Long-Term Survival in Patients with Oligometastatic Non-Small Cell Lung Cancer by a Multimodality Treatment-Comparison with Stage III Disease
In patients with oligometastatic NSCLC, a cT3-cT4 primary tumor or an cN2/cN3 lymph node status was reported to be associated with unfavorable outcome. The aim of this study was to assess the importance of definitive or neoadjuvant thoracic radiochemotherapy for long-term outcome of these patients i...
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| Veröffentlicht in: | Cancers 2024-03, Vol.16 (6), p.1174 |
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| creator | Guberina, Maja Pöttgen, Christoph Guberina, Nika Hoffmann, Christian Wiesweg, Marcel Richlitzki, Cedric Metzenmacher, Martin Aigner, Clemens Bölükbas, Servet Gauler, Thomas Eberhardt, Wilfried E E Forsting, Michael Herrmann, Ken Theegarten, Dirk Darwiche, Kaid Jendrossek, Verena Stuschke, Martin Schuler, Martin |
| description | In patients with oligometastatic NSCLC, a cT3-cT4 primary tumor or an cN2/cN3 lymph node status was reported to be associated with unfavorable outcome. The aim of this study was to assess the importance of definitive or neoadjuvant thoracic radiochemotherapy for long-term outcome of these patients in order to find more appropriate treatment schedules.
Analysis of the West Cancer Centre (WTZ) institutional database from 08/2016 to 08/2020 was performed. Patients with primary synchronous OMD, all without actionable driver mutations, who received definitive thoracic radiochemotherapy (RCT) or neoadjuvant RCT followed by surgery (trimodality treatment) were included. Survival outcome is compared with stage III NSCLC.
Altogether, 272 patients received concurrent radiochemotherapy. Of those, 220 presented with stage III (158 with definitive RCT, 62 with trimodality approach). A total of 52 patients had OMD patients with cT3/cT4 or cN2/cN3 tumors. Overall survival (OS) at five years for OMD patients was 28.3% (95%-CI: 16.4-41.5%), which was not significantly different from OS of patients with stage III NSCLC treated with definitive or neoadjuvant RCT (34.9% (95%-CI: 27.4-42.8%)). However, the PFS of OMD patients at five years or last follow-up was significantly worse than that of stage III patients (13.0% vs. 24.3%,
= 0.0048). The latter was due to a higher cumulative incidence of distant metastases in OMD patients (50.2% vs. 20.4% at 48 months,
< 0.0001) in comparison to stage III patients. A cross-validated classifier that included severe comorbidity, ECOG performance status, gender and pre-treatment serum CRP level as the most important factors in the univariable analysis, was able to divide the OMD patient group into two equally sized groups with a four-year survival rate of 49.4% in the good prognosis group and 9.9% in the poor prognosis group (
= 0.0021). Laboratory chemistry and clinical parameters, in addition to imaging and high-precision therapies, can help to predict and improve prognosis.
A multimodality treatment approach and local metastases-directed therapy in addition to chemoimmunotherapy can lead to good long-term survival in patients with cT3/cT4 or cN2/cN3 OMD NSCLC without severe comorbidities and in good performance status and is therefore recommended. |
| doi_str_mv | 10.3390/cancers16061174 |
| format | Article |
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Analysis of the West Cancer Centre (WTZ) institutional database from 08/2016 to 08/2020 was performed. Patients with primary synchronous OMD, all without actionable driver mutations, who received definitive thoracic radiochemotherapy (RCT) or neoadjuvant RCT followed by surgery (trimodality treatment) were included. Survival outcome is compared with stage III NSCLC.
Altogether, 272 patients received concurrent radiochemotherapy. Of those, 220 presented with stage III (158 with definitive RCT, 62 with trimodality approach). A total of 52 patients had OMD patients with cT3/cT4 or cN2/cN3 tumors. Overall survival (OS) at five years for OMD patients was 28.3% (95%-CI: 16.4-41.5%), which was not significantly different from OS of patients with stage III NSCLC treated with definitive or neoadjuvant RCT (34.9% (95%-CI: 27.4-42.8%)). However, the PFS of OMD patients at five years or last follow-up was significantly worse than that of stage III patients (13.0% vs. 24.3%,
= 0.0048). The latter was due to a higher cumulative incidence of distant metastases in OMD patients (50.2% vs. 20.4% at 48 months,
< 0.0001) in comparison to stage III patients. A cross-validated classifier that included severe comorbidity, ECOG performance status, gender and pre-treatment serum CRP level as the most important factors in the univariable analysis, was able to divide the OMD patient group into two equally sized groups with a four-year survival rate of 49.4% in the good prognosis group and 9.9% in the poor prognosis group (
= 0.0021). Laboratory chemistry and clinical parameters, in addition to imaging and high-precision therapies, can help to predict and improve prognosis.
