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Objective To investigate the impact of lymph node metastasis on the survival of SCLC patients with M1a disease. Methods We retrospectively analyzed the medical records of 7027 SCLC patients with M1a disease from 2004 to 2015 in SEER database. The Kaplan-Meier method and log-rank test were used to estimate the OS in all N stage subgroups. Cox proportional hazard model was used to assess whether N stage was an independent risk factor for prognosis. Results The median OS of all patients was 7 months. Among all M1a patients, the patients without lymph node involvement (N0) had the best OS, followed by N1 stage patients; N2 and N3 stage patients had the worst OS (P < 0.001). Similarly, this trend was observed when M1a disease was subdivided into contralateral pulmonary nodules, malignant pleural effusion and malignant pericardial effusion. Multivariate analysis showed that lymph node metastasis was an independent prognostic factor for SCLC patients with M1a disease, and this result was also noticed in all subgroups of M1a disease. Conclusion Lymph node metastasis may affect the survival of SCLC patients with M1a disease, adding prognostic information. And it is recommended to further improve the N descriptor in the next version of TNM staging system.
RESUMO
BACKGROUND: A strong association between M descriptors and prognosis of non-small cell lung cancer (NSCLC) has been demonstrated recently. However, its predictive and prognostic significance for advanced NSCLC patients treated with immune checkpoint inhibitors (ICIs) remain unclear. In this study, we aimed at investigating the impact of M descriptors on clinical outcomes in those patients. METHODS: A retrospective analysis was conducted. Patients treated with more than two cycles of ICIs were included. Detailed characteristics and clinical response after immunotherapy were recorded. M descriptors were classified into M1a, M1b, and M1c according to the 8th TNM classification. RESULTS: A total of 103 patients were enrolled, including 42 with M1a disease, 16 with M1b disease and 45 with M1c disease. Patients with M1a disease demonstrated significant longer median progress-free survival (PFS) (11.9 vs. 4.1 and 3.2 months, respectively, P=0.0002) and overall survival (OS) (35 vs. 22.1 and 12 months, P=0.02) than those with M1b and M1c disease. Patients with M1a disease showed higher objective response rate (ORR) (28.6% vs. 14.8%, P=0.08) and disease control rate (DCR) (81% vs. 59%, P=0.02) compared with those with M1b and M1c disease. Multivariate analysis identified M1a stage as being independently associated with prolonged PFS and had better OS than those with M1c disease (P=0.05) but not M1b disease (P=0.06). CONCLUSIONS: The current study demonstrated a clear association between M descriptors and the therapeutic response to ICIs and confirmed its prognostic role in advanced patients treated with ICIs monotherapy. M descriptors may need to be stratified in future study design.
