110PD - Single organ metastatic disease, a new prognostic factor for overall survival (OS) in stage IV non-small cell lung cancer (NSCLC)

Date 17 April 2015
Event ELCC 2015
Session Epidemiology, early stage NSCLC and surgery
Topics Non-Small-Cell Lung Cancer, Metastatic
Presenter Lizza Hendriks
Citation Annals of Oncology (2015) 26 (suppl_1): 29-44. 10.1093/annonc/mdv050
Authors L. Hendriks1, J.L. Derks1, P.E. Postmus2, R.A. Damhuis3, R.M. Houben4, E.G. Troost4, M.M. Hochstenbag1, E.F. Smit5, A.C. Dingemans1
  • 1Pulmonary Diseases, Maastricht University Medical Center (MUMC), 6202 AZ - Maastricht/NL
  • 2Pulmonary Diseases, Consultancy, 9351PP - Leek/NL
  • 3Registry And Research, Comprehensive Cancer Centre the Netherlands, Rotterdam/NL
  • 4Radiation Oncology, Maastricht University Medical Center (MUMC), Maastricht/NL
  • 5Pulmonary Diseases, Het Nederlands Kanker Instituut Antoni van Leeuwenhoek (NKI-AVL), Amsterdam/NL



To assess the prognostic impact on OS of single vs multiple organ metastases (M+), the organ affected, and the local disease status in stage IV NSCLC.


Data on histologically confirmed stage IV NSCLC patients (pts) diagnosed between 1-1-2006 and 31-12-2012 were retrieved from the Netherlands Cancer Registry. Multivariable survival analyses (including age, gender, histology, M-status (TNM7 M1a vs M1b and TNM6 M1), local disease status (low: T0-2 and N0-1 vs high: T3-4 and/or N2-3), number of organs with M + , actual organ affected) were performed for all pts, and subsequently for 2 subgroups: 18FDG-PET-staged pts and pts receiving active anticancer treatment.


11,094 pts were selected: 60% male, mean age 65 years, 73% adenocarcinoma (AdC). Median OS for 1 (N = 5676), 2 (N = 3280) and ≥3 (N = 2138) organs with M+ was 6.7, 4.3 and 2.8 months, respectively (p < 0.001). HR for 2 vs 1 organ(s) was 1.3 (p <0.001), and for ≥ 3 vs 1 organ(s) 1.9 (p < 0.001). In 18FDG-PET-staged pts (N = 1517), median OS was 8.6, 5.7 and 3.8 months, respectively (p < 0.001). HR for 2 vs 1 organ(s) was 1.4 (p < 0.001) and for ≥3 vs 1 organ(s) 2.2 (p < 0.001). In single organ M + , OS for high vs low TN status was overall 6.5 vs 8.5 months (HR 1.4, p < 0.001) and was 8.2 vs 11.6 months (HR 1.6, p < 0.001) in those staged with 18FDG-PET. When analyzing the subgroup of pts receiving active anticancer treatment, single organ M+ and low TN-status remained significant prognostic factors: median OS for 1, 2 and ≥ 3 organ M+ was 10.4, 7.3 and 5.7 months, respectively (HR 2 vs 1 organ: 1.4, HR ≥3 organs vs 1: 1.9, p < 0.001). Median OS for high vs low TN-status was 9.9 months vs 13.7 months (HR 1.5, p < 0.001). In single organ M + , only intrathoracic M+ (current M1a) and extrathoracic lymph node (ET-LN) M+ were associated with superior OS. HR for pulmonary M+ was 0.6, for pleural M+ 0.8 and for ET-LN M+ 0.8. Results were comparable when repeating analyses for TNM6 and TNM7 separately.


Single organ M+ stage IV NSCLC pts have a favorable prognosis, especially in combination with low TN status. The current M1a group has a better OS compared to other organs with M+. However, in the distant M+ group (current M1b) there is, apart from ET-LN M + , no organ consistently associated with a superior OS.


All authors have declared no conflicts of interest.