A multimodality treatment approach and local metastases-directed therapy in addition to chemoimmunotherapy can lead to good long-term survival in patients with cT3/cT4 or cN2/cN3 OMD NSCLC without severe comorbidities and in good performance status and is therefore recommended.</description><identifier>ISSN: 2072-6694</identifier><identifier>EISSN: 2072-6694</identifier><identifier>DOI: 10.3390/cancers16061174</identifier><identifier>PMID: 38539510</identifier><language>eng</language><publisher>Switzerland: MDPI AG</publisher><subject>Cancer ; Cancer therapies ; Care and treatment ; Chemoradiotherapy ; Chemotherapy ; Comorbidity ; Computed tomography ; Drug dosages ; Drug therapy ; Immunotherapy ; Interdisciplinary aspects ; Ipilimumab ; Lung cancer ; Lung cancer, Non-small cell ; Lung cancer, Small cell ; Lymph nodes ; Lymphatic system ; Medical prognosis ; Metastases ; Metastasis ; Mutation ; Next-generation sequencing ; Non-small cell lung carcinoma ; Patient outcomes ; Patients ; PD-L1 protein ; PET imaging ; Prognosis ; Radiation therapy ; Radiotherapy ; Small cell lung carcinoma ; Surgery ; Thoracic surgery ; Thorax ; Tumors</subject><ispartof>Cancers, 2024-03, Vol.16 (6), p.1174</ispartof><rights>COPYRIGHT 2024 MDPI AG</rights><rights>2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2024 by the authors. 2024</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c489t-c0ed15d53dc07501a8f7315640ec889dee20eaae48fe56794b630e4afe1891c63</citedby><cites>FETCH-LOGICAL-c489t-c0ed15d53dc07501a8f7315640ec889dee20eaae48fe56794b630e4afe1891c63</cites><orcidid>0000-0003-0681-1325 ; 0000-0001-6836-0940 ; 0000-0002-2166-3394 ; 0000-0001-8275-5957 ; 0000-0003-3218-0539 ; 0000-0003-1058-2107 ; 0000-0002-5776-439X ; 0000-0002-7787-991X ; 0000-0002-9224-9318</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10969158/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10969158/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38539510$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Guberina, Maja</creatorcontrib><creatorcontrib>Pöttgen, Christoph</creatorcontrib><creatorcontrib>Guberina, Nika</creatorcontrib><creatorcontrib>Hoffmann, Christian</creatorcontrib><creatorcontrib>Wiesweg, Marcel</creatorcontrib><creatorcontrib>Richlitzki, Cedric</creatorcontrib><creatorcontrib>Metzenmacher, Martin</creatorcontrib><creatorcontrib>Aigner, Clemens</creatorcontrib><creatorcontrib>Bölükbas, Servet</creatorcontrib><creatorcontrib>Gauler, Thomas</creatorcontrib><creatorcontrib>Eberhardt, Wilfried E E</creatorcontrib><creatorcontrib>Forsting, Michael</creatorcontrib><creatorcontrib>Herrmann, Ken</creatorcontrib><creatorcontrib>Theegarten, Dirk</creatorcontrib><creatorcontrib>Darwiche, Kaid</creatorcontrib><creatorcontrib>Jendrossek, Verena</creatorcontrib><creatorcontrib>Stuschke, Martin</creatorcontrib><creatorcontrib>Schuler, Martin</creatorcontrib><title>Long-Term Survival in Patients with Oligometastatic Non-Small Cell Lung Cancer by a Multimodality Treatment-Comparison with Stage III Disease</title><title>Cancers</title><addtitle>Cancers (Basel)</addtitle><description>In patients with oligometastatic NSCLC, a cT3-cT4 primary tumor or an cN2/cN3 lymph node status was reported to be associated with unfavorable outcome. The aim of this study was to assess the importance of definitive or neoadjuvant thoracic radiochemotherapy for long-term outcome of these patients in order to find more appropriate treatment schedules.
Analysis of the West Cancer Centre (WTZ) institutional database from 08/2016 to 08/2020 was performed. Patients with primary synchronous OMD, all without actionable driver mutations, who received definitive thoracic radiochemotherapy (RCT) or neoadjuvant RCT followed by surgery (trimodality treatment) were included. Survival outcome is compared with stage III NSCLC.
