Local ablative therapy with or without chemotherapy for non-small-cell lung cancer patients with postoperative oligometastases

Figures & data

Figure 1 Scheme of this study.

Abbreviations: ORR, objective response rate; OS, overall survival; PFS, progression-free survival.

Table 1 Characteristics of patients

Characteristics	Local ablative therapy + chemotherapy (n=105)	Local ablative therapy alone (n=58)	P-value
Age (years), n (%)
≤65	91 (86.7)	47 (81.0)	0.339
>65	14 (13.3)	11 (19.0)
Gender, n (%)
Male	82 (78.1)	46 (79.3)	0.856
Female	23 (21.9)	12 (20.7)
Histology, n (%)
Squamous	39 (37.1)	26 (44.8)	0.337
Non-squamous	66 (62.9)	32 (55.2)
Differentiation, n (%)
Low	49 (46.7)	28 (48.3)	1.000
Intermediate/high	50 (47.6)	27 (46.5)
Unknown	6 (5.7)	3 (5.2)
pTNM stage, n (%)
I/II	60 (57.2)	35 (60.3)	0.437
III	39 (37.1)	17 (29.3)
Unknown	6 (5.7)	6 (10.4)
ECOG PS, n (%)
0	36 (34.3)	17 (29.3)	0.529
1	58 (55.2)	37 (63.8)
2	11 (10.5)	4 (6.9)
Adjuvant therapy, n (%)
Chemotherapy	80 (76.2)	42 (72.4)	0.820
Chemoradiotherapy	9 (8.6)	5 (8.6)
Others	16 (15.2)	11 (19.0)
Disease-free interval (months), n (%)
≤24	73 (69.5)	37 (63.8)	0.455
>24	32 (30.5)	21 (36.2)
Image diagnosis, n (%)
PET	16 (15.2)	10 (17.2)	0.738
CT/MRI/ECT	89 (84.8)	48 (82.8)
Metastasis, n (%)
1	77 (73.3)	48 (82.8)	0.173
2–5	28 (26.7)	10 (17.2)
Local ablative therapy, n (%)
Radiotherapy	93 (88.6)	49 (84.5)	0.072
Surgery	10 (9.5)	3 (5.2)
Radiotherapy + surgery	0 (0.0)	1 (1.7)
Othersa	2 (1.9)	5 (8.6)
Metastasis location, n (%)
Regional lymph nodes	48 (45.7)	22 (37.9)	0.124
Brain	25 (23.8)	21 (36.2)
Lung	20 (19.0)	7 (12.1)
Bone	18 (17.1)	4 (6.9)
Adrenal gland	5 (4.8)	1 (1.7)
Liver	1 (1.0)	3 (5.2)
Othersb	8 (7.6)	5 (8.6)

Notes:

a In addition to radiotherapy and surgery, one patient underwent radiofrequency ablation and one underwent particle implantation in the combination therapy group, whereas four underwent embolizations and one received particle implantation in the local treatment group.

b Other metastasis sites included the chest wall and retroperitoneal lymph nodes.

Abbreviations: CT, computed tomography; ECOG PS, Eastern Cooperative Oncology Group performance score; ECT, emission computed tomography; MRI, magnetic resonance imaging; PET, positron emission tomography; pTNM, Pathological Tumor-Node-Metastasis.

Figure 2 Kaplan–Meier curves of OS (A) and PFS (B) for the local ablative therapy with or without chemotherapy in NSCLC patients with postoperative oligometastases.

Abbreviations: NSCLC, non-small-cell lung cancer; OS, overall survival; PFS, progression-free survival.

