Abstract
BackgroundLocal consolidative treatment (LCT) is important for oligometastasis, defined as the restricted metastatic capacity of a tumor. This study aimed to determine the effects and prognostic heterogeneity of LCT in oligometastatic non-small cell lung cancer.MethodsThis retrospective study identified 436 eligible patients treated for oligometastatic disease at the Guangdong Provincial People’s Hospital during 2009–2016. A Cox regression analysis was used to identify potential predictors of overall survival (OS). After splitting cases randomly into training and testing sets, risk stratification was performed using recursive partitioning analysis with a training dataset. The findings were confirmed using a validation dataset. The effects of LCT in different risk groups were evaluated using the Kaplan-Meier method.ResultsThe T stage (p = 0.001), N stage (p = 0.008), number of metastatic sites (p = 0.031), and EGFR status (p = 0.043) were identified as significant predictors of OS. A recursive partitioning analysis was used to establish a prognostic risk model with the following four risk groups: Group I included never smokers with N0 disease (3-year OS: 55.6%, median survival time [MST]: 42.8 months), Group II included never smokers with N+ disease (3-year OS: 32.8%, MST: 26.5 months), Group III included smokers with T0–2 disease (3-year OS: 23.3%, MST: 19.4 months), and Group IV included smokers with T3/4 disease (3-year OS: 12.5%, MST: 11.1 months). Significant differences in OS according to LCT status were observed in all risk groups except Group IV (p = 0.45).ConclusionsSmokers with T3/4 oligometastatic non-small cell lung cancer may not benefit from LCT.
Highlights
Local consolidative treatment (LCT) is important for oligometastasis, defined as the restricted metastatic capacity of a tumor
Based on the training dataset, the patients were divided into four risk groups: Group I included never smokers with N0 disease (3-year overall survival (OS): 83.1%), Group II included never smokers with N+ disease (3-year OS: 28.7%), Group III included smokers with T0–2 disease (3-year OS: 28.0%), and Group IV included smokers with T3/4 disease (3-year OS: 18.3%)
Our results indicate that patients who smoked and had T3/4 oligometastatic non-small cell lung cancer (NSCLC) would not be expected to benefit from LCT
Summary
Local consolidative treatment (LCT) is important for oligometastasis, defined as the restricted metastatic capacity of a tumor. In 1995, Hellman and Weichselbaum proposed a clinically significant state of metastasis, “oligometastasis,” which refers to a restricted tumor metastatic capacity [5]. This clinical entity was initially considered an intermediate state of metastatic evolution, and local treatments were considered potentially curative in this setting [6,7,8]. The first randomized phase 2 study on this topic, which investigated local consolidative therapy (LCT) for oligometastatic non-small cell lung cancer (NSCLC), was reported in 2016 and revealed median progression-free
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