Predicting Survival in Patients with Advanced Non-squamous Non-small Cell Lung Cancer: Validating the Extent of Metastasis
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Purpose A number of factors related to overall survival (OS) have been addressed in advanced non-small cell lung cancer (NSCLC). This study was conducted to determine the impact of whole-body metastatic regions on survival outcome in advanced nonsquamous NSCLC. Materials and Methods Between March 2005 and February 2011, 112 eligible patients with newly confirmed stage IV non-squamous NSCLC, available for epidermal growth factor receptor (EGFR)mutation status 18-21 analysis, and accessible for the determination of pretreatment whole-body metastatic regions were enrolled in this retrospective study. The total number of synchronous metastatic regions was scored according to the following disease sites: abdomen/pelvis, lung to lung/pulmonary lymphangitic spread, bone,pleura/pleural effusion/pericardial effusion, neck/axillary lymph nodes, other soft tissue, brain. Results The median age of the cohort was 65 years (range, 31 to 88 years) . The median whole-body metastatic score was 2 (range, 1 to 6), and bone and lung to lung were the most common metastatic sites. EGFR mutations were observed in 40 (35.7%)patients with a deletion in exon 19 and Leu858Arg mutation in exon 21 being detected in 16 (40.0%) and 19 (47.5%) patients, respectively. Multivariate analysis for OS revealed that treatment factors (p=0.005), performance status (p=0.006),whole-body metastatic score (p<0.001), and EGFR mutation status (p=0.095) were significantly or marginally associated with OS. Conclusion The results of the present study demonstrated that whole-body metastatic extent strongly affects survival outcome, even after adjustment for other significant variables in advanced non-squamous NSCLC. The clinical validity of more curative multimodal approaches in cohorts with limited metastases remains to be explored.
Abstract
Purpose A number of factors related to overall survival (OS) have been addressed in advanced non-small cell lung cancer (NSCLC). This study was conducted to determine the impact of whole-body metastatic regions on survival outcome in advanced nonsquamous NSCLC. Materials and Methods Between March 2005 and February 2011, 112 eligible patients with newly confirmed stage IV non-squamous NSCLC, available for epidermal growth factor receptor (EGFR)mutation status 18-21 analysis, and accessible for the determination of pretreatment whole-body metastatic regions were enrolled in this retrospective study. The total number of synchronous metastatic regions was scored according to the following disease sites: abdomen/pelvis, lung to lung/pulmonary lymphangitic spread, bone,pleura/pleural effusion/pericardial effusion, neck/axillary lymph nodes, other soft tissue, brain. Results The median age of the cohort was 65 years (range, 31 to 88 years) . The median whole-body metastatic score was 2 (range, 1 to 6), and bone and lung to lung were the most common metastatic sites. EGFR mutations were observed in 40 (35.7%)patients with a deletion in exon 19 and Leu858Arg mutation in exon 21 being detected in 16 (40.0%) and 19 (47.5%) patients, respectively. Multivariate analysis for OS revealed that treatment factors (p=0.005), performance status (p=0.006),whole-body metastatic score (p<0.001), and EGFR mutation status (p=0.095) were significantly or marginally associated with OS. Conclusion The results of the present study demonstrated that whole-body metastatic extent strongly affects survival outcome, even after adjustment for other significant variables in advanced non-squamous NSCLC. The clinical validity of more curative multimodal approaches in cohorts with limited metastases remains to be explored.
