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Published in: Clinical and Translational Oncology 9/2017

01-09-2017 | Research Article

The TNM 8 M1b and M1c classification for non-small cell lung cancer in a cohort of patients with brain metastases

Authors: C. Nieder, M. Hintz, O. Oehlke, A. Bilger, A. L. Grosu

Published in: Clinical and Translational Oncology | Issue 9/2017

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Abstract

Background and purpose

According to the recent TNM 8 classification, patients with metastatic non-small cell lung cancer (NSCLC) and single extrathoracic metastasis should be classified as stage M1b, while those with 2 or more metastases comprise stage M1c. The purpose of this study was to analyze the impact of this classification in patients with brain metastases.

Materials and methods

This retrospective study included 172 patients treated with individualized approaches. Actuarial survival was calculated. Uni- and multivariate analyses were performed.

Results

Thirty patients (17%) were staged as M1b. Those with squamous cell cancer were more likely to harbor M1b disease (29%, adenocarcinoma 14%, other histology 17%, p = 0.16). Median survival was 5.4 months (8.0 months in case of M1b disease and 4.5 months in case of M1c disease, p = 0.001). Multivariate analysis confirmed the role of M1b stage. M1b patients managed with upfront surgery or radiosurgery had significantly longer median survival than those who received whole-brain irradiation (21.0 vs. 3.5 months, p = 0.0001) and the potential to survive beyond 5 years.

