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Validation of prognostic impact of number of extrathoracic metastases according to the eighth TNM classification: a single-institution retrospective study in Japan

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Abstract

Background

In the eighth edition of the TNM classification of lung cancer, the M1b and M1c descriptors are newly defined by the number of extrathoracic metastases. To verify the prognostic value of these descriptors in Japan, we reclassified our cases and re-evaluated prognosis in M1b and M1c patients.

Methods

All non-small cell lung cancer (NSCLC) patients with extrathoracic metastases who visited Saitama Medical Center from 2010 to 2016 were evaluated, divided according to the eighth edition of the TNM classification criteria into two groups (M1b, patients with single extrathoracic metastasis, and M1c, patients with multiple extrathoracic metastases), and followed up until December 31, 2017. Survival time analysis was performed using the Kaplan–Meier method, and between-group differences in overall survival time (OS) were evaluated by the log-rank test.

Results

A total of 231 NSCLC patients were divided into 57 patients with M1b and 174 with M1c. Median OS was 15.2 months (95% confidence interval [CI]: 9.3–19.9) and 7.3 months (95% CI 5.7–10.7) for M1b and M1c, respectively, with no significant between-group difference (P = 0.239). However, after excluding patients with epidermal growth factor receptor (EGFR) mutation or echinoderm microtubule-associated protein-like 4 and anaplastic lymphoma kinase (EML4–ALK) fusion gene, median OS was 12.9 months (95% CI 7.2–19.9) for M1b and 5.4 months (95% CI 3.8–6.3) for M1c, respectively, showing a significant difference (P = 0.029).

Conclusions

The effect of therapy directed toward EGFR mutation or EML4–ALK fusion gene might obscure the significant prognostic difference between M1b and M1c.

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Acknowledgements

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Pulmonary Medicine, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan

    Kosuke Sakai, Joji Kuramoto, Akitoshi Kojima, Hiroaki Nishimura, Yoshiki Kuwabara, Maiko Toda, Yumiko Kobayashi, Satoshi Kikuchi, Yusuke Hirata, Yuriko Mikami-Saito, Shintaro Mikami, Hiroyuki Kyoyama, Gaku Moriyama & Kazutsugu Uematsu

  2. Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan

    Kosuke Sakai, Yumiko Kobayashi, Gaku Moriyama & Akihiko Gemma

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  1. Kosuke Sakai
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  2. Joji Kuramoto
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  3. Akitoshi Kojima
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  15. Kazutsugu Uematsu
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Corresponding author

Correspondence to Kazutsugu Uematsu.

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Conflict of interest

Kosuke Sakai received research funding from Eli-Lilly. Akihiko Gemma received honoraria from Nippon Boehringer Ingelheim, Pfizer, Ono Pharmaceutical, Taiho Phamaceutical, MSD, AstraZeneca, Chugai Pharmaceutical and Nippon Kayaku.

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Sakai, K., Kuramoto, J., Kojima, A. et al. Validation of prognostic impact of number of extrathoracic metastases according to the eighth TNM classification: a single-institution retrospective study in Japan. Int J Clin Oncol 24, 1549–1557 (2019). https://doi.org/10.1007/s10147-019-01525-8

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  • DOI: https://doi.org/10.1007/s10147-019-01525-8

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