Cancer Res Treat.  2023 Apr;55(2):468-478. 10.4143/crt.2022.1342.

Optimal Definition of Oligometastasis Showing Survival Benefits of Local Therapies during Tyrosine Kinase Inhibitor Treatment

• Jang YJ
• Hyun Dg
• Ji W
• Choi CM
• Yoon S
• Lee DH
• Kim SW
• Lee JC

• KMID: 2541233
• DOI: http://doi.org/10.4143/crt.2022.1342

Abstract

Purpose
We aimed to investigate the feasibility of four criteria on oligometastasis (OM) concerning clear survival benefits of local therapy (LT) during tyrosine kinase inhibitor (TKI) treatment in non–small cell lung cancer (NSCLC).
Materials and Methods
This single-center, retrospective study included patients with advanced NSCLC who received LT because of OM during TKI treatment at Asan Medical Center from January 2011 to December 2020. At the application of LT OM was classified according to four criteria: TNM, European Organization for Research and Treatment of Cancer Lung Cancer Group (EORTC-LCG), National Comprehensive Network (NCCN), and ORGAN. We compared survival outcomes between patients with and without OM.
Results
The median overall survival of the 117 patients included in the analysis was 70.8 months (95% confidence interval [CI], 56.6 to 85.1). The patients with OM meeting all four criteria (hazard ratio [HR] with 95% CI of TNM criteria 0.24 with 0.10-0.57; p=0.001, EORTC-LCG criteria 0.34 with 0.17-0.67; p=0.002, NCCN criteria 0.41 with 0.20-0.86; p=0.018 and ORGAN criteria 0.33 with 0.18-0.60; p < 0.001) had significantly longer survival compared with patients who did not after adjusting for confounding factors. Furthermore, increasing the number of extra-thoracic metastatic organs to two or more were independent predictive factors for worse survival outcomes (2 organs: HR, 3.51; 95% CI, 1.01 to 12.14; p=0.048; 3 organs: HR, 4.31; 95% CI, 0.94 to 19.73; p=0.060; 4 organs: HR, 24.47; 95% CI, 5.08 to 117.80; p < 0.001).
Conclusion
Patients with OM defined by all four criteria showed prognostic benefits from LT during TKI therapy.

Keyword

Lung neoplasms; Non?small cell lung carcinoma; Metastasis; Radiotherapy; Prognosis

Figure

• 

  Fig. 1 Kaplan-Meier curves of clinical outcomes in all non–small cell lung cancer patients with oligometastasis after the commencement of tyrosine kinase inhibitor (TKI). (A) Overall survival (OS) from the commencement of TKI. (B) Progression-free survival (PFS) from local therapy to systemic progression. (C) PFS from the commencement of TKI to systemic progression. CI, confidence interval.

• 

  Fig. 2 Kaplan-Meier curves of clinical outcomes for subgroup analyses according to the criterion of oligometastasis. (A) Overall survival from the commencement of tyrosine kinase inhibitor (TKI). (B) Progression-free survival from local therapy to systemic progression. (C) Progression-free survival from the commencement of TKI to systemic progression. EORTC-LCG, The European Organization of Research and Treatment of Cancer Lung Cancer Group; NCCN, National Comprehensive Cancer Network.

• 

  Fig. 3 Risk-adjusted hazard ratios (HRs) associated with clinical outcomes according to the criterion of oligometastasis (OM). Shown were HRs, with 95% confidence interval (CI), which were performed with the use of a Cox proportional hazards model. An HR of less than 1.00 indicates a lower risk of clinical outcomes with OM group than non-OM group. Co-variable selection was based on statistical significance. Progression-free survival (PFS) 1 was defined as PFS from local therapy to systemic progression, and PFS2 as PFS from the commencement of tyrosine kinase inhibitor to systemic progression. EORTC-LCG, The European Organization of Research and Treatment of Cancer Lung Cancer Group; NCCN, National Comprehensive Cancer Network.

Reference

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