Site of Metastases as Prognostic Factors in Unselected Population of Stage IV Non-Small Cell Lung Cancer

Document Type : Research Articles


1 Clinical Oncology and Nuclear Medicine Department, University of Alexandria Faculty of Medicine, Alexandria, Egypt.

2 Preventive Medicine Division, University of Alabama at Birmingham, Birmingham, AL USA

3 Hematology Oncology Division, Wake Forest University Comprehensive Cancer Center, Winston Salem, NC, USA.


Background: Advanced stage non-small cell lung cancer (NSCLC) is a heterogenous disease, yet, with the exception of
targeted therapies, most guidelines recommended uniform treatment irrespective of tumor burden or sites of metastases
and this may explain, in part, the wide range of responses to same lines of therapy. Aim of work: In this work we
tried to explore the effect of metastatic sites in on overall survival (OS), in an unselected group of Non-small cell lung
cancer patients who received different treatments line. Methods: A retrospective analysis was performed on patients
with stage IV NSCLC who received systemic treatment at UAB Cancer Center (NCI designated comprehensive cancer
center) between 2002 to 2012. The details of sites of metastases, systemic therapy and overall survival were recorded
for each patient. Result: In 409 patients who received systemic treatment, there was statistically significant lower OS
in those presenting with liver metastases (p<0.001), adrenal metastases (p=0.011) and metastases to abdominal lymph
nodes (p=0.014). There was no statistically significance difference in OS in patient presenting with pleural metastases
or effusion (p=0.908), metastases to heart or pericardium (p=0.654), metastases to bone (p=0.281), brain (p=0.717) or
skin and subcutaneous tissue (p=0.642). Conclusion: Intra-abdominal metastases confer a particularly poor prognosis
in stage IV NSCLC treated with systemic therapy and may identify patients in whom aggressive treatment beyond first
line therapy is not appropriate.


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