Table 2 Univariate and multivariate analyses of overall survival

Variables	Patients (n=163)	Univariate analysis		Multivariate analysis
		P-value	HR (95% CI)	P-value	HR (95% CI)
Age (years)
≤65	138	<0.001	1	<0.001	1
>65	25		3.91 (1.83–8.38)		3.91 (1.83–8.38)
Gender
Male	128	0.893	1
Female	35		0.94 (0.39–2.30)
Histology
Squamous	65	0.044	1
Non-squamous	98		0.49 (0.25–0.98)
Differentiation
Low	77	0.833	1
Intermediate/high	77		0.90 (0.43–1.88)
Unknown	9		0.64 (0.15–2.83)
pTNM stage
I/II	95	0.115	1
III	56		1.62 (0.78–3.35)
Unknown	12		0.23 (0.03–1.76)
Disease-free interval (months)
≤24	110	0.332	1
>24	53		0.69 (0.32–1.47)
Metastasis
1	125	0.340	1
2–5	38		1.44 (0.68–3.07)
ECOG PS
0	53	0.684	1
1	95		0.84 (0.40–1.77)
2	15		1.34 (0.43–4.20)
Metastasis location
Extracranial	116	0.657	1
Intracranial	47		1.20 (0.53–2.70)
Treatment
Local ablative therapy + chemotherapy	105	0.498	1
Local ablative therapy alone	58		1.28 (0.63–2.58)

Abbreviation: ECOG PS, Eastern Cooperative Oncology Group performance score; pTNM, Pathological Tumor-Node-Metastasis.

Table 3 Univariate and multivariate analyses of progression-free survival

Variables	Patients (n=163)	Univariate analysis		Multivariate analysis
		P-value	HR (95% CI)	P-value	HR (95% CI)
Age (years)
≤65	138	0.818	1
>65	25		0.94 (0.53–1.64)
Gender
Male	128	0.899	1
Female	35		1.03 (0.65–1.64)
Histology
Squamous	65	0.545	1
Non-squamous	98		1.13 (0.77–1.65)
Differentiation
Low	77	0.592	1
Intermediate/high	77		0.81 (0.38–1.72)
Unknown	9		0.98 (0.47–2.07)
pTNM stage
I/II	95	0.088	1
III	56		1.40 (0.94–2.08)
Unknown	12		0.70 (0.36–1.36)
Disease-free interval (months)
≤24	110	0.017	1	0.012	1
>24	53		0.61 (0.41–0.92)		0.60 (0.40–0.89)
Metastasis
1	125	0.185	1
2–5	38		1.32 (0.88–2.00)
ECOG PS
0	53	0.669	1
1	95		0.97 (0.65–1.46)
2	15		1.32 (0.65–2.67)
Metastasis location
Extracranial	116	0.071	1
Intracranial	47		1.44 (0.97–2.15)
Treatment
Local ablative therapy + chemotherapy	105	0.006	1	0.004	1
Local ablative therapy alone	58		1.68 (1.16–2.44)		1.73 (1.19–2.51)

Abbreviation: ECOG PS, Eastern Cooperative Oncology Group performance score; pTNM, Pathological Tumor-Node-Metastasis.

Table 4 ORR and patterns of failure

	Local ablative therapy + chemotherapy (n=105)	Local ablative therapy alone (n=58)	P-value
ORR, %	66.7	46.5	0.012
Recurrence, n (%)
Local	25 (23.8)	19 (32.8)	0.218
Distant	63 (60.0)	28 (48.3)	0.149
Combination	9 (8.6)	5 (8.6)	0.991
No recurrence	8 (7.6)	6 (10.3)	0.569

Abbreviation: ORR, objective response rate.

Table 5 Treatment toxicities

	Local ablative therapy + chemotherapy (n=105)					Local ablative therapy alone (n=58)
	Grade 1	Grade 2	Grade 3	Grade 4	Grade 5	Grade 1	Grade 2	Grade 3	Grade 4	Grade 5
Myelosuppression	20	25	15	5	0	5	3	1	1	0
Nausea/vomiting	28	22	4	0	0	3	3	0	0	0
Fatigue	20	1	0	0	0	3	0	0	0	0
Esophagitis	12	1	1	0	0	4	0	0	0	0
Radiation pneumonitis	2	1	0	0	0	1	0	0	0	0
Liver injury	5	1	0	0	0	1	0	0	0	0
Arrhythmias	2	1	0	0	0	0	0	0	0	0
Infection	3	1	0	0	1	0	0	0	0	0
Hearing impaired	1	0	0	0	0	0	0	0	0	0
Allergic reaction	1	0	0	0	0	0	0	0	0	0