Altogether, 272 patients received concurrent radiochemotherapy. Of those, 220 presented with stage III (158 with definitive RCT, 62 with trimodality approach). A total of 52 patients had OMD patients with cT3/cT4 or cN2/cN3 tumors. Overall survival (OS) at five years for OMD patients was 28.3% (95%-CI: 16.4-41.5%), which was not significantly different from OS of patients with stage III NSCLC treated with definitive or neoadjuvant RCT (34.9% (95%-CI: 27.4-42.8%)). However, the PFS of OMD patients at five years or last follow-up was significantly worse than that of stage III patients (13.0% vs. 24.3%,
= 0.0048). The latter was due to a higher cumulative incidence of distant metastases in OMD patients (50.2% vs. 20.4% at 48 months,
< 0.0001) in comparison to stage III patients. A cross-validated classifier that included severe comorbidity, ECOG performance status, gender and pre-treatment serum CRP level as the most important factors in the univariable analysis, was able to divide the OMD patient group into two equally sized groups with a four-year survival rate of 49.4% in the good prognosis group and 9.9% in the poor prognosis group (
= 0.0021). Laboratory chemistry and clinical parameters, in addition to imaging and high-precision therapies, can help to predict and improve prognosis.
A multimodality treatment approach and local metastases-directed therapy in addition to chemoimmunotherapy can lead to good long-term survival in patients with cT3/cT4 or cN2/cN3 OMD NSCLC without severe comorbidities and in good performance status and is therefore recommended.</description><subject>Cancer</subject><subject>Cancer therapies</subject><subject>Care and treatment</subject><subject>Chemoradiotherapy</subject><subject>Chemotherapy</subject><subject>Comorbidity</subject><subject>Computed tomography</subject><subject>Drug dosages</subject><subject>Drug therapy</subject><subject>Immunotherapy</subject><subject>Interdisciplinary aspects</subject><subject>Ipilimumab</subject><subject>Lung cancer</subject><subject>Lung cancer, Non-small cell</subject><subject>Lung cancer, Small cell</subject><subject>Lymph nodes</subject><subject>Lymphatic system</subject><subject>Medical 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Survival in Patients with Oligometastatic Non-Small Cell Lung Cancer by a Multimodality Treatment-Comparison with Stage III Disease</title><author>Guberina, Maja ; Pöttgen, Christoph ; Guberina, Nika ; Hoffmann, Christian ; Wiesweg, Marcel ; Richlitzki, Cedric ; Metzenmacher, Martin ; Aigner, Clemens ; Bölükbas, Servet ; Gauler, Thomas ; Eberhardt, Wilfried E E ; Forsting, Michael ; Herrmann, Ken ; Theegarten, Dirk ; Darwiche, Kaid ; Jendrossek, Verena ; Stuschke, Martin ; Schuler, Martin</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c489t-c0ed15d53dc07501a8f7315640ec889dee20eaae48fe56794b630e4afe1891c63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Cancer</topic><topic>Cancer therapies</topic><topic>Care and treatment</topic><topic>Chemoradiotherapy</topic><topic>Chemotherapy</topic><topic>Comorbidity</topic><topic>Computed tomography</topic><topic>Drug dosages</topic><topic>Drug therapy</topic><topic>Immunotherapy</topic><topic>Interdisciplinary aspects</topic><topic>Ipilimumab</topic><topic>Lung cancer</topic><topic>Lung cancer, Non-small cell</topic><topic>Lung cancer, Small cell</topic><topic>Lymph nodes</topic><topic>Lymphatic system</topic><topic>Medical prognosis</topic><topic>Metastases</topic><topic>Metastasis</topic><topic>Mutation</topic><topic>Next-generation sequencing</topic><topic>Non-small cell lung carcinoma</topic><topic>Patient outcomes</topic><topic>Patients</topic><topic>PD-L1 protein</topic><topic>PET imaging</topic><topic>Prognosis</topic><topic>Radiation therapy</topic><topic>Radiotherapy</topic><topic>Small cell lung carcinoma</topic><topic>Surgery</topic><topic>Thoracic surgery</topic><topic>Thorax</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Guberina, Maja</creatorcontrib><creatorcontrib>Pöttgen, 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E</au><au>Forsting, Michael</au><au>Herrmann, Ken</au><au>Theegarten, Dirk</au><au>Darwiche, Kaid</au><au>Jendrossek, Verena</au><au>Stuschke, Martin</au><au>Schuler, Martin</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Long-Term Survival in Patients with Oligometastatic Non-Small Cell Lung Cancer by a Multimodality Treatment-Comparison with Stage III Disease</atitle><jtitle>Cancers</jtitle><addtitle>Cancers (Basel)</addtitle><date>2024-03-17</date><risdate>2024</risdate><volume>16</volume><issue>6</issue><spage>1174</spage><pages>1174-</pages><issn>2072-6694</issn><eissn>2072-6694</eissn><abstract>In patients with oligometastatic NSCLC, a cT3-cT4 primary tumor or an cN2/cN3 lymph node status was reported to be associated with unfavorable outcome. The aim of this study was to assess the importance of definitive or neoadjuvant thoracic radiochemotherapy for long-term outcome of these patients in order to find more appropriate treatment schedules.
