The Journal of Thoracic and Cardiovascular Surgery
Thoracic: Lung CancerSurgical management of non–small cell lung cancer with limited metastatic disease involving only the brain
Graphical abstract
Section snippets
Data Source
The data used in this study were from the NCDB, a joint project of the Commission on Cancer of the American College of Surgeons and the American Cancer Society. The NCDB is estimated to capture 80% of all newly diagnosed cases of lung cancer in the United States and Puerto Rico.9
Study Design
The Institutional Review Board of Massachusetts General Hospital approved the study protocol and publication of data (Protocol #2020P004110; approved on February 2, 2021). Data were analyzed from a de-identified NCDB
Study Cohort
Between 2010 and 2017, 1240 patients diagnosed with cT1-3, N0-1, M1b-c NSCLC presented with synchronous limited metastatic disease involving only the brain and met the study eligibility criteria. Definitive thoracic treatment included surgery as part of multimodal therapy (“Thoracic Surgery”) for 270 patients (21.8%) compared with systemic therapy with or without radiation without thoracic surgery (“No Thoracic Surgery”) in 970 patients (78.2%) (Figure 1). Patients with missing data are
Discussion
In this national analysis of patients with stage IV cM1b-c NSCLC presenting with synchronous limited metastatic disease involving only the brain and who received brain SRS or neurosurgical resection, multimodal therapy that included primary site thoracic surgical resection (“Thoracic Surgery”) was associated with better overall survival than systemic therapy with or without radiation (“No Thoracic Surgery”). Accounting for potential underlying bias in the selection of patients who underwent
Conclusions
In this national analysis, patients with stage IV cM1b-c NSCLC presenting as a primary tumor with synchronous limited metastatic disease involving only the brain who underwent metastatic treatment with SRS or neurosurgical resection had better overall survival after multimodal therapy that included primary site resection compared with systemic therapy with or without radiation without surgery. Primary site resection was associated with improved overall survival after multivariable-adjusted Cox
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