek 医院接受手术切除治疗晚期 NSCLC 寡进展的患者。收集与无进展生存期（PFS）和总生存期（OS）相关的患者和治疗特征。
2015 年 1 月至 2019 年 12 月，28 例患者因寡进展病变（原发性肺癌（n=12），其他转移部位（n=16））接受手术治疗。中位年龄为 60 岁（39-86 岁），57%为女性。2 例（7%）患者术后出现并发症。在切除寡进展部位后，17 例（61%）患者出现疾病进展。自切除日期起，中位 PFS 为 7 个月（95%CI 6.0-25.0），中位 OS 未达到。7 例（25%）患者在随访期间死亡。年龄与 OS 相关，临床 T4 期与 PFS 相关。初始表现为 M1 疾病的患者与初始诊断为 M0 疾病的患者相比，PFS 更好。与其他转移性部位的寡进展相比，因原发性肺部肿瘤寡进展而接受手术切除的患者具有更好的 PFS。
在接受系统治疗的晚期 NSCLC 患者中，对寡进展病变进行手术切除是可行的，可以考虑以获得长期生存。
