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The TNM 8 M1b and M1c classification for non-small cell lung cancer in a cohort of patients with brain metastases

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Abstract

Background and purpose

According to the recent TNM 8 classification, patients with metastatic non-small cell lung cancer (NSCLC) and single extrathoracic metastasis should be classified as stage M1b, while those with 2 or more metastases comprise stage M1c. The purpose of this study was to analyze the impact of this classification in patients with brain metastases.

Materials and methods

This retrospective study included 172 patients treated with individualized approaches. Actuarial survival was calculated. Uni- and multivariate analyses were performed.

Results

Thirty patients (17%) were staged as M1b. Those with squamous cell cancer were more likely to harbor M1b disease (29%, adenocarcinoma 14%, other histology 17%, p = 0.16). Median survival was 5.4 months (8.0 months in case of M1b disease and 4.5 months in case of M1c disease, p = 0.001). Multivariate analysis confirmed the role of M1b stage. M1b patients managed with upfront surgery or radiosurgery had significantly longer median survival than those who received whole-brain irradiation (21.0 vs. 3.5 months, p = 0.0001) and the potential to survive beyond 5 years.

Conclusions

We found the M1b classification to provide clinically relevant information. The multivariate analysis suggested that patients with M1b disease, better performance status and younger age have better survival.

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References

  1. Goldstraw P, Chansky K, Crowley J, Rami-Porta R, Asamura H, Eberhardt WE, et al. International Association for the Study of Lung Cancer Staging and Prognostic Factors Committee, Advisory Boards, and Participating Institutions. The IASLC lung cancer staging project: proposals for revision of the TNM stage groupings in the forthcoming (eighth) edition of the TNM classification for lung cancer. J Thorac Oncol. 2016;11:39–51.

    Article  PubMed  Google Scholar 

  2. Asamura H, Chansky K, Crowley J, Goldstraw P, Rusch VW, Vansteenkiste JF, et al. International Association for the Study of Lung Cancer Staging and Prognostic Factors Committee, Advisory Board Members, and Participating Institutions. The International Association for the Study of Lung Cancer Lung Cancer Staging Project: Proposals for the revision of the N descriptors in the forthcoming 8th edition of the TNM classification for lung cancer. J Thorac Oncol. 2015;10:1675–84.

    Article  CAS  PubMed  Google Scholar 

  3. Eberhardt WE, Mitchell A, Crowley J, Kondo H, Kim YT, Turrisi A, et al. International Association for Study of Lung Cancer Staging and Prognostic Factors Committee, Advisory Board Members, and Participating Institutions. The IASLC Lung Cancer Staging Project: Proposals for the revision of the M descriptors in the forthcoming 8th edition of the TNM classification of lung cancer. J Thorac Oncol. 2015;10:1515–22.

    Article  PubMed  Google Scholar 

  4. Enders F, Geisenberger C, Jungk C, Bermejo JL, Warta R, von Deimling A, et al. Prognostic factors and long-term survival in surgically treated brain metastases from non-small cell lung cancer. Clin Neurol Neurosurg. 2016;142:72–80.

    Article  PubMed  Google Scholar 

  5. Nieder C, Spanne O, Mehta MP, Grosu AL, Geinitz H. Presentation, patterns of care, and survival in patients with brain metastases: what has changed in the last 20 years? Cancer. 2011;117:2505–12.

    Article  PubMed  Google Scholar 

  6. Goncalves PH, Peterson SL, Vigneau FD, Shore RD, Quarshie WO, Islam K, et al. Risk of brain metastases in patients with nonmetastatic lung cancer: analysis of the metropolitan detroit surveillance, epidemiology, and end results (SEER) data. Cancer. 2016;122:1921–7.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Hendriks LE, Troost EG, Steward A, Bootsma GP, De Jaeger K, van den Borne BE, et al. Patient selection for whole brain radiotherapy (WBRT) in a large lung cancer cohort: impact of a new dutch guideline on brain metastases. Acta Oncol. 2014;53:945–51.

    Article  CAS  PubMed  Google Scholar 

  8. Khalifa J, Amini A, Popat S, Gaspar LE. Faivre-Finn C; International Association for the Study of Lung Cancer Advanced Radiation Technology Committee. Brain metastases from NSCLC: radiation therapy in the era of targeted therapies. J Thorac Oncol. 2016;11:1627–43.

    Article  PubMed  Google Scholar 

  9. Greto D, Scoccianti S, Compagnucci A, Arilli C, Casati M, Francolini G, et al. Gamma Knife radiosurgery in the management of single and multiple brain metastases. Clin Neurol Neurosurg. 2016;141:43–7.

    Article  CAS  PubMed  Google Scholar 

  10. Nieder C, Grosu AL, Marienhagen K, Andratschke NH, Geinitz H. Non-small cell lung cancer histological subtype has prognostic impact in patients with brain metastases. Med Oncol. 2012;29:2664–8.

    Article  CAS  PubMed  Google Scholar 

  11. Nieder C, Andratschke NH, Geinitz H, Grosu AL. Diagnosis-specific graded prognostic assessment score is valid in patients with brain metastases treated in routine clinical practice in two European countries. Med Sci Monit. 2012;18:CR450–5.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Gaspar LE, Scott C, Murray K, Curran W. Validation of the RTOG recursive partitioning analysis (RPA) classification for brain metastases. Int J Radiat Oncol Biol Phys. 2000;47:1001–6.

