Survival Analysis Of Surgical Intervention For NSCLC With Extrathoracic Oligometastasis

Objective: Treatment guidelines recommend surgical treatment in selected patients with IV NSCLC,but the evidence is limited,and this study assessed the survival impact of surgical intervention on extrathoracic single-organ metastatic NSCLC.Methods: Extrathoracic single-organ metastatic NSCLC patients diagnosed from2010 to 2015 were extracted from the Surveillance,Epidemiology,and End Results(SEER)database,baseline characteristics were balanced using the Progressionspecificesurvival(PSM),survival curves were plotted using the Kaplan-Meier method,and differences in cancer-specific survival(CSS)were compared using the log-rank test;multivariate Cox regression was used to analyze risk factors affecting prognosis.Results: The total number of eligible patients was 23,291,and 8592(36.9%),11,886(51.0%),and 2814(12.1%)had brain metastases,bone metastases,and liver metastases,respectively.Multivariate Cox regression analysis indicated that surgical intervention was independently associated with improved patient CSS(P < 0.001).The surgical nonsurgical group was matched 1:1 for propensity score.In patients undergoing primary tumor surgery,the CSS was better in the surgery group after propensity matching score(P < 0.001),and 20 months and 9 months in the surgery group.Analysis according to different metastatic organs showed that the CSS was better in the brain metastasis cohort and bone metastasis surgery group after propensity matching score,with statistically significant difference(P < 0.001).There was no statistical difference in CSS between the surgical group and the non-surgical group in the liver metastasis cohort(P > 0.05).Different surgical treatment modalities for the primary tumor showed better survival benefits both before and after propensity score matching compared with no surgery.In patients undergoing surgery for metastases,the CSS was better in the surgery group after propensity matching score(P < 0.001),and analysis was performed according to different metastatic organs.After propensity matching score,the CSS was significantly better in the group undergoing surgery for metastases only in the brain metastasis cohort than in the nonsurgery group(P < 0.001),with corresponding CSS of 11 months and 8 months,respectively.Cohort bone metastasis and liver metastasis CSS in surgery group was not statistically different from that in non-surgery group(P > 0.05).For patients with brain metastases,PMTR was superior to PTR or MTR.The CSS of PMTR,PTR,MTR and NONE were 31 months,17 months,10 months and 6 months,respectively.There were significant differences between different surgical intervention methods(P< 0.005).Conclusion: In patients with extrathoracic single-organ metastatic NSCLC,surgical treatment of the primary tumor is superior to no surgical treatment in patients with brain metastases and bone metastases.Lobectomy or bilobectomy of the primary tumor is superior to wedge resection and pneumonectomy.For patients with brain metastases alone,surgical treatment of metastases has a better prognosis compared with non-surgical treatment,and PMTR is superior to PTR or MTR in different surgical intervention modalities.