Lung adenocarcinoma with intraoperatively diagnosed pleural seeding: Is main tumor resection beneficial for prognosis?

Li, Chi; Kuo, Shuenn‐Wen; Hsu, Hsao‐Hsun; Lin, Mong-Wei; Chen, Jin‐Shing

doi:10.1016/j.jtcvs.2017.09.162

Cited by 37 publications

(54 citation statements)

References 33 publications

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“…In the last decade, several singlecenter retrospective studies with sample sizes ranging from 25 to 110 patients have shown favorable outcomes for M1a patients undergoing PTR, with MSTs ranging from 15 to 64 months and three-year OSs ranging from 34.2% to 82.9%, respectively. 6,12,[17][18][19][20][21][22] A recent meta-analysis of nine retrospective studies 23 also suggested that PTR was a beneficial prognostic factor among cM0 and pM1a NSCLC patients.…”

Section: Discussionmentioning

confidence: 99%

“…In 2015, Yun et al 6 reported a similar rate (approximately 50%) of EGFR mutation and EGFR-TKI treatment between a resection and an exploration group in patients with localized pleural seeding first detected during surgery. In the most recent study by Li et al 12 approximately 67% of patients with adenocarcinomas (n = 29) received EGFR-TKI therapy, which contributed, in part, to the surprising surgical outcomes of patients with lung adenocarcinoma with intraoperatively diagnosed pleural seeding. However, the question remains whether main tumor resection still needs to be performed among EGFR mutation-positive patients who could have excellent survival receiving only EGFR-TKI therapy.…”

Section: Discussionmentioning

confidence: 99%

“…In the last decade, new multimodality treatment options, especially targeted therapy for driver oncogenepositive patients, have significantly improved the survival of stage IV NSCLC patients. 10,11 Recently, Li and colleagues 12 reported that patients with intraoperatively diagnosed pleural seeding who underwent PTR had a three-year progression-free survival (PFS) of 44.5% and a three-year OS of 82.9%. The extremely long survival may be related to the high adoption rate (approximately 76%) of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI).…”

Section: Introductionmentioning

confidence: 99%

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Primary tumor resection of non‐small cell lung cancer patients with ipsilateral pleural dissemination (M1a) in the era of targeted therapy

Liu

Sun

et al. 2020

Thoracic Cancer

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Background Non‐small cell lung cancer (NSCLC) patients with ipsilateral pleural dissemination (M1a) are generally contraindicated for surgery. Recently, several studies have demonstrated that these patients might benefit from primary tumor resection (PTR). However, whether PTR is beneficial for driver oncogene‐positive patients treated with targeted therapy, remains unclear. Here, we investigated the effects of PTR on survival in the era of targeted therapy. Methods In total, 105 NSCLC patients with ipsilateral pleural dissemination were identified. The mode of systemic treatment was assessed in this study. Survival analysis was performed with the Kaplan‐Meier method and Cox proportional hazards regression. The overall survival (OS) of patients with or without PTR was compared between propensity score‐matched groups (caliper: 0.02). Results In the entire cohort, PTR was associated with improved OS in both unmatched (median survival time [MST]: 50.0 vs. 29.6 months, P = 0.019) and matched (MST: 50.0 vs. 34.4 months, P = 0.052) cohorts. Multivariate regression models showed that surgery was an independent favorable prognostic factor for OS. A total of 70 patients underwent genetic testing, and targeted therapies, such as EGFR‐TKIs or ALK‐TKIs, were used in the driver oncogene‐positive patients. Subgroup analysis showed that PTR did not improve OS in the targeted therapy group (MST: 57.1 months vs. 50.4 months, P = 0.840). However, surgery significantly prolonged survival in the nontargeted therapy group (MST: 39.8 vs. 14.2 months, P = 0.002). Conclusions The results of this study indicated that PTR could prolong OS in stage IV NSCLC patients with ipsilateral pleural dissemination, especially in patients who are not candidates for targeted therapy. Key points Non‐small cell lung cancer patients with ipsilateral pleural dissemination can benefit from primary tumor resection. Primary tumor resection could prolong overall survival (OS) in non‐small cell lung cancer patients with ipsilateral pleural dissemination who are not candidates for targeted therapy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Primary tumor resection of non‐small cell lung cancer patients with ipsilateral pleural dissemination (M1a) in the era of targeted therapy

Liu

Sun

et al. 2020

Thoracic Cancer

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“…[ 1 , 2 ] Although every pleural dissemination is classified as the same stage, M1a, pleural dissemination is not a single entity of disease but a spectrum of disease with various tumor burden encompassing from limited pleural seeding to overt malignant pleural effusion (MPE). [ 3 , 4 ] Dry pleural dissemination (DPD) is a relatively early stage of pleural dissemination defined as pleural seeding without effusion and can be detected radiologically or surgically in a patient with clinically resectable lung cancer. DPD is detected in 1.2% to 2% of clinically resectable lung cancer patients.…”

