Abstract
Introduction
Lung cancer with extrathoracic metastases is classified as M1c. However, extrathoracic metastases can be further classified into different patterns. The purpose of this study was to analyze the survival differences between different patterns of extrathoracic metastases in patients with stage M1c lung adenocarcinoma after receiving immunotherapy.
Materials and methods
This study included 160 stage M1c lung adenocarcinoma patients and treated with immunotherapy. The enrolled patients were divided into two groups: those with multiple extrathoracic metastases alone (EM group) and those with simultaneous multiple extrathoracic and intrathoracic metastases (EIM group). Progression-free survival (PFS) and overall survival (OS) were evaluated.
Results
The median PFS and OS in the whole group were 7.7 months and 25.4 months, respectively. The patients in the EM group show better PFS (13.0 months vs. 5.0 months; hazard ratio [HR] = 0.462, 95% confidence interval [CI] 0.317–0.673, P < 0.0001) and OS (35.0 months vs. 18.9 months; HR 0.592, 95% CI 0.380–0.922, P = 0.019) compared with the EIM group. Furthermore, in patients with lung adenocarcinoma with simultaneous extrathoracic and intrathoracic metastases who received immunotherapy, immunotherapy combined with chemotherapy has better PFS and OS than immunotherapy alone. There was no difference between immunotherapy alone or combined with chemotherapy in patients with lung adenocarcinoma with extrathoracic metastasis alone.
Conclusion
The different patterns of extrathoracic metastasis were related to the efficacy and prognosis of immunotherapy in M1c cohort. In addition, patients with simultaneous extrathoracic and intrathoracic metastases were more recommended to choose immunotherapy in combination with chemotherapy rather than immunotherapy alone.
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Data availability
The data of the current study are available from the corresponding author and first author on reasonable request.
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Acknowledgements
This study was supported in part by the Chinese Society of Clinical Oncology (CSCO) Tumor Research Fund (No. Y-2019AZZD-0038), the Beijing Medical and health public welfare foundation project (No. YWJKJJHKYJ), and the National Natural Science Foundation of China (No. 82150005). The funding agencies played no role in the design, analysis or publication of the results of the study. The authors are grateful to all patients and their families for their participation in this study.
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Conception and design of study: Fang Hu, Liyan Jiang; Acquisition of data: Fang Hu, Jin Peng, Yanjie Niu, Meili Ma, Yizhuo Zhao, Aiqin Gu; Analysis and interpretation of data: Fang Hu, Jin Peng, Xiaowei Mao; All authors reviewed the manuscript.
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This study was approved by the institutional review board of the Shanghai Chest Hospital (Shanghai, China; approval number: IS21127), and carried out in accordance with the Declaration of Helsinki.
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Hu, F., Peng, J., Mao, X. et al. Prognosis of different extrathoracic metastasis patterns in patients with M1c lung adenocarcinoma receiving immunotherapy. J Cancer Res Clin Oncol 149, 3171–3184 (2023). https://doi.org/10.1007/s00432-022-04182-z
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DOI: https://doi.org/10.1007/s00432-022-04182-z