title: Survival of patients treated surgically for synchronous single-organ metastatic NSCLC and advanced pathologic TN stage.
abstract: BACKGROUND
  Patients with stage IV metastatic non-small cell lung cancer (NSCLC) are generally not considered for surgery due to their poor median survival ranging from 4 to 11 months. However published results suggested that carefully selected patients with oligometastatic disease may benefit from resection of both the primary and metastatic sites in a multidisciplinary treatment approach. The aim of the study was to analyze and detect prognostic factors in surgically treated patients with synchronous single-organ metastasis from NSCLC.
  
  
  METHODS
  This is a retrospective single-center study including 29 patients with synchronous single-organ metastatic NSCLC who underwent lung resection and local treatment of the metastasis between 2002 and 2008. Overall survival was estimated from the date of lung surgery until last follow-up. The impact on survival of nine variables (age, pT, pN, site of metastasis, presence of solitary metastasis, R-resection status, presence of neoadjuvant or adjuvant treatment, tumor histology) were further assessed.
  
  
  RESULTS
  Twenty-nine patients (20 males, 69%) with a median age of 62 (from 44 to 77) were included. Site of metastatic disease was the brain in 19, the lung in 8 and the adrenal glands in 2 patients. Histology was adenocarcinoma in 21, large-cell carcinoma in 3, squamous-cell carcinoma in 2 and other in 3 patients. Type of lung resection performed for primary tumors were pneumonectomy in 3, bilobar resection in 3, lobar resection in 17 and sublobar resection in 6 patients. Survival at 1 and 5 years for the overall population reached 65% and 36%, respectively. Median survival was 20.5 months. Univariate regression model analysis identified pathologic T stage as a predictor of survival. Patients with pT1-2 behaved statistically significantly better (p=0.007) compared to patients with pT3-4 tumors. No impact on survival for the other 8 variables has been shown.
  
  
  CONCLUSIONS
  The 5-year survival rate of 36% confirms that multimodality treatment including surgical lung resection should be considered in the therapy of single-site metatastatic NSCLC for selected patients. Pathologic T stage appeared to have significant impact on predicting patient survival.
authors.affiliation: Division of Thoracic Surgery, University Hospital Zurich, Rämistrasse 100, CH-8091 Zürich, Switzerland. stephane.collaud@gmail.com
authors.forename: Stéphane
authors.initials: S
authors.lastname: Collaud
authors.forename: Rolf
authors.initials: R
authors.lastname: Stahel
authors.forename: Ilhan
authors.initials: I
authors.lastname: Inci
authors.forename: Sven
authors.initials: S
authors.lastname: Hillinger
authors.forename: Didier
authors.initials: D
authors.lastname: Schneiter
authors.forename: Peter
authors.initials: P
authors.lastname: Kestenholz
authors.forename: Walter
authors.initials: W
authors.lastname: Weder
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000401:mortality* / Q000556:secondary / Q000601:surgery; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality* / Q000556:secondary / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012044:Regression Analysis; D012189:Retrospective Studies