Survival Significance of Metastasis Type in Non–Small Cell Lung Cancer

This study published in JAMA Open Network found that patients with distant recurrent non–small cell lung cancer (NSCLC) had better survival outcomes compared to patients with de novo disease, highlighting the importance of considering metastatic disease type in future clinical trial design. 

The cohort study was designed to evaluate the association of metastatic disease type on overall survival (OS) among patients with NSCLC and to identify potential mechanisms underlying any survival difference. 

Participants were sourced using participant data from the National Lung Screening Trial (NLST). Qualifying participants were enrolled between 2002 and 2004 at a tertiary referral center in the San Francisco Bay Area and followed up for up to 7 years as the primary cohort and patient data from Stanford Healthcare (SHC) for diagnoses between 2009 and 2019 and followed up for up to 13 years as the validation cohort. Participants from NLST were included with de novo metastatic or distant recurrent NSCLC diagnoses.  

The final cohort was analyzed from January 2021 to March 2023 and consisted of 660 and 180 participants, respectively. The cohorts were predominantly men [62.3% and 60.6%] and White [91.2% and 61.7%] with a mean age of 66.8 vs 71.4 years at metastasis, respectively.  

Patients with distant recurrence had a better OS compared to patients with de novo metastasis, according to the NLST study (adjusted hazard ratio [aHR], 0.72; 95% CI, 0.60-0.87; P<.001). This finding was also replicated in the SHC study (aHR, 0.64; 95% CI, 0.43-0.96; P=.03). In the SHC study, patients with de novo metastasis were more likely to progress to the bone or pleura compared to patients with distant recurrence. Additionally, de novo metastasis was primarily detected through symptoms rather than posttreatment surveillance. The main finding remained consistent even after adjusting for metastasis sites and detection methods. 

“In this cohort study, patients with distant recurrent NSCLC had significantly better OS than those with de novo disease, and the latter group was associated with characteristics that may affect overall survival,” said researchers. “This finding can help inform future clinical trial designs to ensure a balance for baseline patient characteristics.”  

Reference  

Su CC, Wu JT, Choi E, et al. Overall survival among patients with de novo stage IV metastatic and distant metastatic recurrent non–small cell lung cancer. JAMA Netw Open. 2023;6(9):e2335813. doi:10.1001/jamanetworkopen.2023.35813