Background:In patients with oligometastatic NSCLC, a cT3–cT4 primary tumor or an cN2/cN3 lymph node status was reported to be associated with unfavorable outcome. The aim of this study was to assess the importance of definitive or neoadjuvant thoracic radiochemotherapy for long-term outcome of these patients in order to find more appropriate treatment schedules.Methods:Analysis of the West Cancer Centre (WTZ) institutional database from 08/2016 to 08/2020 was performed. Patients with primary synchronous OMD, all without actionable driver mutations, who received definitive thoracic radiochemotherapy (RCT) or neoadjuvant RCT followed by surgery (trimodality treatment) were included. Survival outcome is compared with stage III NSCLC.Results:Altogether, 272 patients received concurrent radiochemotherapy. Of those, 220 presented with stage III (158 with definitive RCT, 62 with trimodality approach). A total of 52 patients had OMD patients with cT3/cT4 or cN2/cN3 tumors. Overall survival (OS) at five years for OMD patients was 28.3% (95%-CI: 16.4–41.5%), which was not significantly different from OS of patients with stage III NSCLC treated with definitive or neoadjuvant RCT (34.9% (95%-CI: 27.4–42.8%)). However, the PFS of OMD patients at five years or last follow-up was significantly worse than that of stage III patients (13.0% vs. 24.3%,p= 0.0048). The latter was due to a higher cumulative incidence of distant metastases in OMD patients (50.2% vs. 20.4% at 48 months,p< 0.0001) in comparison to stage III patients. A cross-validated classifier that included severe comorbidity, ECOG performance status, gender and pre-treatment serum CRP level as the most important factors in the univariable analysis, was able to divide the OMD patient group into two equally sized groups with a four-year survival rate of 49.4% in the good prognosis group and 9.9% in the poor prognosis group (p= 0.0021). Laboratory chemistry and clinical parameters, in addition to imaging and high-precision therapies, can help to predict and improve prognosis.Conclusions:A multimodality treatment approach and local metastases-directed therapy in addition to chemoimmunotherapy can lead to good long-term survival in patients with cT3/cT4 or cN2/cN3 OMD NSCLC without severe comorbidities and in good performance status and is therefore recommended.
背景：在寡转移性非小细胞肺癌（NSCLC）患者中，cT3–cT4原发肿瘤或cN2/cN3淋巴结状态被认为与不良预后相关。本研究旨在评估根治性或新辅助胸部放化疗对这些患者长期预后的重要性，以寻找更合适的治疗方案。 方法：对西部癌症中心（WTZ）2016年8月至2020年8月的机构数据库进行分析。纳入对象为初诊同步寡转移（OMD）、均无可操作驱动基因突变、接受根治性胸部放化疗（RCT）或新辅助RCT后手术（三联治疗）的患者。其生存结局与III期NSCLC患者进行比较。 结果：共有272例患者接受了同步放化疗。其中220例为III期患者（158例接受根治性RCT，62例接受三联治疗）。52例OMD患者具有cT3/cT4或cN2/cN3肿瘤。OMD患者的五年总生存（OS）率为28.3%（95% CI：16.4–41.5%），与接受根治性或新辅助RCT治疗的III期NSCLC患者的OS率（34.9%（95% CI：27.4–42.8%））无显著差异。然而，OMD患者的五年或无进展生存期（PFS）显著差于III期患者（13.0% vs. 24.3%，p=0.0048）。这主要是由于与III期患者相比，OMD患者的远处转移累积发生率更高（48个月时50.2% vs. 20.4%，p<0.0001）。通过单变量分析确定严重合并症、ECOG体能状态、性别和治疗前血清CRP水平为最重要因素，构建的交叉验证分类器可将OMD患者分为两组规模相当的亚组：良好预后组的四年生存率为49.4%，不良预后组为9.9%（p=0.0021）。除影像学和高精度治疗外，实验室化学和临床参数也有助于预测和改善预后。 结论：对于无严重合并症且体能状态良好的cT3/cT4或cN2/cN3 OMD NSCLC患者，采用多模式治疗方案（包括化疗免疫治疗）联合局部转移灶定向治疗可获得良好的长期生存，因此推荐该治疗策略。
肿瘤(癌症)患者之家