Exploring the Role of Preoperative Systemic Therapy and Primary Resection in NSCLC With Extrathoracic Metastases: Identifying the Optimal Candidates
Background In non-small cell lung cancer (NSCLC), patients with extrathoracic metastases typically have a poor prognosis, with systemic chemotherapy being the standard care. The full potential of primary resection therapy (PRT) in these patients, especially during the immunotherapy era, is not fully...
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2024-11-01
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| Series: | Cancer Control |
| Online Access: | https://doi.org/10.1177/10732748241304973 |
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| author | Xuanhong Jin MD Xinyu Zhu MD Hangchen Shen MD Chongya Zhai PhD Hongming Pan PhD Liangkun You PhD |
| author_facet | Xuanhong Jin MD Xinyu Zhu MD Hangchen Shen MD Chongya Zhai PhD Hongming Pan PhD Liangkun You PhD |
| author_sort | Xuanhong Jin MD |
| collection | DOAJ |
| description | Background In non-small cell lung cancer (NSCLC), patients with extrathoracic metastases typically have a poor prognosis, with systemic chemotherapy being the standard care. The full potential of primary resection therapy (PRT) in these patients, especially during the immunotherapy era, is not fully established. Additionally, the effectiveness of systemic preoperative therapy in this context is unclear. Methods This retrospective study identified NSCLC patients with extrathoracic metastases from the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2019. We compared the survival rates of those treated with just chemotherapy vs those receiving both chemotherapy and PRT. Results In a study of 41 909 patients with extrathoracic metastatic NSCLC receiving chemotherapy, we found that adding PRT significantly increased overall survival (median OS post-PSM: 18 months vs 11 months, P < 0.001). However, in the immunotherapy era, its effectiveness was less pronounced (HR: 0.56 vs 0.7, P for interaction = 0.011). For patients who have metastases to multiple distant organs, combined distant organ and distant lymph node metastases, or lung metastases, no additional survival benefit from PRT was observed (all P > 0.05). Patients receiving systemic preoperative therapy before PRT had significantly better outcomes than those who did not (HR = 0.69, P < 0.001). A predictive nomogram was developed and validated, showing AUCs of 0.751 and 0.766 in the training and test sets. Conclusion In both pre- and post-immunotherapy eras, patients with extrathoracic metastatic NSCLC benefit more from adding primary tumor resection to chemotherapy, especially those with preoperative systemic therapy. We created a precise nomogram to identify the best candidates for PRT among patients with extrathoracic NSCLC metastases. |
| format | Article |
| id | doaj-art-2adc65a5ac77456c9d8be47c24d6ddc0 |
| institution | Kabale University |
| issn | 1526-2359 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Cancer Control |
| spelling | doaj-art-2adc65a5ac77456c9d8be47c24d6ddc02024-12-04T22:03:21ZengSAGE PublishingCancer Control1526-23592024-11-013110.1177/10732748241304973Exploring the Role of Preoperative Systemic Therapy and Primary Resection in NSCLC With Extrathoracic Metastases: Identifying the Optimal CandidatesXuanhong Jin MDXinyu Zhu MDHangchen Shen MDChongya Zhai PhDHongming Pan PhDLiangkun You PhDBackground In non-small cell lung cancer (NSCLC), patients with extrathoracic metastases typically have a poor prognosis, with systemic chemotherapy being the standard care. The full potential of primary resection therapy (PRT) in these patients, especially during the immunotherapy era, is not fully established. Additionally, the effectiveness of systemic preoperative therapy in this context is unclear. Methods This retrospective study identified NSCLC patients with extrathoracic metastases from the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2019. We compared the survival rates of those treated with just chemotherapy vs those receiving both chemotherapy and PRT. Results In a study of 41 909 patients with extrathoracic metastatic NSCLC receiving chemotherapy, we found that adding PRT significantly increased overall survival (median OS post-PSM: 18 months vs 11 months, P < 0.001). However, in the immunotherapy era, its effectiveness was less pronounced (HR: 0.56 vs 0.7, P for interaction = 0.011). For patients who have metastases to multiple distant organs, combined distant organ and distant lymph node metastases, or lung metastases, no additional survival benefit from PRT was observed (all P > 0.05). Patients receiving systemic preoperative therapy before PRT had significantly better outcomes than those who did not (HR = 0.69, P < 0.001). A predictive nomogram was developed and validated, showing AUCs of 0.751 and 0.766 in the training and test sets. Conclusion In both pre- and post-immunotherapy eras, patients with extrathoracic metastatic NSCLC benefit more from adding primary tumor resection to chemotherapy, especially those with preoperative systemic therapy. We created a precise nomogram to identify the best candidates for PRT among patients with extrathoracic NSCLC metastases.https://doi.org/10.1177/10732748241304973 |
| spellingShingle | Xuanhong Jin MD Xinyu Zhu MD Hangchen Shen MD Chongya Zhai PhD Hongming Pan PhD Liangkun You PhD Exploring the Role of Preoperative Systemic Therapy and Primary Resection in NSCLC With Extrathoracic Metastases: Identifying the Optimal Candidates Cancer Control |
| title | Exploring the Role of Preoperative Systemic Therapy and Primary Resection in NSCLC With Extrathoracic Metastases: Identifying the Optimal Candidates |
| title_full | Exploring the Role of Preoperative Systemic Therapy and Primary Resection in NSCLC With Extrathoracic Metastases: Identifying the Optimal Candidates |
| title_fullStr | Exploring the Role of Preoperative Systemic Therapy and Primary Resection in NSCLC With Extrathoracic Metastases: Identifying the Optimal Candidates |
| title_full_unstemmed | Exploring the Role of Preoperative Systemic Therapy and Primary Resection in NSCLC With Extrathoracic Metastases: Identifying the Optimal Candidates |
| title_short | Exploring the Role of Preoperative Systemic Therapy and Primary Resection in NSCLC With Extrathoracic Metastases: Identifying the Optimal Candidates |
| title_sort | exploring the role of preoperative systemic therapy and primary resection in nsclc with extrathoracic metastases identifying the optimal candidates |
| url | https://doi.org/10.1177/10732748241304973 |
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