An individual patient data metaanalysis of outcomes and prognostic factors after treatment of oligometastatic non-small-cell lung cancer
Abstract
Introduction/background An individual patient data metaanalysis was performed to determine clinical outcomes, and to propose a risk stratification system, related to the comprehensive treatment of patients with oligometastatic NSCLC.Materials and methods After a systematic review of the literature, data were obtained on 757 NSCLC patients with 1 to 5 synchronous or metachronous metastases treated with surgical metastectomy, stereotactic radiotherapy/radiosurgery, or radical external-beam radiotherapy, and curative treatment of the primary lung cancer, from hospitals worldwide. Factors predictive of overall survival (OS) and progression-free survival were evaluated using Cox regression. Risk groups were defined using recursive partitioning analysis (RPA). Analyses were conducted on training and validating sets (two-thirds and one-third of patients, respectively).Results Median OS was 26 months, 1-year OS 70.2%, and 5-year OS 29.4%. Surgery was the most commonly used treatment for the primary tumor (635 patients [83.9%]) and metastases (339 patients [62.3%]). Factors predictive of OS were: synchronous versus metachronous metastases (P < .001), N-stage (P = .002), and adenocarcinoma histology (P = .036); the model remained predictive in the validation set (c-statistic = 0.682). In RPA, 3 risk groups were identified: low-risk, metachronous metastases (5-year OS, 47.8%); intermediate risk, synchronous metastases and N0 disease (5-year OS, 36.2%); and high risk, synchronous metastases and N1/N2 disease (5-year OS, 13.8%).Conclusion Significant OS differences were observed in oligometastatic patients stratified according to type of metastatic presentation, and N status. Long-term survival is common in selected patients with metachronous oligometastases. We propose this risk classification scheme be used in guiding selection of patients for clinical trials of ablative treatment.
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In a systematic review of patients with NSCLC with one to five metastases undergoing radiation or surgery, significant factors predicting favorable outcomes included definitive treatment of the primary site, nodal status, and a disease-free interval of 6 to 12 months.
“From a systematic review of patients with NSCLC with one to five metastases undergoing radiation or surgery, significant factors that predicted favorable outcomes include definitive treatment of the primary site of disease, nodal status, and a disease-free interval of 6 to 12 months.124”
A systematic review identified 757 NSCLC patients who had been treated for one to five synchronous or metachronous metastases.
“A systematic literature review identified 757 NSCLC patients treated with 1-5 synchronous or metachronous metastases [167].”
From Metastatic non-small-cell lung cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up (2016) · cites this paper as [167]
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- Authors
- Ashworth, A. B., Senan, S., Palma, D. A., Riquet, M., Ahn, Y. C., Ricardi, U., Congedo, M. T., Gomez, D. R., Wright, G. M., Melloni, G., Milano, M. T., Sole, C. V., De Pas, T. M., Carter, D. L., Warner, A. J., & Rodrigues, G. B.
- Affiliations
- London Health Sciences Centre (CA)
- Amsterdam UMC Location Vrije Universiteit Amsterdam (NL)
- Hôpital Européen Georges-Pompidou (FR)
- Samsung Medical Center (KR)
- University of Turin (IT)
- Università Cattolica del Sacro Cuore (IT)
- The University of Texas MD Anderson Cancer Center (US)
- The University of Melbourne (AU)
- IRCCS Ospedale San Raffaele (IT)
- University of Rochester Medicine (US)
- Rocky Mountain Cancer Centers (US)
- ORCID
- Venue
- Clinical Lung Cancer
- Publisher
- Elsevier BV
- Published
- 2014-09
- Volume
- 15
- Issue
- 5
- Pages
- 346-355
- ISSN
- 1525-7304 (ISSN-L)
- OpenAlex
- W1969531640
- Cited by
- 435
- References
- 56
- Citations by year
- 2026: 11 · 2025: 20 · 2024: 29 · 2023: 39 · 2022: 56 · 2021: 49 · 2020: 44 · 2019: 49 · 2018: 42 · 2017: 32 · 2016: 30 · 2015: 26 · 2014: 8
- FWCI
- 5.47
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Lung Cancer (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- Institutional Research Information System University of Turin (University of Turin) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Diagnosis and Treatment
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Treatments and Mutations
- Health Sciences › Medicine › Oncology › Lung Cancer Research Studies
- Keywords
- oligometastatic non-small cell lung cancer, synchronous metastases, metachronous metastasis, risk stratification, prognostic factors, overall survival, progression-free survival, N stage, adenocarcinoma histology, stereotactic radiotherapy, external beam radiotherapy, recursive partitioning
- MeSH terms
- Adenocarcinoma, Carcinoma, Non-Small-Cell Lung, Humans, Lung Neoplasms, Neoplasm Metastasis, Prognosis, Risk, Survival Rate, Proportional Hazards Models, Disease-Free Survival
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