Lung cancer surgery in oligometastatic patients: outcome and survival

• Published in: European journal of cardio-thoracic surgery Vol. 57; no. 6; pp. 1173 - 1180
• Main Authors: Casiraghi, Monica, Bertolaccini, Luca, Sedda, Giulia, Petrella, Francesco, Galetta, Domenico, Guarize, Juliana, Maisonneuve, Patrick, De Marinis, Filippo, Spaggiari, Lorenzo
• Format: Journal Article
• Language: English
• Published: Germany Oxford University Press 01-06-2020
• Subjects: Oligometastasis; Surgery; Non-small cell lung cancer
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1093/ejcts/ezaa005

Abstract
OBJECTIVES
A few studies have already demonstrated survival benefits for local treatment in solitary metastatic non-small-cell lung cancer (NSCLC). The aim of this study is to retrospectively investigate the role of surgery in patients with oligometastatic (OM) NSCLC.
METHODS
Between January 1998 and December 2018, 57 patients with OM stage IV NSCLC (1 or 2) underwent a multidisciplinary approach including lung cancer surgery, local treatment of the distant metastasis (DM) and systemic medical treatments.
RESULTS
All patients had DM synchronous to lung cancer. Fifty-one (90%) patients had a single DM whereas 6 (11%) patients had 2 DMs. Forty-eight (84%) patients underwent induction chemotherapy. We performed 47 (82%) lobectomies, 4 (7%) segmentectomies and 6 (11%) pneumonectomies. Pathological lymph node involvement was evident in 28 (49%) patients. Adjuvant chemotherapy was administered in 20 (35%) patients. Forty-six (81%) patients had local treatment of the DM before lung resection, and 11 (19%) patients had after lung resection; 6 (11%) patients had both treatments. The median overall survival (OS) was 30 months, with the 2-, 3- and 5-year OS of 57%, 50% and 30%, respectively. OS was significantly related to lymph node involvement (P = 0.04), size of the primary tumour (P < 0.001), neoadjuvant chemotherapy (P = 0.02) and the time period between metastasis diagnosis and primary tumour removal (P = 0.04).
CONCLUSIONS
Multidisciplinary approach is the gold standard in OM patients. Patients with no lymph node involvement are the best candidates, with an acceptable OS. Thus, patients with OM-NSCLC should not be excluded from surgery as a matter of principle.