Skip to main content

Advertisement

SpringerLink
Log in

Osteogenic and brain metastases after non-small cell lung cancer resection

  • Original Article
  • Published:
International Journal of Clinical Oncology Aims and scope Submit manuscript

Abstract

Background

A significant number of non-small cell lung cancer (NSCLC) patients develop osteogenic metastases (OMs) and/or brain metastases (BMs) after surgery, however, routine chest computed tomography (CT) sometimes fails to diagnose these recurrences. We investigated the incidence of BMs and OMs after pulmonary resection and aimed to identify candidates who can benefit from brain magnetic resonance imaging (MRI) and 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) in addition to CT.

Methods

We retrospectively reviewed medical records of 1099 NSCLC patients who underwent pulmonary resection between 2002 and 2013. Clinicopathological factors associated with OM and/or BM were investigated using univariate and multivariate analyses.

Results

Postoperative recurrence occurred in 344 patients (32.6%). OMs were diagnosed in 56 patients (5.6%) with 93% within 3 years. BMs were identified in 72 patients (6.6%) with 91.1% within 3 years. Multivariate analysis revealed that poorly differentiated tumor and the presence of pathological nodal metastases were significantly associated with postoperative BM (p = 0.037, < 0.001), preoperative serum carcinoembryonic antigen (CEA) level of 5 ng/mL or higher and the presence of pathological nodal metastases were significantly associated with OM (p = 0.034, < 0.001). The prevalence of OM and/or BM in 5 years was as high as 25.9% in patients with pathological nodal metastases.

Conclusions

We identified significant predictive factors of postoperative BM and OM. Under patient selection, the effectiveness of intensive surveillance for the modes of recurrence should be investigated with respect to earlier detection, maintenance of quality of life, and survival outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Izar B, Sequist L, Lee M et al (2013) The impact of EGFR mutation status on outcomes in patients with resected stage I non-small cell lung cancers. Ann Thorac Surg 96(3):962–968

    Article  Google Scholar 

  2. Sugimura H, Nichols FC, Yang P et al (2007) Survival after recurrent nonsmall-cell lung cancer after complete pulmonary resection. Ann Thorac Surg 83(2):409–417

    Article  Google Scholar 

  3. Kudo Y, Shimada Y, Saji H et al (2015) Prognostic factors for survival after recurrence in patients with completely resected lung adenocarcinoma: important roles of epidermal growth factor receptor mutation status and the current staging system. Clin Lung Cancer 16(6):e213-221

    Article  CAS  Google Scholar 

  4. Lou F, Sima CS, Rusch VW et al (2014) Differences in patterns of recurrence in early-stage versus locally advanced non-small cell lung cancer. Ann Thorac Surg 98(5):1755–1760

    Article  Google Scholar 

  5. Shimada Y, Saji H, Yoshida K et al (2013) Prognostic factors and the significance of treatment after recurrence in completely resected stage I non-small cell lung cancer. Chest 143(6):1626–1634

    Article  CAS  Google Scholar 

  6. Taylor MD, Nagji AS, Bhamidipati CM et al (2012) Tumor recurrence after complete resection for non-small cell lung cancer. Ann Thorac Surg 93(6):1813–1820

    Article  Google Scholar 

  7. Colt HG, Murgu SD, Korst RJ et al (2013) Follow-up and surveillance of the patient with lung cancer after curative-intent therapy: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 143(5 Suppl):e437S-e454S

    Article  Google Scholar 

  8. Postmus PE, Kerr KM, Oudkerk M et al (2017) Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. https://doi.org/10.1093/annonc/mdx222

    Article  PubMed  Google Scholar 

  9. Vansteenkiste J, De Ruysscher D, Eberhardt WE et al (2013) Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. https://doi.org/10.1093/annonc/mdt241

    Article  PubMed  Google Scholar 

  10. Gambazzi F, Frey LD, Bruehlmeier M et al (2019) Comparing two imaging methods for follow-up of lung cancer treatment: a randomized pilot study. Ann Thorac Surg 107(2):430–435

    Article  Google Scholar 

  11. Monteil J, Vergnenegre A, Bertin F et al (2010) Randomized follow-up study of resected NSCLC patients: conventional versus 18F-DG coincidence imaging. Anticancer Res 30(9):3811–3816

    CAS  PubMed  Google Scholar 

  12. Okami J, Shintani Y, Okumura M et al (2019) Demographics, safety and quality, and prognostic information in both the seventh and eighth editions of the tnm classification in 18,973 surgical cases of the Japanese Joint Committee of Lung Cancer Registry Database in 2010. J Thorac Oncol 14(2):212–222

    Article  Google Scholar 

  13. Williams BA, Sugimura H, Endo C et al (2006) Predicting postrecurrence survival among completely resected non small-cell lung cancer patients. Ann Thorac Surg 81(3):1021–1027

    Article  Google Scholar 

  14. Chang WY, Wu YL, Su PL et al (2018) The impact of EGFR mutations on the incidence and survival of stages I to III NSCLC patients with subsequent brain metastasis. PLoS ONE. https://doi.org/10.1371/journal.pone.0192161

    Article  PubMed  PubMed Central  Google Scholar 

  15. Hung JJ, Jeng WJ, Wu YC et al (2016) Factors predicting organ-specific distant metastasis in patients with completely resected lung adenocarcinoma. Oncotarget 7(36):58261–58273