Analysis of the West Cancer Centre (WTZ) institutional database from 08/2016 to 08/2020 was performed. Patients with primary synchronous OMD, all without actionable driver mutations, who received definitive thoracic radiochemotherapy (RCT) or neoadjuvant RCT followed by surgery (trimodality treatment) were included. Survival outcome is compared with stage III NSCLC.
Altogether, 272 patients received concurrent radiochemotherapy. Of those, 220 presented with stage III (158 with definitive RCT, 62 with trimodality approach). A total of 52 patients had OMD patients with cT3/cT4 or cN2/cN3 tumors. Overall survival (OS) at five years for OMD patients was 28.3% (95%-CI: 16.4-41.5%), which was not significantly different from OS of patients with stage III NSCLC treated with definitive or neoadjuvant RCT (34.9% (95%-CI: 27.4-42.8%)). However, the PFS of OMD patients at five years or last follow-up was significantly worse than that of stage III patients (13.0% vs. 24.3%,
= 0.0048). The latter was due to a higher cumulative incidence of distant metastases in OMD patients (50.2% vs. 20.4% at 48 months,
< 0.0001) in comparison to stage III patients. A cross-validated classifier that included severe comorbidity, ECOG performance status, gender and pre-treatment serum CRP level as the most important factors in the univariable analysis, was able to divide the OMD patient group into two equally sized groups with a four-year survival rate of 49.4% in the good prognosis group and 9.9% in the poor prognosis group (
= 0.0021). Laboratory chemistry and clinical parameters, in addition to imaging and high-precision therapies, can help to predict and improve prognosis.
A multimodality treatment approach and local metastases-directed therapy in addition to chemoimmunotherapy can lead to good long-term survival in patients with cT3/cT4 or cN2/cN3 OMD NSCLC without severe comorbidities and in good performance status and is therefore recommended.</abstract><cop>Switzerland</cop><pub>MDPI AG</pub><pmid>38539510</pmid><doi>10.3390/cancers16061174</doi><orcidid>https://orcid.org/0000-0003-0681-1325</orcidid><orcidid>https://orcid.org/0000-0001-6836-0940</orcidid><orcidid>https://orcid.org/0000-0002-2166-3394</orcidid><orcidid>https://orcid.org/0000-0001-8275-5957</orcidid><orcidid>https://orcid.org/0000-0003-3218-0539</orcidid><orcidid>https://orcid.org/0000-0003-1058-2107</orcidid><orcidid>https://orcid.org/0000-0002-5776-439X</orcidid><orcidid>https://orcid.org/0000-0002-7787-991X</orcidid><orcidid>https://orcid.org/0000-0002-9224-9318</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 2072-6694 |
| ispartof | Cancers, 2024-03, Vol.16 (6), p.1174 |
| issn | 2072-6694 2072-6694 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10969158 |
| source | MDPI - Multidisciplinary Digital Publishing Institute; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; PubMed Central Open Access |
| subjects | Cancer Cancer therapies Care and treatment Chemoradiotherapy Chemotherapy Comorbidity Computed tomography Drug dosages Drug therapy Immunotherapy Interdisciplinary aspects Ipilimumab Lung cancer Lung cancer, Non-small cell Lung cancer, Small cell Lymph nodes Lymphatic system Medical prognosis Metastases Metastasis Mutation Next-generation sequencing Non-small cell lung carcinoma Patient outcomes Patients PD-L1 protein PET imaging Prognosis Radiation therapy Radiotherapy Small cell lung carcinoma Surgery Thoracic surgery Thorax Tumors |
| title | Long-Term Survival in Patients with Oligometastatic Non-Small Cell Lung Cancer by a Multimodality Treatment-Comparison with Stage III Disease |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-06T11%3A16%3A01IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Long-Term%20Survival%20in%20Patients%20with%20Oligometastatic%20Non-Small%20Cell%20Lung%20Cancer%20by%20a%20Multimodality%20Treatment-Comparison%20with%20Stage%20III%20Disease&rft.jtitle=Cancers&rft.au=Guberina,%20Maja&rft.date=2024-03-17&rft.volume=16&rft.issue=6&rft.spage=1174&rft.pages=1174-&rft.issn=2072-6694&rft.eissn=2072-6694&rft_id=info:doi/10.3390/cancers16061174&rft_dat=%3Cgale_pubme%3EA788244853%3C/gale_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2996468829&rft_id=info:pmid/38539510&rft_galeid=A788244853&rfr_iscdi=true |