Abstract
Objective
The TNM 8 lung cancer staging system reclassifies patients with a solitary extrathoracic metastasis as M1b and two or more extrathoracic metastases as M1c. This study investigates the clinical relevance of this change.
Methods
Advanced lung cancer patients were retrospectively restaged according to the TNM8 M1b and M1c classifiers. Overall survival was compared in M1b and M1c patients staged with and without PET-CT. We then summarized the TNM 8 staging classification and the relevant literature on the treatment of oligometastatic lung cancer.
Results
In all, 82 patients with metastatic lung cancer were reclassified according to the TNM 8: 14 had M1b and 58 had M1c disease. Those with M1b disease lived significantly longer than those with M1c disease (15.2 vs. 7.3 months, p = 0.0029). Among those with M1b disease, survival was the highest when M1b status was confirmed by PET-CT (21.4 vs. 7 months). M1c patients with 4 or less distant metastases had a trend to longer survival vs. M1c patients with 5 or more metastases (9.4 vs. 7.3 months), especially when PET-CT staging was used (13.9 months).
Conclusions
We confirmed the prognostic value of the M1b and M1c descriptors in a Western European tertiary care population. The use of PET-CT seems to increase the prognostic value of the M descriptor and may define an additional oligometastatic subgroup of M1c patients. Clinical trials investigating the treatment of patients with varying degrees of metastatic disease are needed and should be based on PET-CT staging.
Zusammenfassung
Zielsetzung
Das TNM-8-Staging reklassifiziert Patienten mit einer solitären extrathorakalen Metastase als M1b und mit zwei bis mehreren extrathorakalen Metastasen als M1c. Die Studie untersucht die klinische Relevanz dieser Änderung.
Methoden
Patienten mit fortgeschrittenem Lungenkarzinom wurden retrospektiv anhand der TNM-8-M1b- und -M1c-Einteilung analysiert. Das Gesamtüberleben von Patienten im Stadium M1b und M1c mit oder ohne PET-CT-Staging wurde verglichen. Außerdem fassten wir die Ergebnisse der TNM-8-Staging-Klassifikation und die aktuelle Literatur zur Behandlung des oligometastatischen Lungenkarzinoms zusammen.
Ergebnisse
Insgesamt 82 Patienten mit einem oligometastatischen Lungenkarzinom wurden mittels TNM 8 reklassifiziert: 14 hatten eine M1b- und 58 eine M1c-Erkrankung. M1b-Patienten lebten signifikant länger als M1c-Patienten (15,2 vs. 7,3 Monate; p = 0,0029). M1b-Patienten zeigten das beste Gesamtüberleben, wenn sich der M1b-Status mittels PET-CT bestätigen ließ (21,4 vs. 7 Monate). M1c-Patienten mit 4 oder weniger Fernmetastasen wiesen ein tendenziell längeres Überleben auf als M1c-Patienten mit 5 oder mehr Metastasen (9,4 vs. 7,3 Monate), insbesondere, wenn die PET-CT verwendet wurde (13,9 Monate).
Schlussfolgerung
Wir konnten den positiven prognostischen Effekt der vorgeschlagenen M1b- und M1c-Deskriptoren in einer westeuropäischen Population mit Maximalversorgung bestätigen. Die PET-CT scheint die prognostische Vorhersagekraft des M-Deskriptors zu steigern und kann eine zusätzliche oligometastatische Subgruppe von M1c-Patienten definieren. Klinische Studien, welche die Behandlung von Patienten mit unterschiedlichem Ausmaß der metastatischen Erkrankung untersuchen, sind nötig und sollten auf dem PET-CT-Staging basieren.
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A. Tufman, K. Kahnert, D. Kauffmann-Guerrero, F. Manapov, K. Milger, U. Müller-Lisse, H. Winter, R.M. Huber and C. Schneider declare that they have no competing interests.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This retrospective analysis of anonymized tumor and treatment data was approved by the institutional ethics board (Ludwig Maximilians University).
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AT, KK, HW, FM, CS, KM, DK, UML and RMH designed the study, performed the literature search, and wrote and revised the manuscript. AT, KK, DK , FM and KM reviewed the patient charts and documented clinical data, and AT, RMH, KK, HW and CS performed the statistical analysis.
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Tufman, A., Kahnert, K., Kauffmann-Guerrero, D. et al. Clinical relevance of the M1b and M1c descriptors from the proposed TNM 8 classification of lung cancer. Strahlenther Onkol 193, 392–401 (2017). https://doi.org/10.1007/s00066-017-1118-9
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DOI: https://doi.org/10.1007/s00066-017-1118-9