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Bertolaccini L, Casiraghi M, Sedda G, de Marinis F, Spaggiari L. Clinical prognostic factors in surgically treated oligometastatic non-small cell lung cancer: a systematic review. Transl Lung Cancer Res 2021; 10:3401-3408. [PMID: 34430375 PMCID: PMC8350109 DOI: 10.21037/tlcr-20-1123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 04/19/2021] [Indexed: 12/11/2022]
Abstract
Background Since the concept of oligometastatic (OM) disease was introduced in the oncological scenario of non-small cell lung cancer (NSCLC), these patients progressively became a new category of stage IV NSCLC in whom the multimodality approach, including surgery, may improve prognosis. This systematic review aimed to investigate the clinical prognostic factors in OM-NSCLC surgically treated with radical intent. Methods This systematic review is reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Cochrane’s Collaboration Tool was used to determine the risk of bias for the included studies’ primary outcome. A search strategy using a combination of free-text words, relevant MeSH headings and appropriate restrictions (time limit: from January 1997 to March 2020, language: English) was designed. Potentially qualified papers were subjected to an in-depth full-text examination after preliminary title/abstract screening to identify studies for inclusion in the systematic review. Data extracted included: study characteristics, baseline patient characteristics, primary and secondary outcomes. The Cochrane’s Collaboration Tool was used to determine the risk of bias for included studies’ primary outcome. The risk of bias due to incomplete outcome data was evaluated at an outcome level. However, at the study stage, the possibility of bias due to sequence generation, allocation concealment, blinding, selective reporting, or funding was assessed. Two independent observers calculated the probability of bias, and differences were resolved through dialogue and consensus. Results Nine studies were selected. Overall survival (OS) was 51.8 months and varied from 21.1 to 60 months, but results were not statistically significant. Positive prognostic factors for survival were cessation of smoking, age <60, a histologic grade of G1/G2, pN0. The presence of extra-brain OM and multiple metastases negatively affected survival. Discussion For otherwise stable patients with a single organ site with synchronous (or metachronous) extrathoracic M1 disease and no intrathoracic lymph node involvement, aggressive treatment should be used in the absence of randomized evidence to help determine the effective management of OM-NSCLC.
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Affiliation(s)
- Luca Bertolaccini
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Monica Casiraghi
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Giulia Sedda
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Filippo de Marinis
- Department of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Casiraghi M, Bertolaccini L, Sedda G, Petrella F, Galetta D, Guarize J, Maisonneuve P, De Marinis F, Spaggiari L. Lung cancer surgery in oligometastatic patients: outcome and survival. Eur J Cardiothorac Surg 2021; 57:1173-1180. [PMID: 32091083 DOI: 10.1093/ejcts/ezaa005] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/29/2019] [Accepted: 12/10/2019] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES A few studies have already demonstrated survival benefits for local treatment in solitary metastatic non-small-cell lung cancer (NSCLC). The aim of this study is to retrospectively investigate the role of surgery in patients with oligometastatic (OM) NSCLC. METHODS Between January 1998 and December 2018, 57 patients with OM stage IV NSCLC (1 or 2) underwent a multidisciplinary approach including lung cancer surgery, local treatment of the distant metastasis (DM) and systemic medical treatments. RESULTS All patients had DM synchronous to lung cancer. Fifty-one (90%) patients had a single DM whereas 6 (11%) patients had 2 DMs. Forty-eight (84%) patients underwent induction chemotherapy. We performed 47 (82%) lobectomies, 4 (7%) segmentectomies and 6 (11%) pneumonectomies. Pathological lymph node involvement was evident in 28 (49%) patients. Adjuvant chemotherapy was administered in 20 (35%) patients. Forty-six (81%) patients had local treatment of the DM before lung resection, and 11 (19%) patients had after lung resection; 6 (11%) patients had both treatments. The median overall survival (OS) was 30 months, with the 2-, 3- and 5-year OS of 57%, 50% and 30%, respectively. OS was significantly related to lymph node involvement (P = 0.04), size of the primary tumour (P < 0.001), neoadjuvant chemotherapy (P = 0.02) and the time period between metastasis diagnosis and primary tumour removal (P = 0.04). CONCLUSIONS Multidisciplinary approach is the gold standard in OM patients. Patients with no lymph node involvement are the best candidates, with an acceptable OS. Thus, patients with OM-NSCLC should not be excluded from surgery as a matter of principle.
