title: Number of liver metastatic nodules affects treatment options for pulmonary adenocarcinoma patients with liver metastases.
abstract: BACKGROUND
  In patients with non-small cell lung cancer (NSCLC), the development of liver metastasis (LM) is a poor prognostic factor. Whether systemic treatment combined with local treatment for LM has benefit for NSCLC patients with LM is unknown.
  
  
  METHODS
  We retrospectively reviewed and analyzed the clinical data and tumor epidermal growth factor receptor (EGFR) mutation status of 673 pulmonary adenocarcinoma patients, including 85 patients who developed LM at any time point in the course of the disease. Radiofrequency ablation (RFA) with real-time ultrasonographic guidance was used for local treatment of LM in these patients, if appropriate.
  
  
  RESULTS
  Patients with an EGFR mutation were more prone to having synchronous LM than patients with EGFR wild-type (50.0% vs. 23.5%, P=0.019). Fifty-six patients (65.9%) had ≦5 LM nodules. The median overall survival (OS) of patients with ≦5 LM nodules was 7.6 months compared with 2.9 months for those with multiple nodules (P<0.001). The independent prognostic factors after LM were performance status, EGFR mutation, synchronous LM and LM numbers. The independent prognostic factors for patients with ≦5 LM nodules were performance status, EGFR mutation, LM concomitant with adrenal metastasis and having received RFA. Patients who received RFA treatment (n=6) had longer OS after LM than those without RFA treatment (n=42) (23.1 vs. 7.9 months, P=0.035).
  
  
  CONCLUSIONS
  We recommend that patients with a better performance status and ≦5 LM nodules be considered for systemic treatment combined with RFA when LM develops.
authors.affiliation: Internal Medicine Department, Zhongxing Branch, Taipei City Hospital, Taipei, Taiwan.
authors.forename: Shih-En
authors.initials: SE
authors.lastname: Tseng
authors.affiliation: Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University, School of Medicine, Taipei, Taiwan.
authors.forename: Yi-You
authors.initials: YY
authors.lastname: Chiou
authors.affiliation: Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University, School of Medicine, Taipei, Taiwan.
authors.forename: Yu-Chin
authors.initials: YC
authors.lastname: Lee
authors.affiliation: Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University, School of Medicine, Taipei, Taiwan.
authors.forename: Reury-Perng
authors.initials: RP
authors.lastname: Perng
authors.affiliation: Center of Excellent Cancer Research, Taipei Medical University, Taipei, Taiwan.
authors.forename: Whang-Peng
authors.initials: WP
authors.lastname: Jacqueline
authors.affiliation: Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University, School of Medicine, Taipei, Taiwan; Center of Excellent Cancer Research, Taipei Medical University, Taipei, Taiwan. Electronic address: ymchen@vghtpe.gov.tw.
authors.forename: Yuh-Min
authors.initials: YM
authors.lastname: Chen
mesh_terms: D000230:Adenocarcinoma / Q000235:genetics / Q000473:pathology / Q000628:therapy; D000077192:Adenocarcinoma of Lung; D000368:Aged; D003131:Combined Modality Therapy; D066246:ErbB Receptors / Q000235:genetics; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000556:secondary*; D008175:Lung Neoplasms / Q000235:genetics / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009154:Mutation; D011379:Prognosis; D012307:Risk Factors; D016896:Treatment Outcome; D047368:Tumor Burden
chemical_list: D066246:ErbB Receptors
keywords: Epidermal growth factor receptor (EGFR); Liver metastasis; Prognostic factors; Pulmonary adenocarcinoma; Radiofrequency ablation (RFA); Survival