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Objective  To analyze the relationship between tumor size and metastatic site in stage IV NSCLC patients.    Methods  A total of 40,196 stage IV NSCLC patients from 2010 to 2015 were screened by SEER database. Chi-square test was used to compare the characteristics of clinical variables. At the same time, multivariate Logistic regression analysis was used to evaluate the relationship between tumor size and organ metastasis.    Results  Regardless of tumor size, the proportion of bone metastasis and lung metastasis was higher and similar in patients with squamous cell carcinoma, while in patients with adenocarcinoma, bone metastasis accounted for the highest proportion. We found that whether the metastatic site was bone, brain, liver or lung, the proportion of patients with a tumor size of 3–7 cm was the highest. Multivariate regression analysis demonstrated that patients with a tumor size of 3–7 cm and a tumor size ≥7 cm were more likely to develop brain metastasis and lung metastasis compared with patients with a tumor size ≤3 cm (all  P  < 0.001), which meant the larger the tumor, the greater the risk of brain or lung metastasis. At the same time, the results indicated that patients with a tumor size of 3–7 cm had a tendency to develop liver metastasis ( P  = 0.004), while the statistical significance was not found for patients with a tumor size ≥7 cm ( P  = 0.524). The results also revealed that patients with a tumor size of 3–7cm had no significant difference to develop bone metastasis ( P  = 0.116), while the statistical significance was found for patients with a tumor size ≥7 cm ( P  < 0.001).    Conclusions  There was statistical significance between tumor size and metastatic site in patients with stage IV NSCLC. For brain or lung metastasis, the larger the tumor, the higher the risk of brain or lung metastasis. For liver metastasis, patients with a tumor size of 3–7 cm were more prone to develop liver metastasis. For bone metastasis, patients with a tumor size ≥7 cm were more likely to have bone metastasis.

Relationship between tumor size and metastatic site in patients with stage IV non-small cell lung cancer: A large SEER-based study