The prognosis after contraindicated surgery of NSCLC patients with malignant pleural effusion (M1a) may be better than expected.

Yijiu Ren,Yang Liu,Dong Xie,Chenyang Dai,Chang Chen,Gening Jiang,Wenhua Liang,Jianxing He,Hui Zheng,Jianfei Shen,Jiaxi He,Ping Yang,Ke Fei

doi:10.18632/oncotarget.8566

Abstract

Although non-small cell lung cancer (NSCLC) with malignant pleural effusion (M1a) is generally contraindicated for surgery, several reports have demonstrated favorable prognosis. This study aimed to describe the results of surgical intervention in this disease. In this retrospective study, we evaluated NSCLC patients with ipsilateral malignant pleural effusion selected from Surveillance Epidemiology and End-Results database (SEER). Primary tumor resection was compared to no tumor resection in the overall survival (OS) and lung cancer-specific survival (LCSS). Multivariate analyses and propensity score matching were applied to compare the two groups. The study included 2,217 eligible patients. Primary tumor resection group was significantly associated with better OS and LCSS compared to no tumor resection group (the median survival time (MST), 20 vs 7 months; OS, p <0.001; LCSS, p <0.001). Multivariable analyses indicated that no primary tumor resection was associated with decreased OS (Hazard Ratio (HR), 2.136; p<0.001) and LCSS (HR, 2.053; p<0.001). In propensity score-matched pairs, better OS and LCSS were further validated in patients with ipsilateral malignant pleural effusion who underwent primary tumor resection compared to no tumor resection (MST, 20 vs 6 months; OS, p <0.001; LCSS, p <0.001). Similarly, multivariable analyses also indicated that no primary tumor resection was associated with decreased OS (HR, 2.309; p <0.001) and LCSS (HR, 2.301; p <0.001) for patients with ipsilateral malignant pleural effusion. In conclusion, the prognosis after contraindicated surgery of NSCLC patients with malignant pleural effusion (M1a) may be better than expected. Thus, subsequent studies should aim to identify patients who could benefit from surgery.

Highlights

Malignant pleural effusion, as one kind of non-small-cell lung cancer (NSCLC) with pleural dissemination, has been proved to have poor outcomes, and it is generally contraindicated for operations [1,2,3]
This study included 2,217 patients with ipsilateral malignant pleural effusion from Surveillance Epidemiology and End-Results database (SEER) registry patients diagnosed with NSCLC between 2004 and 2012 with no prior history of malignancy
Kaplan-Meier analysis showed that for patients with ipsilateral malignant pleural effusion, primary tumor resection group showed significantly better overall survival (OS) and lung cancer-specific survival (LCSS) compared to no tumor resection group (MST, 20 vs 7 months; OS, p

Summary

Introduction

As one kind of non-small-cell lung cancer (NSCLC) with pleural dissemination, has been proved to have poor outcomes, and it is generally contraindicated for operations [1,2,3]. The International Association for the Study of Lung Cancer (IASLC) Staging Project had stated that the median survival time (MST) and the 5-year survival rate of patients with pleural dissemination were 8 months and 2%, respectively [3]. NSCLC with malignant pleural effusion was staged as IV (M1a) in the new staging system of the Union for International Cancer Control [4]. Lim and colleagues reported that positive pleural lavage cytology during surgical resection is an independent predictor factor in predicting worse survival www.impactjournals.com/oncotarget of NSCLC patients with a resectable-stage tumor [5]. Ryu and colleagues founded that prognostic impact effect of minimal pleural effusion was higher in early rather than advanced stages of NSCLC [6]. Many surgeons have reported that the postoperative prognosis of patients diagnosed with malignant pleural disease at thoracotomy is relatively favorable [7,8,9,10,11,12]

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