    Article  Google Scholar 

  16. Shimizu R, Kinoshita T, Sasaki N et al (2020) Clinicopathological factors related to recurrence patterns of resected non-small cell lung cancer. J Clin Med. https://doi.org/10.3390/jcm9082473

    Article  PubMed  PubMed Central  Google Scholar 

  17. Wang H, Zhang Y, Zhu H et al (2017) Risk factors for bone metastasis in completely resected non-small-cell lung cancer. Future Oncol 13(8):695–704

    Article  CAS  Google Scholar 

  18. Suda K, Mitsudomi T, Shintani Y et al (2021) Clinical impacts of EGFR mutation status: analysis of 5780 surgically resected lung cancer cases. Ann Thorac Surg 111(1):269–276

    Article  Google Scholar 

  19. Sun JM, Zhou W, Choi YL et al (2016) Prognostic significance of PD-L1 in Patients with non-small cell lung cancer: a large cohort study of surgically resected cases. J Thorac Oncol 11(7):1003–1011

    Article  CAS  Google Scholar 

  20. Ahmed F, Muzaffar R, Fernandes H et al (2016) Skeletal metastasis as detected by 18F-FDG PET with negative CT of the PET/CT: frequency and impact on cancer staging and/or management. Front Oncol. https://doi.org/10.3389/fonc.2016.00208

    Article  PubMed  PubMed Central  Google Scholar 

  21. Jimenez-Bonilla JF, Quirce R, Martinez-Rodriguez I et al (2013) Diagnosis of recurrence and assessment of post-recurrence survival in patients with extracranial non-small cell lung cancer evaluated by 18F-FDG PET/CT. Lung Cancer 81(1):71–76

    Article  Google Scholar 

  22. Kanzaki R, Higashiyama M, Maeda J et al (2010) Clinical value of F18-fluorodeoxyglucose positron emission tomography-computed tomography in patients with non-small cell lung cancer after potentially curative surgery: experience with 241 patients. Interact Cardiovasc Thorac Surg 10(6):1009–1014

    Article  Google Scholar 

  23. Keidar Z, Haim N, Guralnik L et al (2004) PET/CT using 18F-FDG in suspected lung cancer recurrence: diagnostic value and impact on patient management. J Nucl Med 45(10):1640–1646

    PubMed  Google Scholar 

  24. Takenaka D, Ohno Y, Koyama H et al (2010) Integrated FDG-PET/CT vs. standard radiological examinations: comparison of capability for assessment of postoperative recurrence in non small cell lung cancer patients. Eur J Radiol 74(3):458–464

    Article  Google Scholar 

  25. Toba H, Sakiyama S, Otsuka H et al (2012) 18F-fluorodeoxyglucose positron emission tomography/computed tomography is useful in postoperative follow-up of asymptomatic non-small-cell lung cancer patients. Interact Cardiovasc Thorac Surg 15(5):859–864

    Article  Google Scholar 

  26. Onishi Y, Ohno Y, Koyama H et al (2011) Non-small cell carcinoma: comparison of postoperative intra- and extrathoracic recurrence assessment capability of qualitatively and/or quantitatively assessed FDG-PET/CT and standard radiological examinations. Eur J Radiol 79(3):473–479

    Article  Google Scholar 

  27. Yokoi K, Kamiya N, Matsuguma H et al (1999) Detection of brain metastasis in potentially operable non-small cell lung cancer: a comparison of CT and MRI. Chest 115(3):714–719

    Article  CAS  Google Scholar 

  28. Yokoi K, Miyazawa N, Arai T (1996) Brain metastasis in resected lung cancer: value of intensive follow-up with computed tomography. Ann Thorac Surg 61(2):546–550

    Article  CAS  Google Scholar 

  29. McMurry TL, Stukenborg GJ, Kessler LG et al (2018) More frequent surveillance following lung cancer resection is not associated with improved survival: a nationally representative cohort study. Ann Surg 268(4):632–639

    Article  Google Scholar 

  30. Calman L, Beaver K, Hind D et al (2011) Survival benefits from follow-up of patients with lung cancer: a systematic review and meta-analysis. J Thorac Oncol 6(12):1993–2004

    Article  Google Scholar 

Download references

Acknowledgments

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The authors would like to thank Editage for the English language review.

Author information

Authors and Affiliations

  1. Division of Thoracic Surgery, Shizuoka Cancer Center, Shimonagakubo 1007, Nagaizumi-cho, Shunto-gun, Shizuoka, 411-8777, Japan

    Tetsuya Mizuno, Hayato Konno, Toshiyuki Nagata, Mitsuhiro Isaka & Yasuhisa Ohde

Authors
  1. Tetsuya Mizuno
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hayato Konno
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Toshiyuki Nagata
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mitsuhiro Isaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yasuhisa Ohde
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tetsuya Mizuno.

Ethics declarations

Conflicts of interest

The authors have no conflicts of interest to declare.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mizuno, T., Konno, H., Nagata, T. et al. Osteogenic and brain metastases after non-small cell lung cancer resection. Int J Clin Oncol 26, 1840–1846 (2021). https://doi.org/10.1007/s10147-021-01969-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10147-021-01969-x

Keywords

Search

Navigation