Abstract

Introduction: Several studies have shown that tyrosine kinase inhibitors (TKI) and chemotherapy improve the short term and median survival of patients with metastatic adenocarcinoma of the lung (MAL), but there is less data on the long-term survival (LTS) of these patients.

Methods: A univariate retrospective analysis was performed on 174 patients with MAL diagnosed at our institution between 2009 and 2011, and with up to a 5-year follow-up. Overall survival was estimated using the product-limit method and drawing the Kaplan-Meier curves and compared using the log-rank test.

Results: Factors associated with a statistically significant survival benefit in our patients were: having undergone lung surgery, female gender, never smokers, bronchioalveolar histology, and lower TNM nodal stage.  Particularly prior lung surgery was shown to improve survival in patients treated with erlotinib.  This was also true when comparing patients from a historical cohort as well.  Among patients with EGFR mutation, there was no statistically significant difference in survival amongst patients treated with either surgery or erlotinib.

Conclusion: In our patients with MAL the only treatment modality that improved LTS in a statistically significant way was lung surgery. This is an important finding as NCCN guidelines consider surgery as a treatment option only in MAL with isolated lesions.