Surgical choice of non-small cell lung cancer with unexpected pleural dissemination intraoperatively

Junjie Hu,Jing Zhang,Qiang Ma,Peng Zhang,Gening Jiang,Yan Chen,Xinsheng Zhu

doi:10.1186/s12885-021-08180-1

Junjie Hu, Jing Zhang + Show 5 more

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https://doi.org/10.1186/s12885-021-08180-1

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Journal: BMC Cancer	Publication Date: Apr 22, 2021
Citations: 3	License type: open-access

Affiliation: Shanghai Pulmonary Hospital, Tongji University

Abstract

BackgroundWhether patients with non-small cell lung cancer (NSCLC) with unexpected pleural dissemination (UPD) could get survival benefit from tumor resection remained controversial.MethodsTotally, 169 patients with NSCLC with UPD were included between 2012 and 2016. Patients were divided into the tumor resection and open-close group. Progression-free survival (PFS) and overall survival (OS) were compared with a log-rank test. The multivariable Cox analysis was applied to identify prognostic factors.ResultsSixty-five patients received open-close surgery and 104 patients underwent main tumor and visible pleural nodule resection. Tumor resection significantly prolonged OS (hazard ratio [HR]: 0.408, P < 0.001), local PFS (HR: 0.283, P < 0.001), regional PFS (HR: 0.506, P = 0.005), and distant metastasis (HR: 0.595, P = 0.032). Multivariable Cox analysis confirmed that surgical method was an independent prognostic factor for OS, local PFS and regional PFS, except distant metastasis. Subgroup analyses indicated that tumor resection could not improve OS in the patients who received targeted therapy (HR: 0.649, P = 0.382), however, tumor resection was beneficial for the patients who received adjuvant chemotherapy alone (HR: 0.322, P < 0.001). In the tumor resection group, lobectomy (HR: 0.960, P = 0.917) and systematic lymphadenectomy (HR: 1.512, P = 0.259) did not show survival benefit for OS.ConclusionsMain tumor and visible pleural nodule resection could improve prognosis in patients with UPD who could not receive adjuvant targeted therapy. Sublobar resection without systematic lymphadenectomy may be the optimal procedure.

Highlights

Lung cancer ranked first in terms of the incidence and the mortality among malignant tumors [1], and nonsmall cell lung cancer (NSCLC) represented approximately 85% of lung cancer cases [2]
Of the 169 patients, 65 patients received open-close surgery and 104 patients underwent main tumor and visible pleural nodule resection
Two cases of anaplastic lymphoma kinase (ALK) rearrangement were detected in the tumor resection group, and one case in the open-close group

Summary

Introduction

Lung cancer ranked first in terms of the incidence and the mortality among malignant tumors [1], and nonsmall cell lung cancer (NSCLC) represented approximately 85% of lung cancer cases [2]. Several studies revealed that tumor resection could bring survival benefit in the patients with UPD [4,5,6,7]. Hu et al BMC Cancer (2021) 21:445 small These studies did not make subgroup analysis for adjuvant therapy. Given that targeted therapy had a greater survival benefit for advanced NSCLC than conventional chemotherapy [8,9,10], the survival benefit of tumor resection for the patients who received targeted therapy was unclear. Our aims were to validate the benefit of tumor resection in the patients with UPD and explore its benefit in subgroups of different adjuvant therapeutic regimens. Whether patients with non-small cell lung cancer (NSCLC) with unexpected pleural dissemination (UPD) could get survival benefit from tumor resection remained controversial

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