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Affiliation(s)
- Monica Casiraghi
- Division of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Luca Bertolaccini
- Division of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Giulia Sedda
- Division of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Francesco Petrella
- Division of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Domenico Galetta
- Division of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Juliana Guarize
- Division of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Patrick Maisonneuve
- Division of Epidemiology and Biostatistics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Filippo De Marinis
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Lorenzo Spaggiari
- Division of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Shang S, Wang L, Su Y, Li B, Guo M, Zhu Z, Sun X, Yu J. Local therapy combined with chemotherapy versus chemotherapy for postoperative oligometastatic non-small-cell lung cancer. Future Oncol 2019; 15:1593-1603. [PMID: 30855987 DOI: 10.2217/fon-2018-0923] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Aim: To compare the efficacy and toxicity of local therapy plus chemotherapy versus chemotherapy in non-small-cell lung cancer (NSCLC) patients with oligometastases after surgery. Patients & methods: A total of 152 patients with oligometastases after surgery were enrolled. Data of patient survival, treatment response and toxicities were compared between the groups receiving local ablative therapy plus chemotherapy and chemotherapy alone. Results: Compared with chemotherapy, the combination treatment conferred better progression-free survival, objective response rate and disease control rate (10 vs 7 months; 66.7 vs 31.9%; 94.3 vs 80.9%, respectively), but with more grade ≥3 adverse events. Besides, the overall survival was not significantly different (19 vs 20 months). Conclusion: The addition of local therapy to chemotherapy improved progression-free survival, objective response rate and disease control rate, but not overall survival in postoperative oligometastatic non-small-cell lung cancer.
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Affiliation(s)
- Shuheng Shang
- Department of Radiation Oncology, School of Medicine, Shandong University, Jinan 250117, PR China.,Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, Jinan 250117, PR China
| | - Linlin Wang
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, Jinan 250117, PR China
| | - Yi Su
- Department of Radiotherapy, the Affiliated Yantai Yuhuangding Hospital of Qingdao University Institution, Yantai 264009, PR China
| | - Butuo Li
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, Jinan 250117, PR China.,Department of Radiation Oncology, Tianjin Medical University, Tianjin 300070, PR China
| | - Meiying Guo
- Department of Radiation Oncology, School of Medicine, Shandong University, Jinan 250117, PR China.,Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, Jinan 250117, PR China
| | - Zhaofeng Zhu
- Department of Radiotherapy, Taian Central Hospital, Taian 271000, PR China
| | - Xindong Sun
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, Jinan 250117, PR China
| | - Jinming Yu
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, Jinan 250117, PR China
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Bertolaccini L, Pardolesi A, Forti Parri SN, Bonfanti B, Brandolini J, Solli P. Surgical approaches in patients with oligometastatic non-small cell lung cancer. J Thorac Dis 2018; 10:498-502. [PMID: 29600084 DOI: 10.21037/jtd.2017.11.135] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
In recent years, retrospective analyses have suggested that an oligometastatic state could exist, but the best evidence to date that a temporary oligometastatic disease exists for lung cancer mainly derives from the survival data on retrospective patients underwent surgical resection of a single M1 site and all intrathoracic disease. The critical determinates of long-term survival include definitive treatment of the primary non-small cell lung cancer (NSCLC), a single organ site of synchronous or metachronous disease, a long disease-free interval between treatment of the primary NSCLC and development of metastases, and the absence of intrathoracic lymph node (N0) disease. The ongoing development of innovative approaches to local therapy and treatment directed to the oligometastatic sites should be defined in future studies.
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Affiliation(s)
- Luca Bertolaccini
- Department of Thoracic Surgery, AUSL Bologna, Maggiore Teaching Hospital, Bologna, Italy
| | - Alessandro Pardolesi
- Department of Thoracic Surgery, AUSL Bologna, Maggiore Teaching Hospital, Bologna, Italy
| | | | - Barbara Bonfanti
- Department of Thoracic Surgery, AUSL Bologna, Maggiore Teaching Hospital, Bologna, Italy
| | - Jury Brandolini
- Department of Thoracic Surgery, AUSL Romagna Teaching Hospital, Forlì, Italy
| | - Piergiorgio Solli
- Department of Thoracic Surgery, AUSL Bologna, Maggiore Teaching Hospital, Bologna, Italy
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