    Article  CAS  PubMed  Google Scholar 

  13. Sperduto PW, Chao ST, Sneed PK, Luo X, Suh J, Roberge D, et al. Diagnosis-specific prognostic factors, indexes, and treatment outcomes for patients with newly diagnosed brain metastases: a multi-institutional analysis of 4,259 patients. Int J Radiat Oncol Biol Phys. 2010;77:655–61.

    Article  PubMed  Google Scholar 

  14. Sperduto PW, Kased N, Roberge D, Xu Z, Shanley R, Luo X, et al. Summary report on the graded prognostic assessment: an accurate and facile diagnosis-specific tool to estimate survival for patients with brain metastases. J Clin Oncol. 2012;30:419–25.

    Article  PubMed  Google Scholar 

  15. Xu Q, Wang Y, Liu H, Meng S, Zhou S, Xu J, et al. Treatment outcome for patients with primary NSCLC and synchronous solitary metastasis. Clin Transl Oncol. 2013;15:802–9.

    Article  CAS  PubMed  Google Scholar 

  16. Kashima J, Okuma Y, Miwa M, Hosomi Y. Survival of patients with brain metastases from non-small cell lung cancer harboring EGFR mutations treated with epidermal growth factor receptor tyrosine kinase inhibitors. Med Oncol. 2016;33:129.

    Article  PubMed  Google Scholar 

  17. Soon YY, Leong CN, Koh WY, Tham IW. EGFR tyrosine kinase inhibitors versus cranial radiation therapy for EGFR mutant non-small cell lung cancer with brain metastases: a systematic review and meta-analysis. Radiother Oncol. 2015;114:167–72.

    Article  CAS  PubMed  Google Scholar 

  18. Nieder C, Bremnes RM, Andratschke NH. Prognostic scores in patients with brain metastases from non-small cell lung cancer. J Thorac Oncol. 2009;4:1337–41.

    Article  PubMed  Google Scholar 

  19. Parlak C, Mertsoylu H, Güler OC, Onal C, Topkan E. Definitive chemoradiation therapy following surgical resection or radiosurgery plus whole-brain radiation therapy in non-small cell lung cancer patients with synchronous solitary brain metastasis: a curative approach. Int J Radiat Oncol Biol Phys. 2014;88:885–91.

    Article  PubMed  Google Scholar 

  20. Yuksel C, Bozkurt M, Yenigun BM, Enon S, Ozkan M, Kose SK, et al. The outcome of bifocal surgical resection in non-small cell lung cancer with synchronous brain metastases: results of a single center retrospective study. Thorac Cardiovasc Surg. 2014;62:605–11.

    PubMed  Google Scholar 

  21. Louie AV, Rodrigues G, Yaremko B, Yu E, Dar AR, Dingle B, et al. Management and prognosis in synchronous solitary resected brain metastasis from non-small-cell lung cancer. Clin Lung Cancer. 2009;10:174–9.

    Article  PubMed  Google Scholar 

  22. Flannery TW, Suntharalingam M, Regine WF, Chin LS, Krasna MJ, Shehata MK, et al. Long-term survival in patients with synchronous, solitary brain metastasis from non-small-cell lung cancer treated with radiosurgery. Int J Radiat Oncol Biol Phys. 2008;72:19–23.

    Article  PubMed  Google Scholar 

  23. Hu C, Chang EL, Hassenbusch SJ 3rd, Allen PK, Woo SY, Mahajan A, et al. Nonsmall cell lung cancer presenting with synchronous solitary brain metastasis. Cancer. 2006;106:1998–2004.

    Article  PubMed  Google Scholar 

  24. Navarro-Martin A, Aso S, Cacicedo J, Arnaiz M, Navarro V, Rosales S, et al. Phase II trial of SBRT for stage I NSCLC: survival, local control, and lung function at 36 months. J Thorac Oncol. 2016;11:1101–11.

    Article  PubMed  Google Scholar 

  25. Ceniceros L, Aristu J, Castañón E, Rolfo C, Legaspi J, Olarte A, et al. Stereotactic body radiotherapy (SBRT) for the treatment of inoperable stage I non-small cell lung cancer patients. Clin Transl Oncol. 2016;18:259–68.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Oncology and Palliative Medicine, Nordland Hospital, 8092, Bodø, Norway

    C. Nieder

  2. Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, 9037, Tromsø, Norway

    C. Nieder

  3. Department of Radiation Oncology, University Hospital Freiburg, 79106, Freiburg, Germany

    M. Hintz, O. Oehlke, A. Bilger & A. L. Grosu

  4. German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany

    O. Oehlke, A. Bilger & A. L. Grosu

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  1. C. Nieder
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  2. M. Hintz
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  3. O. Oehlke
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  4. A. Bilger
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  5. A. L. Grosu
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Corresponding author

Correspondence to C. Nieder.

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Funding

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

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

As a retrospective quality of care analysis, no approval from the Regional Committee for Medical and Health Research Ethics (REK Nord) was necessary. This research project was carried out according to our institutions’ guidelines and with permission to access the patients’ data.

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Nieder, C., Hintz, M., Oehlke, O. et al. The TNM 8 M1b and M1c classification for non-small cell lung cancer in a cohort of patients with brain metastases. Clin Transl Oncol 19, 1141–1146 (2017). https://doi.org/10.1007/s12094-017-1651-0

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  • DOI: https://doi.org/10.1007/s12094-017-1651-0

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