Pulmonary Resection for Synchronous M1b-cStage IV Non-Small Cell Lung Cancer?Patients

摘要

Background We wanted to assess the efficacy of curative intent pulmonary resection for non-small cell lung cancer (NSCLC) patients with synchronous M1b-distant metastases in a single organ or lesion.;Methods Between 1995 and 2015, 23 consecutive synchronous M1b-cStage IV NSCLC patients who underwent any treatment for metastases and curative intent pulmonary resection were retrospectively analyzed.;Results Sixteen patients were men and 7 were women, with a median age of 56 years (range: 41 to 76 years). There were 17 adenocarcinoma, 4 large-cell carcinoma, 1 large-cell neuroendocrine cancer, and 1 carcinosarcoma. Thirteen patients had no lymph node metastasis. Fourteen patients received preoperative chemotherapy, and 10 received postoperative chemotherapy. The metastatic sites were the brain in 13 patients; bone in 3 patients; adrenal glands and extrathoracic lymph nodes in 2 patients each; and the liver, small intestine, and subcutaneous tissue in 1 patient each. Nineteen patients underwent lobectomy, and the other 4 patients underwent pneumonectomy. Seventeen patients experienced recurrence as follows: local recurrence in 3 patients, distant recurrence in 13 patients, and both in 1 patient. The 5-year progression-free survival rates in the 23 patients was14.5% (95% confidence interval: 0% to 30.6%), and the 5-year overall survival rate was 41.7% (95% confidence interval: 19.6% to 63.8%).;Conclusions Some M1b-cStage IV NSCLC patients achieved longer survival than others with the same stage disease by using local treatment for distant metastases and curative intent pulmonary resection. Oligometastatic patients might have been inadvertently included in the present cohort. However, at present, the optimum method for patient selection remains unclear.;;The Supplemental TableSupplemental Table can be viewed in the online version of this article [http://dx.doi.org/10.1016/j.athoracsur.2016.08.098] on http://www.annalsthoracicsurgery.org.;We retrospectively reviewed the medical charts of 1829 consecutive NSCLC patients who underwent curative intent pulmonary resection by lobectomy or greater lung parenchymal resection between January 1995 and August 2015 at the Department of Thoracic Oncology, National Kyushu Cancer Center, Japan. We analyzed 23 synchronous M1b-cStage IV NSCLC patients with their distant metastases in a single organ or lesion treated with curative intent pulmonary resection.The patients with contralateral pulmonary metastases were eliminated, because the differentiation of pulmonary metastasis from multiple primary lung cancer can be difficult, especially for patients without lymph node metastasis, even in the retrospective setting. All of the 23 M1b-cStage IV NSCLC patients were cytologically or histologically confirmed to have NSCLC before any treatment, and 22 of 23 patients underwent stereotactic, conventional radiation therapy or surgical removal of the metastatic site; the remaining patient received chemotherapy alone followed by curative intent pulmonary resection.A histologic analysis of the tumor was conducted according to the World Health Organization classification for cell types [18][18]. The clinical or pathologic stage of the disease was defined based on the general rules?for the TNM Classification of Malignant Tumors (7th?edition) [19][19]. The eligibility for surgical resection in this series of patients was determined based on clinical practice; basically, the patients with an Eastern Cooperative Oncology Group performance status (PS) of 0 to 1, an estimated postoperative forced expiratory volume in 1 second greater than 600 mL/m2 of the body surface area, and adequate preserved organ functions expected to tolerate chemotherapy radiotherapy or both were considered to be eligible. Chest radiography, computed tomography (CT) of the chest and upper abdomen, CT or magnetic resonance imaging of the brain, a bone scan or fluorodeoxyglucose positron emission tomography, and flexible optical bronchoscopy wer