Single organ metastatic disease and local disease status, prognostic factors for overall survival in stage IV non-small cell lung cancer: Results from a population-based study.

PURPOSE:

To analyse the prognostic impact on overall survival (OS) of single versus multiple organ metastases, organ affected, and local disease status in a population based stage IV non-small cell lung cancer (NSCLC) cohort.
METHODS:

In this observational study, data were analysed of all histologically confirmed stage IV NSCLC patients diagnosed between 1 January 2006 and 31 December 2012 registered in the Netherlands Cancer Registry. Location of metastases before treatment was registered. Multivariable survival analyses [age, gender, histology, M-status, local disease status, number of involved organs, actual organ affected] were performed for all patients and for an (18)fluorodeoxyglucose-positron emission tomography ((18)FDG-PET)-staged subgroup.
RESULTS:

11,094 patients were selected: 60% male, mean age 65years, 73% adenocarcinoma. Median OS for 1 (N=5676), 2 (N=3280), and ⩾3 (N=2138) metastatically affected organs was 6.7, 4.3, 2.8months, respectively (p<0.001). Hazard ratio (HR) for 2 versus 1 organ(s) was 1.33 (p<0.001), for ⩾3 versus 1 organ(s) 1.91 (p<0.001). Results were confirmed in the (18)FDG-PET-staged cohort (N=1517): patients with single organ versus 2 and ⩾3 organ metastases had higher OS (8.6, 5.7, 3.8months, HR 1.40 and 2.17, respectively, p<0.001). In single organ metastases, OS for low versus high TN-status was 8.5 versus 6.5months [HR 1.40 (p<0.001)]. (18)FDG-PET-staged single organ metastases patients with low TN-status had a superior OS than those with high TN-status (11.6 versus 8.2months, HR 1.62, p<0.001).
CONCLUSION:

Patients with single organ metastases stage IV NSCLC have a favourable prognosis, especially in combination with low TN status. They have to be regarded as a separate subgroup of stage IV disease.