Anne-Claire Toffart1, Michaël Duruisseaux2, Pierre-Yves Brichon3, Augustin Pirvu3, Julie Villa4, Laurent Selek5, Pascale Guillem6, Isabelle Dumas6, Léonie Ferrer2, Matteo Giaj Levra2, Denis Moro-Sibilot7. 1. Clinique Universitaire de Pneumologie, Pôle Thorax et Vaisseaux, CHU Grenoble Alpes, Grenoble, France; Institut pour l'Avancée des Biosciences, Centre de Recherche UGA/Inserm U 1209/CNRS UMR 5309, La Tronche, France. Electronic address: atoffart@chu-grenoble.fr. 2. Clinique Universitaire de Pneumologie, Pôle Thorax et Vaisseaux, CHU Grenoble Alpes, Grenoble, France. 3. Clinique Universitaire de Chirurgie Thoracique, Vasculaire et Endocrinienne, Pôle Thorax et Vaisseaux, CHU Grenoble Alpes, Grenoble, France. 4. Clinique Universitaire de Radiothérapie, Pôle Cancérologie, CHU Grenoble Alpes, Grenoble, France. 5. Clinique Universitaire de Neurochirurgie, Pôle Tête et Cou et Chirurgie réparatrice, CHU Grenoble Alpes, Grenoble, France; Clinatec Lab INSERM U 1205, Grenoble, France. 6. Centre de Coordination en Cancérologie, Pôle Cancérologie, CHU Grenoble Alpes, Grenoble, France. 7. Clinique Universitaire de Pneumologie, Pôle Thorax et Vaisseaux, CHU Grenoble Alpes, Grenoble, France; Institut pour l'Avancée des Biosciences, Centre de Recherche UGA/Inserm U 1209/CNRS UMR 5309, La Tronche, France.
Abstract
BACKGROUND: Stage IV non-small cell lung cancer (NSCLC) is considered incurable; however, some patients with only few metastases may benefit from treatment with a curative intent. We aimed to identify the prognostic factors for stage IV NSCLC with synchronous solitary M1. METHODS: A database constructed from our weekly multidisciplinary thoracic oncology meetings was retrospectively screened from 1993 to 2012. Consecutive patients with NSCLC stages I to IV were included. RESULTS: Of the 6,760 patients found, 4,832 patients were studied. Among the 1,592 patients (33%) with stage IV NSCLC, 109 (7%) had a synchronous solitary M1. Metastasis involved the brain in 64% of patients. Median overall survival was significantly longer in synchronous solitary M1 than in other stage IV (18.9 months, interquartile range [IQR]: 9.9 to 34.6 months versus 6.1 months, IQR: 2.3 to 13.7 months], respectively, p < 10-4). Among patients with synchronous solitary M1, 90 (83%) received a local treatment with curative intent at the primary and metastatic sites. Factors independently associated with survival were age older than 63 years (hazard ratio [HR] 1.63, 95% confidence interval [CI]: 1.01 to 2.63), Performance status of 3 or 4 (HR 7.91, 95% CI: 2.23 to 28.03), use of chemotherapy (HR 0.38, 95% CI: 0.23 to 0.64), and operation conducted at both sites (HR 0.35, 95% CI: 0.19 to 0.65). CONCLUSIONS: Synchronous solitary M1 treated with chemotherapy and operation at both sites resulted in better survival. Survival of NSCLC with synchronous solitary M1 was more similar to stage III than other stage IV NSCLCs. The eighth TNM classification takes this into account by distinguishing between stages M1b and M1c.
BACKGROUND: Stage IV non-small cell lung cancer (NSCLC) is considered incurable; however, some patients with only few metastases may benefit from treatment with a curative intent. We aimed to identify the prognostic factors for stage IV NSCLC with synchronous solitary M1. METHODS: A database constructed from our weekly multidisciplinary thoracic oncology meetings was retrospectively screened from 1993 to 2012. Consecutive patients with NSCLC stages I to IV were included. RESULTS: Of the 6,760 patients found, 4,832 patients were studied. Among the 1,592 patients (33%) with stage IV NSCLC, 109 (7%) had a synchronous solitary M1. Metastasis involved the brain in 64% of patients. Median overall survival was significantly longer in synchronous solitary M1 than in other stage IV (18.9 months, interquartile range [IQR]: 9.9 to 34.6 months versus 6.1 months, IQR: 2.3 to 13.7 months], respectively, p < 10-4). Among patients with synchronous solitary M1, 90 (83%) received a local treatment with curative intent at the primary and metastatic sites. Factors independently associated with survival were age older than 63 years (hazard ratio [HR] 1.63, 95% confidence interval [CI]: 1.01 to 2.63), Performance status of 3 or 4 (HR 7.91, 95% CI: 2.23 to 28.03), use of chemotherapy (HR 0.38, 95% CI: 0.23 to 0.64), and operation conducted at both sites (HR 0.35, 95% CI: 0.19 to 0.65). CONCLUSIONS: Synchronous solitary M1 treated with chemotherapy and operation at both sites resulted in better survival. Survival of NSCLC with synchronous solitary M1 was more similar to stage III than other stage IV NSCLCs. The eighth TNM classification takes this into account by distinguishing between stages M1b and M1c.
Authors: Begoña Campos-Balea; Javier de Castro Carpeño; Bartomeu Massutí; David Vicente-Baz; Diego Pérez Parente; Pedro Ruiz-Gracia; Leonardo Crama; Manuel Cobo Dols Journal: Thorac Cancer Date: 2020-09-28 Impact factor: 3.500