Local Consolidative Surgery for Oligometastatic Non-Small Cell Lung Cancer With Bone Metastasis

Local consolidative therapy (LCT) can improve overall survival (OS) and progression-free survival (PFS) in oligometastatic non-small cell lung cancer (NSCLC). Bone metastases (BM) are associated with poorer prognosis after LCT. However, the prognostic influence of BM on outcomes after pulmonary resection remains unknown, particularly in an era with advanced systemic therapies. We identified patients from 2 centers with oligometastatic (≤3 synchronous sites) NSCLC who underwent pulmonary resection from 1996 to 2023. Patients were stratified by BM presence. Survival outcomes were evaluated by Kaplan-Meier and multivariable Cox regression models. There were 87 patients who met study criteria, including 10 (11.5%) patients with BM (+BM) and 77 (88.5%) without (−BM). Age and smoking patterns were not statistically different between groups, and median number of metastatic sites was 1.0 (interquartile range, 0) for all. Notably, median OS was similar between groups, 39.2 months for +BM (95% CI, 11.81-66.51) and 37.5 months for −BM (95% CI, 22.92-51.98; P = .45). Median PFS was likewise similar, 17.7 months for +BM (95% CI, 5.13-30.29) and 18.4 months for −BM (95% CI, 11.86-24.86; P = .28). Bone involvement did not independently predict PFS (hazard ratio, 1.45; 95% CI, 0.74-2.82; P = .28) or OS (hazard ratio, 1.29; 95% CI, 0.66-2.51; P = .45). In this contemporary study of patients with oligometastatic NSCLC undergoing pulmonary resection as part of comprehensive LCT, +BM patients were not observed to have poorer survival outcomes. Multidisciplinary teams should consider aggressive LCT approaches including pulmonary resection in this setting.