Prognostic Difference of Pleural versus Distant Metastasis after Surgery for Lung Cancer

Abstract

Background: Pleural metastasis in lung cancer found at diagnosis has a poor prognosis, with 5–11 months’ survival. We hypothesized that prognosis might be different for patients who have had curative-intent surgery and subsequent pleural recurrence and that survival might differ based on the location of the first metastasis (distant versus pleural). This may clarify if pleural recurrence is a local event or due to systemic disease. Methods: A database of 5089 patients who underwent curative-intent surgery for lung cancer was queried, and 85 patients were found who had biopsy-proven pleural metastasis during surveillance. We examined survival based on pattern of metastasis (pleural first versus distant first/simultaneously). Results: Median survival was 34 months (range: 1–171) from the time of surgery and 13 months (range: 0–153) from the time of recurrence. The shortest median survival after recurrence was in patients with adenocarcinoma and pleural metastasis as the first site (6 months). For patients with pleural metastasis as the first site, those with adenocarcinoma had a significantly shorter post-recurrence survival when compared with squamous cell carcinoma (6 vs. 12 months; HR = 0.34) and a significantly shorter survival from the time of surgery when compared with distant metastases first/simultaneously (25 vs. 52 months; HR = 0.49). Conclusions: Patients who undergo curative-intent surgery for lung adenocarcinoma that have pleural recurrence as the first site have poor survival. This may indicate that pleural recurrence after lung surgery is not likely due to a localized event but rather indicates systemic disease; however, this would require further study.

Thoracoscopic biopsy in the diagnosis of lung and pleural diseases

“…This result is comparable to Joubert et al, where adenocarcinoma represented 77.6% of cases. 9 Extrathoracic malignancies comprised 9 out of 54 malignancies (16.6%). We had previously reported our experience in a small cross sectional study where the results were similar.…”

Identification of Novel Subtypes in Lung Adenocarcinoma: Evidence from Gene Set Variation Analysis in Tumor and Adjacent Nontumor Samples

“…Additionally, investigations of pathway activity alterations in LUAD have tended to concentrate on particular pathways rather than systematically evaluating plenty of pathways in tumor and nontumor samples. Importantly, in some LUAD patients after pulmonary lobectomy, the remaining cells will proliferate or repair and may sometimes become cancerous again [ 10 ]. Meanwhile, circulating tumor cells (CTCs) in the blood may effectively colonize the lung lobes, resulting in recurrence [ 11 ].…”