Conclusions

We found the M1b classification to provide clinically relevant information. The multivariate analysis suggested that patients with M1b disease, better performance status and younger age have better survival.
Literature
1.
go back to reference Goldstraw P, Chansky K, Crowley J, Rami-Porta R, Asamura H, Eberhardt WE, et al. International Association for the Study of Lung Cancer Staging and Prognostic Factors Committee, Advisory Boards, and Participating Institutions. The IASLC lung cancer staging project: proposals for revision of the TNM stage groupings in the forthcoming (eighth) edition of the TNM classification for lung cancer. J Thorac Oncol. 2016;11:39–51.CrossRefPubMed Goldstraw P, Chansky K, Crowley J, Rami-Porta R, Asamura H, Eberhardt WE, et al. International Association for the Study of Lung Cancer Staging and Prognostic Factors Committee, Advisory Boards, and Participating Institutions. The IASLC lung cancer staging project: proposals for revision of the TNM stage groupings in the forthcoming (eighth) edition of the TNM classification for lung cancer. J Thorac Oncol. 2016;11:39–51.CrossRefPubMed
2.
go back to reference Asamura H, Chansky K, Crowley J, Goldstraw P, Rusch VW, Vansteenkiste JF, et al. International Association for the Study of Lung Cancer Staging and Prognostic Factors Committee, Advisory Board Members, and Participating Institutions. The International Association for the Study of Lung Cancer Lung Cancer Staging Project: Proposals for the revision of the N descriptors in the forthcoming 8th edition of the TNM classification for lung cancer. J Thorac Oncol. 2015;10:1675–84.CrossRefPubMed Asamura H, Chansky K, Crowley J, Goldstraw P, Rusch VW, Vansteenkiste JF, et al. International Association for the Study of Lung Cancer Staging and Prognostic Factors Committee, Advisory Board Members, and Participating Institutions. The International Association for the Study of Lung Cancer Lung Cancer Staging Project: Proposals for the revision of the N descriptors in the forthcoming 8th edition of the TNM classification for lung cancer. J Thorac Oncol. 2015;10:1675–84.CrossRefPubMed
3.
go back to reference Eberhardt WE, Mitchell A, Crowley J, Kondo H, Kim YT, Turrisi A, et al. International Association for Study of Lung Cancer Staging and Prognostic Factors Committee, Advisory Board Members, and Participating Institutions. The IASLC Lung Cancer Staging Project: Proposals for the revision of the M descriptors in the forthcoming 8th edition of the TNM classification of lung cancer. J Thorac Oncol. 2015;10:1515–22.CrossRefPubMed Eberhardt WE, Mitchell A, Crowley J, Kondo H, Kim YT, Turrisi A, et al. International Association for Study of Lung Cancer Staging and Prognostic Factors Committee, Advisory Board Members, and Participating Institutions. The IASLC Lung Cancer Staging Project: Proposals for the revision of the M descriptors in the forthcoming 8th edition of the TNM classification of lung cancer. J Thorac Oncol. 2015;10:1515–22.CrossRefPubMed
4.
go back to reference Enders F, Geisenberger C, Jungk C, Bermejo JL, Warta R, von Deimling A, et al. Prognostic factors and long-term survival in surgically treated brain metastases from non-small cell lung cancer. Clin Neurol Neurosurg. 2016;142:72–80.CrossRefPubMed Enders F, Geisenberger C, Jungk C, Bermejo JL, Warta R, von Deimling A, et al. Prognostic factors and long-term survival in surgically treated brain metastases from non-small cell lung cancer. Clin Neurol Neurosurg. 2016;142:72–80.CrossRefPubMed
5.
go back to reference Nieder C, Spanne O, Mehta MP, Grosu AL, Geinitz H. Presentation, patterns of care, and survival in patients with brain metastases: what has changed in the last 20 years? Cancer. 2011;117:2505–12.CrossRefPubMed Nieder C, Spanne O, Mehta MP, Grosu AL, Geinitz H. Presentation, patterns of care, and survival in patients with brain metastases: what has changed in the last 20 years? Cancer. 2011;117:2505–12.CrossRefPubMed
6.
go back to reference Goncalves PH, Peterson SL, Vigneau FD, Shore RD, Quarshie WO, Islam K, et al. Risk of brain metastases in patients with nonmetastatic lung cancer: analysis of the metropolitan detroit surveillance, epidemiology, and end results (SEER) data. Cancer. 2016;122:1921–7.CrossRefPubMedPubMedCentral Goncalves PH, Peterson SL, Vigneau FD, Shore RD, Quarshie WO, Islam K, et al. Risk of brain metastases in patients with nonmetastatic lung cancer: analysis of the metropolitan detroit surveillance, epidemiology, and end results (SEER) data. Cancer. 2016;122:1921–7.CrossRefPubMedPubMedCentral
7.
go back to reference Hendriks LE, Troost EG, Steward A, Bootsma GP, De Jaeger K, van den Borne BE, et al. Patient selection for whole brain radiotherapy (WBRT) in a large lung cancer cohort: impact of a new dutch guideline on brain metastases. Acta Oncol. 2014;53:945–51.CrossRefPubMed Hendriks LE, Troost EG, Steward A, Bootsma GP, De Jaeger K, van den Borne BE, et al. Patient selection for whole brain radiotherapy (WBRT) in a large lung cancer cohort: impact of a new dutch guideline on brain metastases. Acta Oncol. 2014;53:945–51.CrossRefPubMed
