WCLC 2018 — Stage IV NSCLC: metastasis number, not location, dictates outcome

  • Brian Hoyle
  • Univadis
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  • A large-scale, multiyear, retrospective analysis has highlighted the importance of the number of metastases, rather than their location, as a prognostic factor of patient outcome in stage IV NSCLC.

Why this matters

  • Mortality from NSCLC with distant metastases exceeds 50%, with death typically occurring within a year of diagnosis.
  • Studies that have attempted to correlate prognostic features of metastatic sites in NSCLC have been hampered by small sample size.
  • Real-world, population-based data would be informative.

Study design

  • Retrospective examination of the Glans Look Lung Cancer database.
  • Data from patients treated in southern Alberta, Canada, between 1999 and 2013.
  • Univariate and multivariate analyses determined demographic, clinical, and treatment details, measured median OS (mOS), and identified prognostic factors.
  • Comparison of patients with 1 extrapulmonary metastatic site (EPMS) and those with 2 or more sites.

Key results

  • 2065 patients with NSCLC with EPMS.
  • 1241 (60%) patients with single distant metastatic disease, 824 (40%) with ≥2 EPMS.
  • Patients with single-site involvement had similar baseline characteristics, except for those with liver involvement, who were more likely to be older (median age, 72 years [interquartile range (IQR), 66-79 years] vs 67 years [IQR, 59-75 years]; P<.001 and to be never smokers vs p with patients epms.>
  • Patients with multiple EPMS displayed similar baseline characteristics.
  • Median age of entire cohort, those with 1 EPMS, and those with ≥2 sites was 67 (IQR, 58-75) years, 68 (IQR, 59-76) years, and 65 (IQR, 57-74) years, respectively.
  • Just more than half the patients were male; they had worse outcomes.
  • Sites of EPMS were not correlated with survival.
  • An increasing number of EPMS signaled significantly decreasing mOS (P<.001 in multivariate analysis.>
  • Nonsquamous/nonadenocarcinoma histology, surgical resection of metastatic disease, systemic anticancer therapy, and radiation therapy correlated with superior survival.

Expert comment

  • "Intuitively, you might think that the location of metastases would be more important. But, our data certainly argues otherwise. These findings could make it a lot easier to evaluate patients, as a simple count of the number of metastases may have clinical value in prognosis and in helping determine management," said poster presenter Amanda Williams Gibson, BSc, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.