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MA01 - Oligometastatic Disease (ID 114)
- Event: WCLC 2019
- Type: Mini Oral Session
- Track: Oligometastatic NSCLC
- Presentations: 1
- Now Available
- Moderators:Anne Marie Clasina Dingemans, Matthias Guckenberger
- Coordinates: 9/08/2019, 10:30 - 12:00, Copenhagen (1980)
MA01.06 - Prognostic Factors of Oligometastatic Non-Small Cell Lung Cancer Following Radical Therapy: A Multicenter-Analysis (Now Available) (ID 3063)
10:30 - 12:00 | Author(s): Hans Gelpke
Patients with oligometastatic non-small cell lung cancer (NSCLC) may benefit from radical therapy. We aimed to identify factors related to better prognosis, in a multicenter analysis of patients who underwent surgery of primary tumours, in combination with radical treatment of metastatic sites, and chemo- or chemoradiation.Method
We retrospectively reviewed the records of oligometastatic patients who all underwent anatomical resection of primary tumor, treated at 4 centers, (August 2001-November 2018). Oligometastasis was defined as ≤5 synchronous metastases in ≤2 organs. Radical metastatic treatment was surgery (n=48), radiotherapy (n=36) or a combination (n=41). Univariate analysis and multivariate Cox proportional hazards model were used for identification of prognostic factors on overall survival (OS) and progression-free survival (PFS). Survival was estimated by Kaplan-Meier analysis. P-value < 0.05 was considered significant.Result
We treated 125 patients; 72 (58%) were male, aged 60±9.8 years, with 88 (70%) adenocarcinoma, and following pathological (pN) stage: pNx: 1 (1%), pN0: 57 (46%), pN1: 23 (18%), pN2: 44 (35%). Brain metastasis was most common (n=76; 61%) followed by adrenal (n=13; 11%) and bone (n=12; 10%). Systemic therapy was administered in 102 (82%). Median follow-up was 60 months (95%, CI: 41-86).
One-, 2-, 3-, and 5-years OS was 80%, 58%, 49% and 36% respectively. Several patient-related and treatment-related factors showed a correlation with OS at univariate analysis. Multivariate analysis showed that patients ≤60 years (HR 0.47, 95% CI:0.28-0.78, p=0.004), and/or pN0, compared to pN1,2 (HR 0.38, 95% CI: 0.22-0.66, p=0.001), had a significant survival benefit (Figure 1A). Bone metastasis were associated with worse prognosis (HR 2.122, 95% CI: 1.00-4.48, p=0.05).
Twenty-eight patients were ≤60 years with pN0, and had 1- and 5-year survival of 100 and 83%.
PFS at 1-, 2-, 3- and 5-years was 41%, 29%, 25% and 23% respectively. In the multivariate analysis, absence of mediastinal lymphnode involvement (HR: 0.483, 95% CI: 0.305-0.764, p=0.002) and surgical treatment of metastasis (HR: 0.553, 95% CI: 0.347-0.880, p=0.013) remained independently associated with better outcome (Figure 1B). The administration of treatments after first progression was strongly associated with better prognosis (HR: 0.252, 95% CI: 0.076-0.834, p=0.013).
Our experience demonstrates, in a multicenter setting, that radical treatment of selected oligometastatic NSCLC results in excellent 5-year survival. Nodal status correlates with both OS and PFS. Surgical metastasectomy appears to improve PFS, but multimodality treatment, especially in case of recurrence, remains mandatory.
These data might contribute to develop future combined strategies in the era of immunotherapy.
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