The Prognosis of Patients with Non-Small Cell Lung Cancer Found to Have Carcinomatous Pleuritis at Thoracotomy

Abstract

Non-small cell lung cancer with carcinomatous pleuritis is considered to be a contraindication of surgical resection. The objective of this study was to clarify the prognosis of patients with non-small cell lung cancer in whom carcinomatous pleuritis was found at thoracotomy. A questionnaire survey on the survival of patients with carcinomatous pleuritis found at thoracotomy between January 1985 and December 1994 was conducted by the Japan Clinical Oncology Group. According to the data collected from 21 hospitals, 8813 patients with non-small cell lung cancer underwent thoracotomy, 284 (3.2%) of whom were found to have carcinomatous pleuritis. Information on survival was available for 227 of these patients, 34 (15%) of whom underwent thoracotomy alone without resection, whereas 193 (85%) underwent surgical resection. Of the 193 resected patients, 155 had no macroscopical residual tumor apart from the carcinomatous pleuritis. The 5-year survival rate was 14%. According to a univariate analysis, female sex, the presence of adenocarcinoma, a tumor size of less than 3.0 cm, no clinical lymph node metastasis, and no macroscopical residual tumor had a significantly favorable impact on survival. A multivariate analysis revealed that the extent of clinical lymph node metastasis (P = 0.006), histology (P = 0.028), and the absence or presence of a macroscopic residual tumor after the operation (P = 0.045) were predominant prognostic factors. The 5-year survival rate of 83 patients with three positive variables was 24%. The prognosis of patients with adenocarcinoma found to have carcinomatous pleuritis at thoracotomy was not necessarily unfavorable if there was no clinically detected lymph node metastasis and no residual tumor apart from the carcinomatous pleuritis.

Surgery for metastatic pleural extension of non-small-cell lung cancer

“…These authors confirmed their results in 2000 [15]. We list some articles published from 2000 to 2002 in Table 5 [15][16][17][18][19]. No 5-year survival was observed in case of exploratory thoracotomy without resection [15][16][17][18]; best results following resection were observed in case of adenocarcinoma [15,16] and in N0 patients [16,17,19], as we also observed.…”

Pulmonary resection for lung cancer with malignant pleural disease first detected at thoracotomy

“…The survival data from the IASLC Staging Project for patients, who were pathologically diagnosed with MPD, revealed an MST and a 5-year survival rate of 18 months and 11%, respectively, which is better than the survival data reported for patients with clinically diagnosed MPD [3]. Other researchers have also reported similar favorable results for patients with pathologically diagnosed MPD [6][7][8][9]. On the other hand, poor postoperative outcomes have also been demonstrated in patients with malignant pleural effusion [1,10].…”

“…Generally, patients with minimal pleural dissemination detected only on lavage cytology have been subjected to surgery [4,10]. The treatment of patients with MPD plus sufficient effusion for standard cytological examination or macroscopically detected pleural nodules at thoracotomy is most controversial, because data on these patients are limited [6][7][8][9][10]. The survival data from the IASLC Staging Project for patients, who were pathologically diagnosed with MPD, revealed an MST and a 5-year survival rate of 18 months and 11%, respectively, which is better than the survival data reported for patients with clinically diagnosed MPD [3].…”

“…In clinical practice, pleural disease is sometimes only discovered at thoracotomy, and then it is often controversial whether or not the primary cancer lesion should be removed [6][7][8][9]. Generally, patients with minimal pleural dissemination detected only on lavage cytology have been subjected to surgery [4,10].…”

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

“…MPD is often discovered at thoracotomy for the NSCLC patients, and the treatment of primary cancer lesion is always controversial (4)(5)(6)(7)(8).…”