Author(s): Ashworth AB, Senan S, Palma DA, Riquet M, Ahn YC,
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Abstract INTRODUCTION/BACKGROUND: An individual patient data metaanalysis was performed to determine clinical outcomes, and to propose a risk stratification system, related to the comprehensive treatment of patients with oligometastatic NSCLC. MATERIALS AND METHODS: After a systematic review of the literature, data were obtained on 757 NSCLC patients with 1 to 5 synchronous or metachronous metastases treated with surgical metastectomy, stereotactic radiotherapy/radiosurgery, or radical external-beam radiotherapy, and curative treatment of the primary lung cancer, from hospitals worldwide. Factors predictive of overall survival (OS) and progression-free survival were evaluated using Cox regression. Risk groups were defined using recursive partitioning analysis (RPA). Analyses were conducted on training and validating sets (two-thirds and one-third of patients, respectively). RESULTS: Median OS was 26 months, 1-year OS 70.2\%, and 5-year OS 29.4\%. Surgery was the most commonly used treatment for the primary tumor (635 patients [83.9\%]) and metastases (339 patients [62.3\%]). Factors predictive of OS were: synchronous versus metachronous metastases (P < .001), N-stage (P = .002), and adenocarcinoma histology (P = .036); the model remained predictive in the validation set (c-statistic = 0.682). In RPA, 3 risk groups were identified: low-risk, metachronous metastases (5-year OS, 47.8\%); intermediate risk, synchronous metastases and N0 disease (5-year OS, 36.2\%); and high risk, synchronous metastases and N1/N2 disease (5-year OS, 13.8\%). CONCLUSION: Significant OS differences were observed in oligometastatic patients stratified according to type of metastatic presentation, and N status. Long-term survival is common in selected patients with metachronous oligometastases. We propose this risk classification scheme be used in guiding selection of patients for clinical trials of ablative treatment. Copyright © 2014 Elsevier Inc. All rights reserved.
This article was published in Clin Lung Cancer
and referenced in Journal of Brain Tumors & Neurooncology