Pulmonary Metastasectomy in Patients with Lung Metastases from Nasopharyngeal Carcinoma

Approximately 10% of patients with nasopharyngeal carcinoma (NPC) develop lung-only metastases. Data regarding the potential role of lung metastasectomy are limited. The aim of this case-control study was to determine whether lung metastasectomy prolongs survival in patients with NPC with lung-only metastases. The resectability of 215 consecutive patients diagnosed with lung-only metastases from 2001 to 2018 was reviewed by doctors blinded to the patient groups. The propensity score matching method was used to balance the potential probability of being assigned to treatment groups based on pretherapeutic information. Postmetastatic survival (PMS) and cumulative incidence of local failure were compared between the surgical and nonsurgical arms. Overall, 120 potentially resectable cases were enrolled, and 45 and 22 patients who underwent and did not undergo metastasectomy, respectively, were included in the propensity-matched cohort. Patients who underwent pulmonary resection had better PMS and a lower cumulative incidence of local failure than those who did not undergo surgery. The 5-year PMS rates were 75.53% and 47.81% in the surgical and nonsurgical arms, respectively (difference 27.72%; 95% confidence interval 3.95–51.49%). Younger patients (≤ 45 years), and those with a lower primary N stage (N0-1), longer disease-free interval (> 2 years), smaller total diameter of the metastatic lesions (≤ 3 cm), unilateral distribution of metastases, no mediastinal/hilar lymph node involvement, and adjuvant chemotherapy showed a significantly longer PMS after metastasectomy by multivariable analysis. Lung metastasectomy may improve PMS and decrease the chance of local treatment failure in NPC patients with potentially resectable lung-only metastases.