Impact of metastasectomy on survival in patients with oligometastatic stage 4a lung cancer: a retrospective analysis.

Abstract

The aim of our study is to evaluate the impact of metastasectomy on survival in patients with oligometastatic stage 4 lung cancer. Fifty-nine oligometastatic lung cancer cases operated on in our clinic between January 2015 and January 2024 were retrospectively examined. Demographic characteristics, metastasis type, metastasis locations, treatments applied, location of the primary tumor, histological type of the tumor, and metastasectomy status of the patients included in the study were evaluated. All patients underwent surgery for primary lung cancer. Generally, the mass in the lung was excised first. The metastasis was then removed. When brain surgery became a priority in some brain metastases, the metastasis was first removed and then the lesion in the lung was completely removed. In patients with oligometastasis, the tumor was either completely removed surgically or a complete cure was achieved with radiotherapy. All patients were stage 4a patients with metastases. The median age of the patients was 61 (36-76) years. 31 (52.6%) of the patients were aged 60 and over. 96.6% (n:57) of the patients were male and 3.4% (n:2) were female. Histopathological diagnosis was 35.6% squamous cell carcinoma (SCC) and 42.4% adeno cancer. 61.0% of the patients had brain metastases and 23.7% had adrenal metastases. The hospital stay of the patients was 14.0 ± 9.9 days. Disease-free survival time was 18.3 ± 24.4 months and overall survival time was 13.6 ± 11.5 months. While 32.2% (n:19) of the patients were alive, 67.8% (n:40) died. The survival rate was statistically significantly higher in patients who underwent metastasectomy compared to those who did not undergo metastasectomy (p = 0.027). The risk factors were found to be significantly associated with survival in the logistic regression analysis included metastasectomy (OR: 3.942, p = 0.030), diagnosis (SCC) (OR: 9,000, p = 0.042), recurrence (OR: 5.248, p = 0.012), adjuvant RT (OR: 0.298, p = 0.045), and neoadjuvant therapy (OR: 4.154, p = 0.040). In stage 4a lung cancer patients with oligometastasis, curative treatment of metastasis (metastasectomy) has a positive effect on survival. The low rate of radiotherapy and chemotherapy treatments given after metastasectomy will protect patients from the side effects of these treatments.