8.
go back to reference Khalifa J, Amini A, Popat S, Gaspar LE. Faivre-Finn C; International Association for the Study of Lung Cancer Advanced Radiation Technology Committee. Brain metastases from NSCLC: radiation therapy in the era of targeted therapies. J Thorac Oncol. 2016;11:1627–43.CrossRefPubMed Khalifa J, Amini A, Popat S, Gaspar LE. Faivre-Finn C; International Association for the Study of Lung Cancer Advanced Radiation Technology Committee. Brain metastases from NSCLC: radiation therapy in the era of targeted therapies. J Thorac Oncol. 2016;11:1627–43.CrossRefPubMed
9.
go back to reference Greto D, Scoccianti S, Compagnucci A, Arilli C, Casati M, Francolini G, et al. Gamma Knife radiosurgery in the management of single and multiple brain metastases. Clin Neurol Neurosurg. 2016;141:43–7.CrossRefPubMed Greto D, Scoccianti S, Compagnucci A, Arilli C, Casati M, Francolini G, et al. Gamma Knife radiosurgery in the management of single and multiple brain metastases. Clin Neurol Neurosurg. 2016;141:43–7.CrossRefPubMed
10.
go back to reference Nieder C, Grosu AL, Marienhagen K, Andratschke NH, Geinitz H. Non-small cell lung cancer histological subtype has prognostic impact in patients with brain metastases. Med Oncol. 2012;29:2664–8.CrossRefPubMed Nieder C, Grosu AL, Marienhagen K, Andratschke NH, Geinitz H. Non-small cell lung cancer histological subtype has prognostic impact in patients with brain metastases. Med Oncol. 2012;29:2664–8.CrossRefPubMed
11.
go back to reference Nieder C, Andratschke NH, Geinitz H, Grosu AL. Diagnosis-specific graded prognostic assessment score is valid in patients with brain metastases treated in routine clinical practice in two European countries. Med Sci Monit. 2012;18:CR450–5.CrossRefPubMedPubMedCentral Nieder C, Andratschke NH, Geinitz H, Grosu AL. Diagnosis-specific graded prognostic assessment score is valid in patients with brain metastases treated in routine clinical practice in two European countries. Med Sci Monit. 2012;18:CR450–5.CrossRefPubMedPubMedCentral
12.
go back to reference Gaspar LE, Scott C, Murray K, Curran W. Validation of the RTOG recursive partitioning analysis (RPA) classification for brain metastases. Int J Radiat Oncol Biol Phys. 2000;47:1001–6.CrossRefPubMed Gaspar LE, Scott C, Murray K, Curran W. Validation of the RTOG recursive partitioning analysis (RPA) classification for brain metastases. Int J Radiat Oncol Biol Phys. 2000;47:1001–6.CrossRefPubMed
13.
go back to reference Sperduto PW, Chao ST, Sneed PK, Luo X, Suh J, Roberge D, et al. Diagnosis-specific prognostic factors, indexes, and treatment outcomes for patients with newly diagnosed brain metastases: a multi-institutional analysis of 4,259 patients. Int J Radiat Oncol Biol Phys. 2010;77:655–61.CrossRefPubMed Sperduto PW, Chao ST, Sneed PK, Luo X, Suh J, Roberge D, et al. Diagnosis-specific prognostic factors, indexes, and treatment outcomes for patients with newly diagnosed brain metastases: a multi-institutional analysis of 4,259 patients. Int J Radiat Oncol Biol Phys. 2010;77:655–61.CrossRefPubMed
14.
go back to reference Sperduto PW, Kased N, Roberge D, Xu Z, Shanley R, Luo X, et al. Summary report on the graded prognostic assessment: an accurate and facile diagnosis-specific tool to estimate survival for patients with brain metastases. J Clin Oncol. 2012;30:419–25.CrossRefPubMed Sperduto PW, Kased N, Roberge D, Xu Z, Shanley R, Luo X, et al. Summary report on the graded prognostic assessment: an accurate and facile diagnosis-specific tool to estimate survival for patients with brain metastases. J Clin Oncol. 2012;30:419–25.CrossRefPubMed
15.
go back to reference Xu Q, Wang Y, Liu H, Meng S, Zhou S, Xu J, et al. Treatment outcome for patients with primary NSCLC and synchronous solitary metastasis. Clin Transl Oncol. 2013;15:802–9.CrossRefPubMed Xu Q, Wang Y, Liu H, Meng S, Zhou S, Xu J, et al. Treatment outcome for patients with primary NSCLC and synchronous solitary metastasis. Clin Transl Oncol. 2013;15:802–9.CrossRefPubMed
16.
go back to reference Kashima J, Okuma Y, Miwa M, Hosomi Y. Survival of patients with brain metastases from non-small cell lung cancer harboring EGFR mutations treated with epidermal growth factor receptor tyrosine kinase inhibitors. Med Oncol. 2016;33:129.CrossRefPubMed Kashima J, Okuma Y, Miwa M, Hosomi Y. Survival of patients with brain metastases from non-small cell lung cancer harboring EGFR mutations treated with epidermal growth factor receptor tyrosine kinase inhibitors. Med Oncol. 2016;33:129.CrossRefPubMed
17.
