Patterns of Distant Metastases After Surgical Management of Non-Small-cell Lung Cancer

The patterns of distant metastatic progression after surgery for nonesmall-cell lung cancer (NSCLC) have not been well described. The present analysis of 1719 surgically resected NSCLC patients found that 50% of those who developed metastases did so in <= 3 locations, with an improved prognosis compared with those with > 3 metastases. This supports efforts to understand the biology of oligometastases and develop novel treatment paradigms. Background: Patients with limited metastases, oligometastases (OMs), might have improved outcomes compared with patients with widespread distant metastases (DMs). The incidence and behavior of OMs from nonesmall-cell lung cancer (NSCLC) need further characterization. Patients and Methods: The medical records of patients who had undergone surgery for stage I-III NSCLC from 1995 to 2009 were retrospectively reviewed. All information pertaining to development of the first metastatic progression was recorded and analyzed. Patients with DMs were categorized into OMs (1-3 lesions potentially amenable to local therapy) and DM subgroups. Results: Of 1719 patients reviewed, 368 (21%) developed DMs with a median follow-up period of 39 months. A single lesion was diagnosed in 115 patients (31%) and 69 (19%) had 2 to 3 lesions (50% oligometastatic). The median survival from the DM diagnosis for oligometastatic and diffuse DM was 12.4 and 6.1 months, respectively (hazard ratio, 0.54; 95% confidence interval, 0.42-0.68; P < .001). Patients with a single metastasis had the longest median survival at 14.7 months. Younger age, OM, the use of chemotherapy for the primary tumor, and DM detection by surveillance imaging were independently associated with improved survival. Conclusion: DMs and OMs are common in surgically managed NSCLC. Overall survival appears to be prolonged with OM.