Section: Introductionmentioning

confidence: 99%

Clinical course of non-small cell lung cancer patients with dry pleural dissemination

Kim

Park

et al. 2020

Medicine

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We investigated the prognosis of patients with dry pleural dissemination (DPD) of non-small cell lung cancer (NSCLC) and the risk factors of developing to malignant pleural effusion (MPE). We retrospectively reviewed 104 patients with NSCLC and DPD, confirmed surgically from 1996 to 2016. Incidence rate and risk factors of MPE were analyzed statistically. The prognosis of NSCLC patients with MPE was evaluated using the Kaplan–Meier method. The most common histologic type was adenocarcinoma in 95 (91.3%) patients. The median follow-up duration was 65.5 months and the median survival time was 37.7 months. MPE developed in 51 (49%) patients, and the median effusion-free interval was 41.9 months. The median survival time of the patients with and without MPE was not different (41.3 vs 31.7 months, P = .16). No predictive factors for the development of MPE were identified. Fifteen (14.4%) patients underwent invasive procedures for the management of MPE. Almost half of all patients with NSCLC and DPD experienced MPE, and 14.4% patients developed symptomatic MPE requiring invasive procedures. MPE in DPD did not affect the survival in NSCLC patients.

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“…For this reason, on the basis of our recent experience with cytoreductive surgery and hyperthermic intrathoracic chemotherapy (HITHOC) for mesothelioma and malignant pleural effusion [2,3], and some recent publications reporting good survival in selected patients with stage IVA lung cancer [4][5][6], we strongly believe that not all patients with stage IVA (M1a) NSCLC are the same and that longer survival can be obtained in those with disease confined in the hemithorax, and therefore a "new" form of precision (individualised) surgery should be explored as part of a multidisciplinary treatment modality. ZHOU et al [7] performed a meta-analysis on the effect of debulking surgery and HITHOC on malignant pleural effusion for various primary cancers.…”

Section: Introductionmentioning

confidence: 99%

Does cytoreduction surgery and hyperthermic intrathoracic chemotherapy prolong survival in patients with N0–N1 nonsmall cell lung cancer and malignant pleural effusion?

Nardini

2019

Eur Respir Rev

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IntroductionDebulking surgery and hyperthermic intrathoracic chemotherapy (HITHOC) has been successfully used in the treatment of thoracic tumours. Few authors report on the feasibility of its use in patients with lung cancer and malignant pleural effusion. The aim of this study was to evaluate the efficacy and results of debulking surgery and HITHOC in the treatment of selected patients with nonsmall cell lung cancer (NSCLC) and malignant pleural effusion.MethodsA systematic review was conducted in MEDLINE in accordance with PRISMA guidelines. The word search included: “hyperthermic intrathoracic chemotherapy and/or HITHOC or hyperthermic intrapleural”. Inclusion criteria were only those studies reporting a sufficient amount of data on HITHOC and surgery for lung cancer. Single case reports and review articles were excluded.Results20 articles were selected as they related to the topic of HITHOC and lung cancer. Most were from China (n=8) and Japan (n=6). Only four out of the 20 articles had sufficient data for this review. In total, data for 21 patients were collected. Debulking surgery ranged from wedge resection to pneumonectomy and pleurectomy. Mean survival was 27 months and median survival was 18 months (range 1–74 months). 13 patients out of 21 (62%) were alive at 1 year and six (28.5%) were alive at 2 years. 10 patients were still alive at the time of the respective publication in the 21 patients included. Systemic toxicity and treatment-related mortality were nil. There were insufficient data to perform a meta-analysis.ConclusionAlthough reported survival in this systematic review is encouraging, available evidence concerning debulking surgery and HITHOC in N0–N1 NSCLC with malignant pleural effusion is weak. Better evidence in the form of a randomised controlled trial is mandatory.

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Lung adenocarcinoma with intraoperatively diagnosed pleural seeding: Is main tumor resection beneficial for prognosis?

Cited by 37 publications

References 33 publications

Primary tumor resection of non‐small cell lung cancer patients with ipsilateral pleural dissemination (M1a) in the era of targeted therapy

Primary tumor resection of non‐small cell lung cancer patients with ipsilateral pleural dissemination (M1a) in the era of targeted therapy

Clinical course of non-small cell lung cancer patients with dry pleural dissemination

Does cytoreduction surgery and hyperthermic intrathoracic chemotherapy prolong survival in patients with N0–N1 nonsmall cell lung cancer and malignant pleural effusion?

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