A Review And Study Of Surgical Treatment For Oligometastatic Non-Small Cell Lung Cancer

Objectives: Lung cancer still takes majority of the deaths in the world,approximately 80%-85% are non-small cell lung cancer(NSCLC),and nearly 50% of them are diagnosed as stage IV at the initial time.In patients with stage IV NSCLC,systematic chemotherapy and target therapy,as well as the new option with immunotherapy have been recommended.However,a series of retrospective studies have shown the feasibility and effectiveness of surgery on a subgroup of highly selected stage IV NSCLC during the past decades.Present study aims to assess the current situation and prognostic factors of surgical treatment for advanced stage NSCLC.Methods: Studies published in 30 years were systematically reviewed and medical records of stage IV NSCLC,who underwent surgery for primary lung in the department of thoracic surgery in Tangdu hospital,from January 2014 to June 2017 were retrieved from medical database.Results: Totally 69 studies enroll into final analysis.Patients with multiple lung nodes obtained a 5-year survival rate of 0%-87% and a median survival time(MST)of 18-65.1 months,with relatively large differentiation on survival.Patients with brain metastases got a 5-year survival rate of 8%-36.8% after surgical treatment.The MST of brain metastastic ones were 6.8-52 months.A 5-year survival rate was 9.1%-34% and an MST of 9-36 months was obtained in patients with adrenal metastases.Ipsilateral adrenal metastases might indicate a favorable outcome.As to solitary vertebral metastatic patients,an MST of 20 months was achieved after thoracic surgery.The absence of mediastinal lymph nodes involvement was an important favorable prognostic factor contributing to survival,as well as T1-2.Totally 88 stage cases diagnosed as stage IV were enrolled in this study.The MST of entire cohort were 31.72 months,and the 1-,2-,3-year survival rate were 75.9%,59.1% and 42.2%,respectively.There were 35 patients with pleural dissemination,18 with brain oligometastases,25 with extra-brain oligometastases and 10 with polymetastases.The MST of them were 36.51,55.78,15.28 and 13.18 months,respectively.The corresponding 3-year survival rate were 49.01%,60.80%,22.02% and 33.33%,respectively(Log-rank,p=0.008).Adjuvant tyrosine kinase inhibitor(TKI)treated patients had an unreached MST at last follow-up,while 24.08,3.607 and 33.22 months of chemotherapy,no treatment and unknown treated ones,respectively(Log-rank,p<0.001).The 3-year survival rate of TKI treated patients was 76.03%.Age <60 years,T1-2 and adjuvant TKI therapy were independent favorable prognostic factors(p<0.05).Conclusion: Surgical treated stage IV NSCLCs still takes a small proportion of entire patients,and surgery is still a cautious choice for these ones.Age younger than 60 years,clinical T1-2 stage,pleural and brain metastatic patients may get the better survival compared with extra-brain and multiple metastatic ones.Surgery followed by MDT and adjuvant target therapy may be a considerable choice for stage IV NSCLC.