TY - JOUR
T1 - Perioperative and oncologic outcomes of pulmonary resection for synchronous oligometastatic non–small cell lung cancer
T2 - Evidence for surgery in advanced disease
AU - Deboever, Nathaniel
AU - Mitchell, Kyle G.
AU - Farooqi, Ahsan
AU - Ludmir, Ethan B.
AU - Hofstetter, Wayne L.
AU - Mehran, Reza J.
AU - Rajaram, Ravi
AU - Rice, David C.
AU - Sepesi, Boris
AU - Swisher, Stephen G.
AU - Vaporciyan, Ara A.
AU - Walsh, Garrett L.
AU - Heymach, John V.
AU - Gomez, Daniel R.
AU - Gandhi, Saumil J.
AU - Antonoff, Mara B.
N1 - Publisher Copyright:
© 2023 The American Association for Thoracic Surgery
PY - 2023
Y1 - 2023
N2 - Objectives: Recent randomized trials have demonstrated a survival advantage with the use of local consolidative therapy in oligometastatic non–small cell lung cancer; however, the indications for and outcomes after pulmonary resection as a component of local consolidative therapy remain ill defined. We sought to characterize the perioperative and long-term survival outcomes among patients with resected oligometastatic non–small cell lung cancer. Methods: Patients presenting to a single center (2000-2017) with oligometastatic non–small cell lung cancer (≤3 synchronous metastases, intrathoracic nodal disease counted as a single site) who underwent resection of the primary tumor were retrospectively identified. Charts were reviewed, and demographic, clinical, pathologic, oncologic, and survival outcomes were recorded. Survival outcomes were analyzed from the date of surgery. Results: A total of 52 patients met inclusion criteria, among whom most (38, 73.1%) were ever smokers, had nonsquamous tumors (48, 92.3%), had no intrathoracic nodal disease (33, 63.5%), and had 1 to 2 sites of metastases (49, 94.2%). The majority (41, 78.9%) received systemic therapy, predominantly in the neoadjuvant setting (24/41, 58.5%). After resection, there were no 30- or 90-day deaths. After a median follow-up of 94.6 months (95% CI, 69.0-139.1), 37 patients (71.2%) progressed and 38 patients (73.1%) died. Median postoperative progression-free survival and overall survival were 9.4 (5.5-11.6) months and 51.7 (22.3-65.3) months, respectively. Conclusions: Pulmonary resection as a means of maximum locoregional control in oligometastatic non–small cell lung cancer is feasible and safe, and may be associated with durable long-term survival benefits. The frequency of systemic postoperative progression highlights an urgent need to characterize perioperative and oncologic outcomes after pulmonary resection in the current era of novel systemic therapies.
AB - Objectives: Recent randomized trials have demonstrated a survival advantage with the use of local consolidative therapy in oligometastatic non–small cell lung cancer; however, the indications for and outcomes after pulmonary resection as a component of local consolidative therapy remain ill defined. We sought to characterize the perioperative and long-term survival outcomes among patients with resected oligometastatic non–small cell lung cancer. Methods: Patients presenting to a single center (2000-2017) with oligometastatic non–small cell lung cancer (≤3 synchronous metastases, intrathoracic nodal disease counted as a single site) who underwent resection of the primary tumor were retrospectively identified. Charts were reviewed, and demographic, clinical, pathologic, oncologic, and survival outcomes were recorded. Survival outcomes were analyzed from the date of surgery. Results: A total of 52 patients met inclusion criteria, among whom most (38, 73.1%) were ever smokers, had nonsquamous tumors (48, 92.3%), had no intrathoracic nodal disease (33, 63.5%), and had 1 to 2 sites of metastases (49, 94.2%). The majority (41, 78.9%) received systemic therapy, predominantly in the neoadjuvant setting (24/41, 58.5%). After resection, there were no 30- or 90-day deaths. After a median follow-up of 94.6 months (95% CI, 69.0-139.1), 37 patients (71.2%) progressed and 38 patients (73.1%) died. Median postoperative progression-free survival and overall survival were 9.4 (5.5-11.6) months and 51.7 (22.3-65.3) months, respectively. Conclusions: Pulmonary resection as a means of maximum locoregional control in oligometastatic non–small cell lung cancer is feasible and safe, and may be associated with durable long-term survival benefits. The frequency of systemic postoperative progression highlights an urgent need to characterize perioperative and oncologic outcomes after pulmonary resection in the current era of novel systemic therapies.
KW - local consolidative therapy
KW - oligometastatic lung cancer
KW - stage IV
KW - surgical difficulty
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U2 - 10.1016/j.jtcvs.2023.08.024
DO - 10.1016/j.jtcvs.2023.08.024
M3 - Article
C2 - 37619884
AN - SCOPUS:85171666804
SN - 0022-5223
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
ER -