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Pulmonary Metastasectomy in Patients with Lung Metastases from Nasopharyngeal Carcinoma

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Approximately 10% of patients with nasopharyngeal carcinoma (NPC) develop lung-only metastases. Data regarding the potential role of lung metastasectomy are limited.

Objective

The aim of this case-control study was to determine whether lung metastasectomy prolongs survival in patients with NPC with lung-only metastases.

Methods

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.

Results

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.

Conclusions

Lung metastasectomy may improve PMS and decrease the chance of local treatment failure in NPC patients with potentially resectable lung-only metastases.

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Funding

This work was supported by the Foundation for Sci & Tech Research Project of Guangdong [2017A020215138].

Author information

Author notes

  1. Ze-Rui Zhao, Di-Han Liu, and Yi-Zhi Wang contributed equally to this work.

Authors and Affiliations

  1. State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, and Department of Thoracic Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, China

    Ze-Rui Zhao MD, PhD, Yi-Zhi Wang MD & Hao Long MD, PhD

  2. Lung Cancer Research Center, Sun Yat-Sen University, Guangzhou, China

    Ze-Rui Zhao MD, PhD, Yi-Zhi Wang MD & Hao Long MD, PhD

  3. The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China

    Di-Han Liu MD

  4. State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, and Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, China

    Xue‐Song Sun MD

Authors
  1. Ze-Rui Zhao MD, PhD
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  2. Di-Han Liu MD
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  3. Yi-Zhi Wang MD
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  4. Xue‐Song Sun MD
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  5. Hao Long MD, PhD
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Contributions

Z-RZ: Conceptualization, data curation, formal analysis, investigation, methodology, software, visualization, writing—original draft. D-HL: Data curation, methodology, writing—original draft. Y-ZW: Data curation, formal analysis, software. X‐SS: Data curation, resources. HL: Conceptualization, funding acquisition, investigation, project administration, supervision, writing—review and editing

Corresponding author

Correspondence to Hao Long MD, PhD.

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The authors declare that they have no conflict of interest.

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Electronic supplementary material

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10434_2021_9597_MOESM1_ESM.tif

Supplementary Figure S1. Number of lung-only metastasis from nasopharyngeal carcinoma treated during the study period. (TIF 352 kb)

10434_2021_9597_MOESM2_ESM.tif

Supplementary Figure S2. Propensity score matching performance. Matched groups have similar propensity score distributions compared with the entire population. (TIF 2341 kb)

10434_2021_9597_MOESM3_ESM.tif

Supplementary Figure S3. Postmetastatic survival (a) and cumulative incidence of local failure (b) in patients of nasopharyngeal carcinoma developing lung-only metastases who received metastasectomy or not (before matching). (TIF 1713 kb)

Supplementary material 4 (TIF 1792 kb)

Supplementary material 5 (DOCX 20 kb)

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Zhao, ZR., Liu, DH., Wang, YZ. et al. Pulmonary Metastasectomy in Patients with Lung Metastases from Nasopharyngeal Carcinoma. Ann Surg Oncol 28, 4542–4550 (2021). https://doi.org/10.1245/s10434-021-09597-5

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  • DOI: https://doi.org/10.1245/s10434-021-09597-5

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