Patient outcomes post-pulmonary resection for synchronous bone-metastatic non-small cell lung cancer

摘要

Background: The efficacy of curative-intent pulmonary resection for non-small cell lung cancer (NSCLC) patients with certain types of oligometastases, particularly brain and adrenal metastases, has previously been described. We investigated the outcomes of curative-intent pulmonary resection for NSCLC patients with synchronous isolated bone metastases, which have been less clear to date. Methods: We retrospectively reviewed the clinical and pathological records of 41 patients with NSCLC and synchronous isolated bone metastases who underwent radical treatments (surgery and/or chemotherapy and/or radiotherapy) for both their primary tumors and bone metastases at the National Hospital Organization, Hokkaido Cancer Center, between 2008 and 2013. Results: Nine of the 41 patients underwent pulmonary primary tumor resection; the rate of clinical N0–1 disease among these 9 patients (100%) was significantly higher than that among the 32 patients who did not undergo resection (34.4%). The five-year overall survival (OS), progression-free survival (PFS), and disease-free survival (DFS) rates of the nine patients who underwent pulmonary resection were 66.7%, 55.6%, and 44.4%, respectively. On multivariate analysis, the predictors of longer OS among all 41 patients were primary site resection [hazard ratio (HR) =4.18, 95% CI, 1.20–14.6, P=0.025] and epidermal growth factor receptor (EGFR) mutation (HR =3.30, 95% CI, 1.08–10.1, P=0.036). The former was also a predictor of longer PFS (HR =3.75, 95% CI, 1.27–11.0, P=0.016). Conclusions: Patients with clinical N0–1 NSCLC and synchronous isolated bone metastases may achieve longer survival rates following primary lung tumor resection.