Single-Site Oligometastatic Lung Cancer: Is Resection of the Primary Tumor Beneficial?

By: Celeste L. Dixon
Posted: Tuesday, March 12, 2024

In a study of more than 12,000 patients with single-site synchronous oligometastatic non–small cell lung cancer (NSCLC) who had received systemic therapy, overall survival was improved in selected patients who also had undergone surgery for the primary tumor vs those who had not (median, 36.8 vs 20.8 months; log-rank P < .001). Brendon M. Stiles, MD, of Montefiore Medical Center, New York, and colleagues described their work—a propensity-matched analysis—in the Journal of the American College of Surgeons.

“This survival advantage persisted after adjustments for various sociodemographic, clinical, and tumor-related factors, demonstrating its robustness across different subgroups. Advances in systemic therapy for patients with NSCLC should arguably change the paradigm of surgical eligibility,” the investigators concluded.

Surgery and resection of the metastatic site were both associated with improved survival (hazard ratios = 0.67 and 0.80, respectively). According to one hypothesis, this may be related to local therapy for the primary tumor removing resistant cancer cells as well as immunosuppressive cells from the tumor microenvironment, potentially improving response to systemic therapy. However, the team found, the patients who underwent surgery also were younger, more often White, had higher income levels, were more likely to have private insurance, and were more often treated at an academic facility.

Of the 12,215 patients from the National Cancer Database (2018–2020) with clinical stage IVA disease who had received systemic therapy (chemotherapy or immunotherapy), 2.9% had undergone surgery for the primary tumor (n = 349; of them, 80 also had undergone resection of the distant metastatic site), and 97.1% (n = 11,886) had not. Metastasis to the bone, node-positive disease, and higher T stage were found to be independently associated with less surgery.

The 30% improvement in 3-year overall survival for patients undergoing resection of the primary site is “substantial… [and] this positive impact was even more pronounced when a negative margin was achieved,” wrote Dr. Stiles and co-investigators.

Disclosure: For full disclosures of the study authors, visit journals.lww.com.

Journal of the American College of Surgeons