Perioperative and long-term survival outcomes following resection of stage iv non-small-cell lung cancer: a multi-center experience

Abstract OBJECTIVES Recent investigations have demonstrated the feasibility of surgery as local consolidative therapy for treating metastatic non-small-cell lung cancer (NSCLC). However, long-term benefits and associated operative risks for these potentially more challenging operations remain unclear. We aimed to explore perioperative and long-term outcomes following pulmonary resection for stage IV NSCLC. METHODS We identified patients from 2 institutions (1 European, 1 North American) with metastatic NSCLC from 1996-2023 who underwent pulmonary resection for NSCLC treatment. Gathered data included demographic, clinicopathologic, and perioperative variables, as well as oncologic and survival outcomes. Survival outcomes were evaluated using the Kaplan–Meier method and multivariate logistic regression. RESULTS We included 179 patients, with 53.1% (95) being women. The median age at surgery was 58.8 (51.8–66.5) years. Median number of metastatic sites was 1.0 (1.0-2.0), with brain (59, 45.4%) being most commonly involved. Multivariable analysis failed to identify any independent predictors of postoperative complications. Only 64 (35.8%) patients developed recurrence at median follow-up of 30.3 months (14.1-70.5). Locoregional and distant recurrences occurred at median of 15.3 (11.0-25.1) and 15.4 (10.7-23.7) months, respectively, which was associated with shortened overall survival (37.4 vs 87.5 months, p = 0.049). Median overall survival and progression free survival were 77.9 (56.5-114.7) and 36.6 months (25.1-49.4), respectively. Mortality predictors included increased age (OR: 1.07, 95% CI: 1.03-1.12, p = 0.002) and greater-than-lobar resection (OR: 2.63, 95% CI: 1.88-24.0, p = 0.040). CONCLUSIONS In appropriately selected patients, pulmonary resection for stage IV NSCLC is safe, and results in excellent perioperative and long-term survival benefits.