Author of

• 12824

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  P3.21 - Poster Session 3 - Diagnosis and Staging (ID 171)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Prevention & Epidemiology
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/30/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 12825

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    P3.21-001 - Metastatic locations in non-small cell lung cancer and their prognostic significance (ID 917)

    09:30 - 09:30  |  Author(s): R. Whittom
    • Abstract

    Background
    For patients with advanced non-small cell lung cancer (NSCLC), it is unclear whether the anatomical location of their metastases has a different impact on survival. In this project, we sought to describe these metastatic sites using the 7th edition of the TNM classification and analyse their prognostic implications. A special emphasis was placed on brain metastases, as these patients are commonly excluded from participating in clinical trials, based on perceptions of inferior outcomes.

    Methods
    Consecutive patients diagnosed with NSCLC, between 2005 and 2009 at Hôpital du Sacré-Coeur de Montréal were included in this retrospective analysis. They were re-classified, from the TNM 6[th] edition, in use at the time, to the TNM 7. The following metastatic locations were considered: brain, pleura, contra lateral lung, extra-thoracic lymph nodes, soft tissues, pericardium, adrenal glands and skeleton. The treatments received were classified in one of these three groups: standard, non-standard and palliative care. Cox proportional hazards analysis was used to identify predictive factors for survival among the following parameters: age, body mass index, gender, histology, smoking history, type of treatment, number and location of metastatic sites.

    Results
    Five hundred thirty seven patients with stage IV NSCLC were identified. Their metastatic sites were, in decreasing order of frequency: skeleton (41%), pleura (32%), contra lateral lung (28%), brain (26%), liver (18%), extra-thoracic lymph nodes (16%), soft tissues (14%), adrenal glands (14%) and pericardium (6%). Forty-five percent of patients had metastases to 1 organ, 33% had 2 and 22% had 3 to 6 organs involved. In univariable analyses, metastases to the liver, adrenal glands or skeleton were associated with worse prognosis (HR=1,37; 1,38 and 1.34, respectively; p < 0.05). The patients with liver or adrenal metastases were more likely to have at least another metastatic site (90%). In multivariable analyses, not surprisingly, better survival was found in patients who could receive standard treatment, those having adenocarcinoma histology and less metastatic sites. Having contra lateral lung metastases conferred a better prognosis (HR=0.74, p=0.0037). Remarkably, brain metastases were not a prognostic factor in uni or multivariable analyses. This group of patients was more likely to have at least one of three better-risk factors: age < 65 (68%), brain as a unique metastatic site (37%), and more frequent in patients with adenocarcinoma than squamous cell cancer (27 vs. 13%). Conversely, they were less likely to be treated with palliative care compared to patients with extra-cerebral metastases (8 vs. 35%).

    Conclusion
    A history of brain metastases did not have a prognostic influence in our NSCLC patient cohort. This finding could be explained by the presence of better-risk factors in that group of patients. Brain metastases should not be considered by itself an exclusion criterion from clinical trials.