go back to reference Soon YY, Leong CN, Koh WY, Tham IW. EGFR tyrosine kinase inhibitors versus cranial radiation therapy for EGFR mutant non-small cell lung cancer with brain metastases: a systematic review and meta-analysis. Radiother Oncol. 2015;114:167–72.CrossRefPubMed Soon YY, Leong CN, Koh WY, Tham IW. EGFR tyrosine kinase inhibitors versus cranial radiation therapy for EGFR mutant non-small cell lung cancer with brain metastases: a systematic review and meta-analysis. Radiother Oncol. 2015;114:167–72.CrossRefPubMed
18.
go back to reference Nieder C, Bremnes RM, Andratschke NH. Prognostic scores in patients with brain metastases from non-small cell lung cancer. J Thorac Oncol. 2009;4:1337–41.CrossRefPubMed Nieder C, Bremnes RM, Andratschke NH. Prognostic scores in patients with brain metastases from non-small cell lung cancer. J Thorac Oncol. 2009;4:1337–41.CrossRefPubMed
19.
go back to reference Parlak C, Mertsoylu H, Güler OC, Onal C, Topkan E. Definitive chemoradiation therapy following surgical resection or radiosurgery plus whole-brain radiation therapy in non-small cell lung cancer patients with synchronous solitary brain metastasis: a curative approach. Int J Radiat Oncol Biol Phys. 2014;88:885–91.CrossRefPubMed Parlak C, Mertsoylu H, Güler OC, Onal C, Topkan E. Definitive chemoradiation therapy following surgical resection or radiosurgery plus whole-brain radiation therapy in non-small cell lung cancer patients with synchronous solitary brain metastasis: a curative approach. Int J Radiat Oncol Biol Phys. 2014;88:885–91.CrossRefPubMed
20.
go back to reference Yuksel C, Bozkurt M, Yenigun BM, Enon S, Ozkan M, Kose SK, et al. The outcome of bifocal surgical resection in non-small cell lung cancer with synchronous brain metastases: results of a single center retrospective study. Thorac Cardiovasc Surg. 2014;62:605–11.PubMed Yuksel C, Bozkurt M, Yenigun BM, Enon S, Ozkan M, Kose SK, et al. The outcome of bifocal surgical resection in non-small cell lung cancer with synchronous brain metastases: results of a single center retrospective study. Thorac Cardiovasc Surg. 2014;62:605–11.PubMed
21.
go back to reference Louie AV, Rodrigues G, Yaremko B, Yu E, Dar AR, Dingle B, et al. Management and prognosis in synchronous solitary resected brain metastasis from non-small-cell lung cancer. Clin Lung Cancer. 2009;10:174–9.CrossRefPubMed Louie AV, Rodrigues G, Yaremko B, Yu E, Dar AR, Dingle B, et al. Management and prognosis in synchronous solitary resected brain metastasis from non-small-cell lung cancer. Clin Lung Cancer. 2009;10:174–9.CrossRefPubMed
22.
go back to reference Flannery TW, Suntharalingam M, Regine WF, Chin LS, Krasna MJ, Shehata MK, et al. Long-term survival in patients with synchronous, solitary brain metastasis from non-small-cell lung cancer treated with radiosurgery. Int J Radiat Oncol Biol Phys. 2008;72:19–23.CrossRefPubMed Flannery TW, Suntharalingam M, Regine WF, Chin LS, Krasna MJ, Shehata MK, et al. Long-term survival in patients with synchronous, solitary brain metastasis from non-small-cell lung cancer treated with radiosurgery. Int J Radiat Oncol Biol Phys. 2008;72:19–23.CrossRefPubMed
23.
go back to reference Hu C, Chang EL, Hassenbusch SJ 3rd, Allen PK, Woo SY, Mahajan A, et al. Nonsmall cell lung cancer presenting with synchronous solitary brain metastasis. Cancer. 2006;106:1998–2004.CrossRefPubMed Hu C, Chang EL, Hassenbusch SJ 3rd, Allen PK, Woo SY, Mahajan A, et al. Nonsmall cell lung cancer presenting with synchronous solitary brain metastasis. Cancer. 2006;106:1998–2004.CrossRefPubMed
24.
go back to reference Navarro-Martin A, Aso S, Cacicedo J, Arnaiz M, Navarro V, Rosales S, et al. Phase II trial of SBRT for stage I NSCLC: survival, local control, and lung function at 36 months. J Thorac Oncol. 2016;11:1101–11.CrossRefPubMed Navarro-Martin A, Aso S, Cacicedo J, Arnaiz M, Navarro V, Rosales S, et al. Phase II trial of SBRT for stage I NSCLC: survival, local control, and lung function at 36 months. J Thorac Oncol. 2016;11:1101–11.CrossRefPubMed
25.
go back to reference Ceniceros L, Aristu J, Castañón E, Rolfo C, Legaspi J, Olarte A, et al. Stereotactic body radiotherapy (SBRT) for the treatment of inoperable stage I non-small cell lung cancer patients. Clin Transl Oncol. 2016;18:259–68.CrossRefPubMed Ceniceros L, Aristu J, Castañón E, Rolfo C, Legaspi J, Olarte A, et al. Stereotactic body radiotherapy (SBRT) for the treatment of inoperable stage I non-small cell lung cancer patients. Clin Transl Oncol. 2016;18:259–68.CrossRefPubMed
Metadata
Title
The TNM 8 M1b and M1c classification for non-small cell lung cancer in a cohort of patients with brain metastases
Authors
C. Nieder
M. Hintz
O. Oehlke
A. Bilger
A. L. Grosu
Publication date
01-09-2017
Publisher
Springer International Publishing
Published in
Clinical and Translational Oncology / Issue 9/2017
Print ISSN: 1699-048X
Electronic ISSN: 1699-3055
DOI
https://doi.org/10.1007/s12094-017-1651-0

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