Prognostic implication of malignant pleural metastases in stage M1a non-small cell lung cancer in a real-world Dutch cohort receiving chemotherapy and/or immunotherapy
Cohort study reveals poorer overall survival for pleural versus contralateral metastases in stage M1a non-small cell lung cancer, suggesting a need to refine staging criteria.
Key Points
To determine whether pleural metastases confer a distinct overall survival prognosis compared to contralateral pulmonary metastases in patients with stage M1a non-small cell lung cancer receiving systemic therapies.
Analyzed nationwide retrospective registry data from the Netherlands Cancer Registry for patients with stage M1a non-small cell lung cancer treated with systemic therapy between 2010 and 2022 (N = 5632).
Assessed 2-year overall survival across metastatic sites (contralateral lung metastases, pleural metastases, or both) stratified by systemic treatment: chemotherapy, immune checkpoint inhibitor monotherapy, or chemo-immunotherapy.
Patients with contralateral lung metastases achieved higher 2-year overall survival across all treatment groups (chemotherapy: 26.9% [95% CI 24.9–28.9]; ICI: 49.5% [95% CI 43.4–55.2]; chemo-ICI: 40.4% [95% CI 36.5–44.2]) compared to those with pleural metastases (chemotherapy: 18.5% [95% CI 16.6–20.4]; ICI: 41.6% [95% CI 36.6–46.5]; chemo-ICI: 28.6% [95% CI 24.9–32.4]).
Patients presenting with both contralateral and pleural metastases had the lowest 2-year overall survival across chemotherapy (12.1% [95% CI 8.2–16.7]), ICI (31.1% [95% CI 18.4–44.7]), and chemo-ICI (25.0% [95% CI 15.7–35.4]).