참고문헌 (25)
- Martin J, "Long-term results of combined-modality therapy in resectable non-small-cell lung cancer", J Clin Oncol, 20, pp.1989~1995 (2002)
- 정규원, "Cancer Statistics in Korea: Incidence, Mortality, Survival, and Prevalence in 2008", Cancer Research and Treatment, 43(1), pp.1~11 (2011), 대한암학회
- Janssen-Heijnen ML, "The changing epide-miology of lung cancer in Europe", Lung Cancer, 41, pp.245~258 (2003)
- Torok S, "Lung cancer in never smokers", Future Oncol, 7, pp.1195~1211 (2011)
- Travis WD, "United States lung carcinoma incidence trends: declining for most histologic types among males, increasing among females", Cancer, 77, pp.2464~2470 (1996)
- Dy GK, "Emerging therapeutic targets in non-small cell lung cancer", Proc Am Thorac Soc, 6, pp.218~223 (2009)
- Wu M, "EGFR mutations are associated with prognosis but not with the response to front-line chemotherapy in the Chinese patients with advanced non-small cell lung cancer", Lung Cancer, 67, pp.343~347 (2010)
- Yamamoto H, "Impact of EGFR mutation analysis in non-small cell lung cancer", Lung Cancer, 63, pp.315~321 (2009)
- Aggarwal C, "Older age, poor performance status and major comorbidities: how to treat high-risk patients with advanced nonsmall cell lung cancer", Curr Opin Oncol, 24, pp.130~136 (2012)
- Giroux Leprieur E, "Factors associated with long-term survival of patients with advanced non-small cell lung cancer", Respirology, 17, pp.134~142 (2012)
- Kalikaki A, "Clinical outcome of patients with non-small cell lung cancer receiving front-line chemotherapy according to EGFR and K-RAS mutation status", Lung Cancer, 69, pp.110~115 (2010)
- Leung EY, "Clinical utility of the pretreatment glasgow prognostic score in patients with advanced inoperable non-small cell lung cancer", J Thorac Oncol, 7, pp.655~662 (2012)
- O'Byrne KJ, "Molecular biomarkers in non-small-cell lung cancer: a retrospective analysis of data from the phase 3 FLEX study", Lancet Oncol, 12, pp.795~805 (2011)
- Pirker R, "Prognostic factors in patients with advanced non-small cell lung cancer: data from the phase III FLEX study", Lung Cancer, 77, pp.376~382 (2012)
- Lee DS, "The References Dong Soo Lee, Metastatic Extent and Survival in Advanced NSCLC VOLUME 45 NUMBER 2 JUNE 2013 101 relevance of serum carcinoembryonic antigen as an indicator of brain metastasis detection in advanced non-small cell lung cancer", Tumour Biol, 33, pp.1065~1073 (2012)
- Kosaka, "Prognostic implication of EGFR, KRAS, and TP53 gene mutations in a large cohort of Japanese patients with surgically treated lung adenocarcinoma", J Thorac Oncol, 4, pp.22~29 (2009)
- Doran E, "Outcomes after combined modality therapy for EGFR-mutant and wild-type locally advan-ced NSCLC", Oncologist, 16, pp.886~895 (2011)
- Riely GJ, "Clinical course of patients with non-small cell lung cancer and epidermal growth factor receptor exon 19 and exon 21 mutations treated with gefitinib or erlotinib", Clin Cancer Res, 12(3 Pt 1), pp.839~844 (2006)
- Arrieta O, "Long-term survival in patients with non-small cell lung cancer and synchronous brain metastasis treated with whole-brain radiotherapy and thoracic chemoradiation", Radiat Oncol, 6, pp.166~ (2011)
- Harita S, "Long-term survival following concurrent chemoradiotherapy in patients with non-small-cell lung cancer with concomitant brain metastases only", Int J Clin Oncol, 10, pp.63~68 (2005)
- Milano MT, "A prospective pilot study of curative-intent stereotactic body radiation therapy in patients with 5 or fewer oligometastatic lesions", Cancer, 112, pp.650~658 (2008)
- Milano MT, "Oligometastases treated with stereotactic body radiotherapy: long-term followup of prospective study", Int J Radiat Oncol Biol Phys, 83, pp.878~886 (2012)
- Norihisa Y, "Stereotactic body radiotherapy for oligometastatic lung tumors", Int J Radiat Oncol Biol Phys, 72, pp.398~403 (2008)
- Takeda A, "Stereotactic body radiotherapy (SBRT) for oligome-tastatic lung tumors from colorectal cancer and other primary cancers in comparison with primary lung cancer", Radiother Oncol, 101, pp.255~259 (2011)
- Welsh JS, "Helical tomotherapy: an innovative technology and approach to radiation therapy", Technol Cancer Res Treat, 1, pp.311~316 (2002)