title: Metastatectomy for extra-cranial extra-adrenal non-small cell lung cancer solitary metastases: systematic review and analysis of reported cases.
abstract: BACKGROUND
  Although patients with stage IV non-small cell lung cancer (NSCLC) have a poor prognosis, a subset of patients with solitary brain or adrenal metastasis have more favorable outcome following surgical resection. Nevertheless, the outcome and predictive factors for survival following metastatectomy for patients with other metastatic sites are not well defined.
  
  
  METHODS
  We performed a systematic review using PUBMED database for all articles which included patients with NSCLC and solitary metastasis to sites other than the adrenal gland or the brain who had undergone resection of their metastasis and definitive treatment of the primary lung cancer. Potential prognostic factors on survival including age, sex, histology, T and N stage of the primary tumor, synchronous vs. metachronous presentation, visceral vs. non-visceral metastasis and the use of perioperative chemotherapy were analyzed using multi-variable Cox proportional hazard model.
  
  
  RESULTS
  62 cases were eligible for the analysis. The 5-year survival rate was 50% for the entire cohort. Mediastinal lymph node involvement was independently predictive of inferior outcome; 5-year survival rate 0% vs. 64% in favor of no involvement, p<0.001. Similarly, patients with intra-thoracic stage III disease had an inferior outcome compared to patients with stage II and stage I disease: 5-year survival rate 0% vs. 77% and 63%, respectively, p<0.001. Other factors have no effect on outcome.
  
  
  CONCLUSIONS
  Selected patients with distant metastatic NSCLC can achieve long term survival following metastatectomy and definitive treatment of the primary tumor. Mediastinal lymph node involvement is associated with poor prognosis.
authors.affiliation: Medical Oncology Department, King Hussein Cancer Center, Al-Jubeiha, Amman 11941, Jordan. ssalah@khcc.jo
authors.forename: Samer
authors.initials: S
authors.lastname: Salah
authors.forename: Tawee
authors.initials: T
authors.lastname: Tanvetyanon
authors.forename: Salah
authors.initials: S
authors.lastname: Abbasi
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology* / Q000556:secondary / Q000601:surgery*; D015331:Cohort Studies; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology* / Q000601:surgery*; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D015996:Survival Rate