Management of occult malignant pleural disease firstly detected at thoracotomy for non-small cell lung cancer patients

Abstract

Background: The current study was to investigate the risk factors of occult malignant pleural disease (MPD) detected at thoracotomy and the outcomes of surgical intervention for these non-small cell lung cancer (NSCLC) patients with or without MPD. Conclusions:We summarized that a new prediction model including 5-risk factors of age, carcinoembryonic antigen (CEA), N stage, adenocarcinoma and pleural invasion was provided to diagnose MPD for the NSCLC patients and primary lesion resection greatly contributed for these MPD patients.

Surgical Resection of Primary Tumors Provides Survival Benefits for Lung Cancer Patients With Unexpected Pleural Dissemination

“…According to the previous studies, the OS, 3- and 5-year survival rate of NSCLC patients with PD were 15–52 months, 25.2–69.2% and 16.0–42.7%, respectively ( 1 , 7 – 9 , 11 , 17 , 21 , 22 , 24 ). Furthermore, the OS, 3- and 5-year survival rate were 20–64 months, 45.8–82.9%, and 31.4–42.7% for patients with primary tumor resection, while 7–35 months, 11.8–41.7%, and 0–19.5% for patients with biopsy alone.…”

“…However, the time span of this study was relatively short and recent (6 years from 2010) compared with other studies ( 1 , 16 , 17 , 19 , 24 ), and no patient was lack of pathological confirmation for malignant PD, unlike other studies ( 16 , 19 ). Besides, the sample size of this study was relatively larger than previous studies, as well as longer follow-up time ( 1 , 7 , 12 , 14 , 15 , 22 ). Additionally, several studies reported that N0 stage was the independent prognostic factor for survival, which, however, has potential bias, given that many patients did not have completely pathological N status ( 1 , 26 ).…”

“…Under these circumstances, surgeons have to decide to stop surgery or go on. Recently, emerging evidence have shown that primary tumor resection could provide survival benefits for NSCLC with malignant PD ( 1 , 7 – 12 , 21 , 22 ), which promoted the re-evaluation of the surgical roles in this type of disease, particularly with the rapid development of VATS with less postoperative pain, shorter hospital stays, and fewer complications ( 23 ). However, some of the studies have the limitation of small sample size, patient selection bias (containing patients with pleural effusion, contralateral nodules, or no pathological confirmation of PD), or lack of control group ( 1 , 7 , 12 , 14 – 19 ).…”

New horizons in non-small-cell lung cancer patients with ipsilateral pleural dissemination (M1a): review of the literature

“…The opposite conclusions of the two similar studies might due to the differences in adjuvant treatment and surgical methods. Then, in the last two decades, several single-center retrospective studies with sample sizes ranging from 25 to 138 also reported outcomes of unexpected M1a patients undergoing PTR, with MSTs ranging from 15-64 months and 3-year OSs ranging from 34.2% to 82.9%, 5-year OSs ranging from 16.3-42.7%, respectively (18)(19)(20)(21)(22)(23)(24)(25)(26)(27). Most studies supported PTR as a significant prognostic factor for better survival for patients intraoperatively diagnosed as M1a.…”

“…In the last 10 years, targeted therapy, such as TKIs for EGFR or anaplastic lymphoma kinase (ALK), significantly improved the survival of driver-oncogene positive stage IV NSCLC patients (35). According to previous literatures, adenocarcinoma is the most common histology subtype in pM1a patients, with a prevalence of 64% to 90.9% (15,(17)(18)(19)(20)(21)(22)(23)(24)(25)27,30,31,33,34). Thus, pM1a patients are likely to benefit from targeted therapy.…”