Site of Metastases as Prognostic Factors in Unselected Population of Stage IV Non-Small Cell Lung Cancer

Abstract

Background: Advanced stage non-small cell lung cancer (NSCLC) is a heterogenous disease, yet, with the exception of<br />targeted therapies, most guidelines recommended uniform treatment irrespective of tumor burden or sites of metastases<br />and this may explain, in part, the wide range of responses to same lines of therapy. Aim of work: In this work we<br />tried to explore the effect of metastatic sites in on overall survival (OS), in an unselected group of Non-small cell lung<br />cancer patients who received different treatments line. Methods: A retrospective analysis was performed on patients<br />with stage IV NSCLC who received systemic treatment at UAB Cancer Center (NCI designated comprehensive cancer<br />center) between 2002 to 2012. The details of sites of metastases, systemic therapy and overall survival were recorded<br />for each patient. Result: In 409 patients who received systemic treatment, there was statistically significant lower OS<br />in those presenting with liver metastases (p<0.001), adrenal metastases (p=0.011) and metastases to abdominal lymph<br />nodes (p=0.014). There was no statistically significance difference in OS in patient presenting with pleural metastases<br />or effusion (p=0.908), metastases to heart or pericardium (p=0.654), metastases to bone (p=0.281), brain (p=0.717) or<br />skin and subcutaneous tissue (p=0.642). Conclusion: Intra-abdominal metastases confer a particularly poor prognosis<br />in stage IV NSCLC treated with systemic therapy and may identify patients in whom aggressive treatment beyond first<br />line therapy is not appropriate.