title: Patterns of Distant Metastases After Surgical Management of Non-Small-cell Lung Cancer.
abstract: Patients with limited metastases, oligometastases (OMs), might have improved outcomes compared with patients with widespread distant metastases (DMs). The incidence and behavior of OMs from non-small-cell lung cancer (NSCLC) need further characterization.
  
  
  
  The medical records of patients who had undergone surgery for stage I-III NSCLC from 1995 to 2009 were retrospectively reviewed. All information pertaining to development of the first metastatic progression was recorded and analyzed. Patients with DMs were categorized into OMs (1-3 lesions potentially amenable to local therapy) and DM subgroups.
  
  
  
  Of 1719 patients reviewed, 368 (21%) developed DMs with a median follow-up period of 39 months. A single lesion was diagnosed in 115 patients (31%) and 69 (19%) had 2 to 3 lesions (50% oligometastatic). The median survival from the DM diagnosis for oligometastatic and diffuse DM was 12.4 and 6.1 months, respectively (hazard ratio, 0.54; 95% confidence interval, 0.42-0.68; P < .001). Patients with a single metastasis had the longest median survival at 14.7 months. Younger age, OM, the use of chemotherapy for the primary tumor, and DM detection by surveillance imaging were independently associated with improved survival.
  
  
  
  DMs and OMs are common in surgically managed NSCLC. Overall survival appears to be prolonged with OM.
authors.affiliation: Department of Radiation Oncology, Duke University Medical Center, Durham, NC. Electronic address: jordan.torok@dm.duke.edu.
authors.forename: Jordan A
authors.initials: JA
authors.lastname: Torok
authors.affiliation: Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC.
authors.forename: Lin
authors.initials: L
authors.lastname: Gu
authors.affiliation: Department of Radiation Oncology, Duke University Medical Center, Durham, NC.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Tandberg
authors.affiliation: Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC.
authors.forename: Xiaofei
authors.initials: X
authors.lastname: Wang
authors.affiliation: Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.
authors.forename: David H
authors.initials: DH
authors.lastname: Harpole
authors.affiliation: Department of Radiation Oncology, Duke University Medical Center, Durham, NC.
authors.forename: Chris R
authors.initials: CR
authors.lastname: Kelsey
authors.affiliation: Department of Radiation Oncology, Duke University Medical Center, Durham, NC.
authors.forename: Joseph K
authors.initials: JK
authors.lastname: Salama
mesh_terms: D000230:Adenocarcinoma / Q000556:secondary / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018287:Carcinoma, Large Cell / Q000556:secondary / Q000601:surgery*; D002289:Carcinoma, Non-Small-Cell Lung / Q000556:secondary / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000556:secondary / Q000601:surgery*; D019468:Disease Management; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult
keywords: Disease progression; NSCLC; Oligometastases; Recurrence; Survival