Localablative treatment (LAT) improves outcome in lung cancer with oligometastatic disease (OMD) and potentially leads to long term survival. The aim of this retrospective study was to evaluate and quantify the additional benefit of LAT in synchronous OMD and to further identify prognostic factors for outcome and survival.
A propensity score matched pairs analysis was performed on a set of patient and disease variables in 180 patients, treated for synchronous OMD (including non-small cell and neuroendocrine lung cancer) with ≤4 metastatic lesions between 2000 and 2016 in 3 specified lung cancer centers in Berlin, Germany. Patients had either received LAT for all sites of disease (intervention group) by surgery or stereotactic ablative body radiation, or standard chemotherapy, if necessary combined with a palliative-intended local treatment (control group).
Median follow-up time was 32.2 and 18.8 months for the intervention and control group, respectively. Substantial benefits in median progression free survival (PFS, 25.1 vs. 8.2 months; HR, 0.30; 95% CI, 0.21-0.43; p < 0.001) and overall survival (OS, 60.4 vs. 22.5 months; HR, 0.42; 95% CI, 0.28-0.62; p < 0.001) were associated to LAT. Histology of adenocarcinoma (PFS: HR, 0.58; 95% CI, 0.37-0.91; p = 0.02; OS: HR, 0.53; 95% CI,0.33-0.86; p = 0.01) and small primaries (T1a; PFS: HR, 0.36; 95% CI, 0.18-0.70, p = 0.003; OS: HR, 0.39; 95% CI, 0.18-0.84; p = 0.02) also predicted a favorable prognosis concerning PFS and OS. Nodal stage (N0-2 vs. 3; HR, 0.49; 95% CI, 0.25-0.97; p = 0.04) and number of metastases (1 vs. 2-4; HR, 0.63; 95% CI, 0.41-0.96; p = 0.03) were associated with an extended PFS, whereas initial ECOG-PS (0-1 vs. 2; HR, 0.42; 95% CI, 0.20-0.91; p = 0.03) predicted OS.
LAT was the strongest predictor for PFS and OS in patients with OMD and ≤4 metastases. Survival observed in the control group identifies OMD as a subset of lung cancer with a generally more favorable prognosis.
Clinical trial identification
Legal entity responsible for the study
Has not received any funding.
All authors have declared no conflicts of interest.