From the Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY (Rodriguez-Quintero, Jindani, Zhu, Vimolratana, Chudgar, Stiles).
Department of Cardiothoracic Surgery, University of Rochester Medical Center, Rochester, NY (Kamel).
J Am Coll Surg. 2024 Jun 1;238(6):1122-1136. doi: 10.1097/XCS.0000000000001035. Epub 2024 Feb 9.
Local therapy for the primary tumor is postulated to remove resistant cancer cells as well as immunosuppressive cells from the tumor microenvironment, potentially improving response to systemic therapy (ST). We sought to determine whether resection of the primary tumor was associated with overall survival (OS) in a multicentric cohort of patients with single-site synchronous oligometastatic non-small cell lung cancer.
Using the National Cancer Database (2018 to 2020), we evaluated patients with clinical stage IVA disease who received ST and stratified the cohort based on receipt of surgery for the primary tumor (S). We used multivariable and propensity score-matched analysis to study factors associated with S (logistic regression) and OS (Cox regression and Kaplan-Meier), respectively.
Among 12,215 patients identified, 2.9% (N = 349) underwent S and 97.1% (N = 11,886) ST (chemotherapy or immunotherapy) without surgery. Patients who underwent S were younger, more often White, had higher income levels, were more likely to have private insurance, and were more often treated at an academic facility. Among those who received S, 22.9% (N = 80) also underwent resection of the distant metastatic site. On multivariable analysis, metastasis to bone, N+ disease, and higher T-stages were independently associated with less S. On Cox regression, S and resection of the metastatic site were associated with improved survival (hazard ratio 0.67, 95% CI 0.56 to 0.80 and hazard ratio 0.80, 95% CI 0.72 to 0.88, respectively). After propensity matching, OS was improved in patients undergoing S (median 36.8 vs 20.8 months, log-rank p < 0.001).
Advances in ST for non-small cell lung cancer may change the paradigm of eligibility for surgery. This study demonstrates that surgical resection of the primary tumor is associated with improved OS in selected patients with single-site oligometastatic disease.
局部治疗原发性肿瘤被认为可以从肿瘤微环境中清除耐药癌细胞和免疫抑制细胞，从而有可能提高全身治疗（systemic therapy，ST）的反应率。我们旨在确定在多中心队列的单部位同步寡转移性非小细胞肺癌患者中，切除原发性肿瘤是否与总生存（overall survival，OS）相关。
我们利用国家癌症数据库（2018 年至 2020 年），评估了接受 ST 的 IVA 期疾病患者，并根据是否接受原发性肿瘤手术（surgery for the primary tumor，S）对队列进行分层。我们分别使用多变量和倾向评分匹配分析来研究与 S（logistic 回归）和 OS（Cox 回归和 Kaplan-Meier）相关的因素。
在确定的 12215 例患者中，2.9%（N=349）接受了 S，97.1%（N=11886）接受了 ST（化疗或免疫治疗）而未行手术。接受 S 的患者年龄较小，白人比例较高，收入水平较高，更有可能拥有私人保险，并且更常接受学术机构的治疗。在接受 S 的患者中，22.9%（N=80）还接受了远处转移灶的切除术。多变量分析显示，骨转移、N+疾病和更高的 T 分期与 S 减少独立相关。在 Cox 回归分析中，S 和转移灶切除术与生存改善相关（风险比 0.67，95%CI 0.56 至 0.80 和风险比 0.80，95%CI 0.72 至 0.88）。经过倾向评分匹配后，S 组患者的 OS 得到改善（中位 36.8 个月比 20.8 个月，对数秩检验，p<0.001）。
非小细胞肺癌 ST 的进展可能改变手术适应证的模式。本研究表明，在选择的单部位寡转移性疾病患者中，原发性肿瘤的手术切除与 OS 改善相关。
