br Article history br Received in revised form
Received in revised form
Available online xxx
Background: This study was performed to investigate the influence of specific metastatic organs on the prognosis and therapeutic effect in patients with advanced lung cancer. Methods: We retrospectively analyzed 400 patients with pathologically diagnosed advanced lung cancer to determine the association of the patients’ metastatic status with their prognoses and responses to first-line therapy. Metastases within the chest cavity (pul-monary metastasis, pleural effusion, and pericardial effusion) were counted as one organ. Results: The numbers of metastatic organs in the patients were as follows: one (n¼199 patients), two (n¼99), three (n ¼61), and four or more (n¼41). A multivariate analysis showed that liver and muscle metastases were independently associated with shorter overall survival (median of 207 and 120 days, respectively) and shorter progression-free survival (median of 125 and 53 days, respectively). Chest cavity, bone, brain, and A 83-01 node metastases were not associated with survival. The presence of either muscle or skin metastasis was associated with a lower response rate to first-line therapy than was the absence of each metastasis (14.3% vs. 49.4% and 11.1% vs. 48.9% in patients with vs. without muscle or skin metastasis, respectively).
Conclusions: Muscle and liver metastases were associated with poor outcomes. Muscle and skin metastases were associated with a lower response rate to treatment. For patients with advanced lung cancer, oncologists should select treatment strategies considering the pa-tients’ metastatic statuses as well as other clinical characteristics.
© 2019 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.
Abbreviations: CT, computed tomography; EGFR, epidermal growth factor receptor; EPMS, extrapulmonary metastatic site; 18F-FDG, 18F-2-fluoro-2-deoxy-D-glucose; HGF, hepatocyte growth factor; ILD, interstitial lung disease; NSCLC, non-small cell lung cancer; OS, overall survival; PET, positron emission tomography; PFS, progression-free survival; SCLC, small cell lung cancer; TKI, tyrosine kinase inhibitor.
* Corresponding author.
E-mail address: [email protected] (N. Kanaji).
Please cite this article as: Kanaji N et al., Association of specific metastatic organs with the prognosis and chemotherapeutic response in patients with advanced lung cancer, Respiratory Investigation, https://doi.org/10.1016/j.resinv.2019.06.004
The International Association for the Study of Lung Cancer proposed the M1a, b, and c categories in the 8th version of the TNM classification for lung cancer staging . A poorer prog-nosis in M1c diseases, which are stage IVB, has been confirmed in several studies [2e4]. Individuals with two or more extrapulmonary metastatic sites (EPMSs) have a worse prognosis than do those with one EPMS . Similarly, a high number of metastatic organs is an independent poor prog-nostic factor in patients with advanced lung adenocarcinoma .
Several research groups have investigated whether specific metastatic organs affect patient survival [2,3,6e10], but their findings have been varied. Bone metastasis may not affect survival or may be associated with better or poor survival [6,9,10]. Adrenal metastases may also be associated with bet-ter or poor survival [2,7]. Thus, the influences of different metastatic organs on the prognosis and therapeutic effect have not been fully elucidated. We conducted the present study to examine the effects of specific metastatic organs on the prognosis and first-line therapeutic efficacy in patients with advanced lung cancer.