Long-Term Survival in Non-Small Cell Lung Cancer Patients with Metachronous Brain-Only Oligorecurrence Who Underwent Definitive Treatment
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: Metachronous brain-only oligorecurrence in patients with non-small cell lung cancer (NSCLC) is a rare event with favorable prognosis, but the clinical outcome has not been fully determined. We retrospectively analyzed clinical outcomes and prognostic factors in metachronous brain-only oligorecurrence in patients with NSCLC who underwent definitive treatment. Materials and methods: We reviewed 4,437 NSCLC patients without oncogenic driver mutations who underwent definitive treatment between 2008 and 2018. Among them, we identified 327 patients who developed 1 to 5 brain metastases with or without systemic metastasis. Of the 327 patients, 71 had metachronous brain-only oligorecurrence without extracranial progression and were treated with local therapy to the brain. Overall survival (OS), progression-free survival (PFS), and prognostic factors affecting OS were analyzed. Results: The median OS was 38.9 months (95% confidence interval [CI], 21.8 to 56.1 months) in 71 patients. The 2-year OS rate was 67.8% and the 5-year OS rate was 33.1%. The median PFS was 25.5 months (95% CI, 12.2 to 14.4 months). The longest surviving patient had a survival period of 115 months. Through multivariate analysis, Eastern Cooperative Oncology Group ≥ 1 (hazard ratio, 5.33; p=0.005) was associated with poor survival. There was no significant difference in OS between patients with local therapy and those with local plus systemic therapy (18.5 months vs. 34.7 months, p=0.815). Conclusion: Metachronous brain-only oligorecurrence NSCLC patients who underwent definitive treatment experienced long-term survival with local therapy, highlighting the unique patient population. The role of systemic chemotherapy in this patient population requires further investigation.
Abstract
Purpose: Metachronous brain-only oligorecurrence in patients with non-small cell lung cancer (NSCLC) is a rare event with favorable prognosis, but the clinical outcome has not been fully determined. We retrospectively analyzed clinical outcomes and prognostic factors in metachronous brain-only oligorecurrence in patients with NSCLC who underwent definitive treatment. Materials and methods: We reviewed 4,437 NSCLC patients without oncogenic driver mutations who underwent definitive treatment between 2008 and 2018. Among them, we identified 327 patients who developed 1 to 5 brain metastases with or without systemic metastasis. Of the 327 patients, 71 had metachronous brain-only oligorecurrence without extracranial progression and were treated with local therapy to the brain. Overall survival (OS), progression-free survival (PFS), and prognostic factors affecting OS were analyzed. Results: The median OS was 38.9 months (95% confidence interval [CI], 21.8 to 56.1 months) in 71 patients. The 2-year OS rate was 67.8% and the 5-year OS rate was 33.1%. The median PFS was 25.5 months (95% CI, 12.2 to 14.4 months). The longest surviving patient had a survival period of 115 months. Through multivariate analysis, Eastern Cooperative Oncology Group ≥ 1 (hazard ratio, 5.33; p=0.005) was associated with poor survival. There was no significant difference in OS between patients with local therapy and those with local plus systemic therapy (18.5 months vs. 34.7 months, p=0.815). Conclusion: Metachronous brain-only oligorecurrence NSCLC patients who underwent definitive treatment experienced long-term survival with local therapy, highlighting the unique patient population. The role of systemic chemotherapy in this patient population requires further investigation.
참고문헌 (14)
- "Non-small cell lung cancer (version 8.2020)" (2020)[URL]
- O’Dowd EL, "Brain metastases following radical surgical treatment of non-small cell lung cancer : is preoperative brain imaging important?", Lung Cancer, 86, pp.185~189 (2014)
- Gaspar LE, "Time from treatment to subsequent diagnosis of brain metastases in stage III non-small-cell lung cancer : a retrospective review by the Southwest Oncology Group", J Clin Oncol, 23, pp.2955~2961 (2005)
- Schouten LJ, "Incidence of brain metastases in a cohort of patients with carcinoma of the breast, colon, kidney, and lung and melanoma", Cancer, 94, pp.2698~2705 (2002)
- Gavrilovic IT, "Brain metastases : epidemiology and pathophysiology", J Neurooncol, 75, pp.5~14 (2005)
- Nayak L, "Epidemiology of brain metastases", Curr Oncol Rep, 14, pp.48~54 (2012)
- Scagliotti GV, "Phase III randomized trial comparing three platinum-based doublets in advanced non-small-cell lung cancer", J Clin Oncol, 20, pp.4285~4291 (2002)
- Hellman S, "Oligometastases", J Clin Oncol, 13, pp.8~10 (1995)
- Niibe Y, "Oligometastases and oligo-recurrence : the new era of cancer therapy", Jpn J Clin Oncol, 40, pp.107~111 (2010)
- Guckenberger M, "Characterisation and classification of oligometastatic disease : a European Society for Radiotherapy and Oncology and European Organisation for Research and Treatment of Cancer consensus recommendation", Lancet Oncol, 21, pp.e18~e28 (2020)
- de Vin T, "Stereotactic radiotherapy for oligometastatic cancer : a prognostic model for survival", Ann Oncol, 25, pp.467~471 (2014)
- Ashworth AB, "An individual patient data metaanalysis of outcomes and prognostic factors after treatment of oligometastatic non-small-cell lung cancer", Clin Lung Cancer, 15, pp.346~355 (2014)
- Gomez DR, "maintenance therapy or observation for patients with oligometastatic non-small-cell lung cancer : long-term results of a multi-institutional, phase II, randomized study", J Clin Oncol, 37, pp.1558~1565 (2019)
- Niibe Y, "Oligo-recurrence predicts favorable prognosis of brain-only oligometastases in patients with non-small cell lung cancer treated with stereotactic radiosurgery or stereotactic radiotherapy : a multi-institutional study of 61 subjects", BMC Cancer, 16, pp.659~ (2016)