Analysis of key clinical features for achieving complete remission in stage III and IV non-small cell lung cancer patients

Autor: Tsuyoshi Oguma, Katsuyoshi Tomomatsu, Naoki Hayama, Naoya Nakamura, Tetsuya Urano, Masako Sato, Takahisa Takihara, Mitsunori Matsumae, Hiroshi Kajiwara, Hitoshi Itoh, Jun Nishiyama, Takuya Aoki, Kyoko Niimi, Ryota Masuda, Mitsutomo Kohno, Hiroto Takiguchi, Sakurako Tajiri, Genki Takahashi, Hiromi Tomomatsu, Takeshi Akiba, Masayuki Iwazaki, Etsuo Kunieda, Jun Tanaka, Koichiro Asano
Jazyk: angličtina
Rok vydání: 2019
Předmět:
Zdroj: Respiratory Research
Respiratory Research, Vol 20, Iss 1, Pp 1-16 (2019)
ISSN: 1465-993X
1465-9921
Popis: BackgroundAlthough development of immune checkpoint inhibitors and various molecular target agents has extended overall survival time (OS) in advanced non-small cell lung cancer (NSCLC), a complete cure remains rare. We aimed to identify features and treatment modalities of complete remission (CR) cases in stages III and IV NSCLC by analyzing long-term survivors whose OS exceeded 3 years.MethodsFrom our hospital database, 1,699 patients, registered as lung cancer between 1stMar 2004 and 30thApr 2011, were retrospectively examined. Stage III or IV histologically or cytologically confirmed NSCLC patients with chemotherapy initiated during this period were enrolled. A Cox proportion hazards regression model was used. Data collection was closed on 13thFeb 2017.ResultsThere were 164 stage III and 279 stage IV patients, including 37 (22.6%) and 51 (18.3%) long-term survivors and 12 (7.3%) and 5 (1.8%) CR patients, respectively. The long-term survivors were divided into three groups: 3 ≤ OS < 5 years, 5 years ≤ OS with tumor, and 5 years ≤ OS without tumor (CR). The median OS of these groups were 1,405, 2,238, and 2,876 days in stage III and 1,368, 2,503, and 2,643 days in stage IV, respectively. The mean chemotherapy cycle numbers were 16, 20, and 10 in stage III and 24, 25, and 5 in stage IV, respectively. In the stage III CR group, all patients received chemoradiation, all oligometastases were controlled by radiation, and none had brain metastases. Compared with non-CR patients, the stage IV CR patients had smaller primary tumors and fewer metastases, which were independent prognostic factors for OS among long-term survivors. The 80% stage IV CR patients received radiation or surgery for controlling primary tumors, and the surgery rate for oligometastases was high. Pathological findings in the stage IV CR patients revealed that numerous inflammatory cells existed around and inside resected lung and brain tumors, indicating strong immune response.ConclusionsMultiple line chemotherapies with primary and oligometastatic controls by surgery and/or radiation might achieve cure in certain advanced NSCLC. Cure strategies must be changed according to stage III or IV.This study was retrospectively registered on 16thJun 2019 in UMIN Clinical Trials Registry (number UMIN000037078).
Databáze: OpenAIRE
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