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J Thorac Dis. 2019 Sep;11(9):3836-3845. doi: 10.21037/jtd.2019.09.17.

Patient outcomes post-pulmonary resection for synchronous bone-metastatic non-small cell lung cancer.

Author information

1
Department of Thoracic Surgery, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Japan.
2
Department of Thoracic Surgery, Sapporo Medical University, School of Medicine and Hospital, Sapporo, Japan.
3
Department of Respiratory Medicine, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Japan.

Abstract

Background:

The efficacy of curative-intent pulmonary resection for non-small cell lung cancer (NSCLC) patients with certain types of oligometastases, particularly brain and adrenal metastases, has previously been described. We investigated the outcomes of curative-intent pulmonary resection for NSCLC patients with synchronous isolated bone metastases, which have been less clear to date.

Methods:

We retrospectively reviewed the clinical and pathological records of 41 patients with NSCLC and synchronous isolated bone metastases who underwent radical treatments (surgery and/or chemotherapy and/or radiotherapy) for both their primary tumors and bone metastases at the National Hospital Organization, Hokkaido Cancer Center, between 2008 and 2013.

Results:

Nine of the 41 patients underwent pulmonary primary tumor resection; the rate of clinical N0-1 disease among these 9 patients (100%) was significantly higher than that among the 32 patients who did not undergo resection (34.4%). The five-year overall survival (OS), progression-free survival (PFS), and disease-free survival (DFS) rates of the nine patients who underwent pulmonary resection were 66.7%, 55.6%, and 44.4%, respectively. On multivariate analysis, the predictors of longer OS among all 41 patients were primary site resection [hazard ratio (HR) =4.18, 95% CI, 1.20-14.6, P=0.025] and epidermal growth factor receptor (EGFR) mutation (HR =3.30, 95% CI, 1.08-10.1, P=0.036). The former was also a predictor of longer PFS (HR =3.75, 95% CI, 1.27-11.0, P=0.016).

Conclusions:

Patients with clinical N0-1 NSCLC and synchronous isolated bone metastases may achieve longer survival rates following primary lung tumor resection.

KEYWORDS:

Surgery; bone metastasis; non-small cell lung cancer (NSCLC)

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