Metastatic organ distribution characteristics and prognosis in patients with non-small cell lung cancer

Non-small cell lung cancer (NSCLC) is often diagnosed at advanced stages, with distant metastasis being the leading cause of death. However, the distribution patterns of metastatic organs and their prognostic impact remain unclear. This study aimed to characterize the distribution of metastatic organs and evaluate their prognostic significance in patients with metastatic NSCLC.

This retrospective study included 305 patients with metastatic NSCLC diagnosed at our institution between 1 January 2022 and 1 January 2026. Patients were categorized into the single-organ metastasis (SOM) group (n = 159) and the multiple-organ metastasis (MOM) group (n = 146). Metastatic sites assessed included the brain, bone, liver, lung, and adrenal glands. Overall survival (OS) was compared between the groups using the Kaplan-Meier analysis and log-rank tests. Univariate and multivariate Cox regression models were used to identify factors associated with OS.

The most common metastatic site was the bone in both the SOM (40.9%) and MOM (82.2%) groups. Patients in the MOM group exhibited significantly worse OS than those in the SOM group (median OS: 3.22 vs. 8.22 months, log-rank test p < 0.05). A multivariate Cox regression analysis identified the MOM pattern (hazard ratio [HR] = 2.60), older age (HR = 1.03), N2 stage (HR = 1.71), and N3 stage (HR = 1.86) as independent risk factors for poorer OS, while chemotherapy (HR = 0.63) and immunotherapy (HR = 0.54) were protective factors (all p < 0.05). Among patients with SOM, the median OS was 9.09, 7.06, 4.99, 21.06, and 5.09 months for the bone, brain, liver, lung, and adrenal gland metastases, respectively. Patients with adrenal gland metastasis had significantly worse OS than those with bone or lung metastases (p < 0.05).

Multiple-organ metastasis independently predicts poorer prognosis. In patients with SOM, preliminary evidence suggests that adrenal gland involvement may be associated with worse survival than bone or lung metastases, whereas no significant differences were observed among the other sites. These findings highlight the importance of assessing both the extent and distribution of metastatic involvement for risk stratification.