1
|
Fujiwara T, Shien K, Matsuura M, Soh J, Yamamoto H, Takao S, Maki Y, Ueno T, Sugimoto R, Suzawa K, Okazaki M, Tao H, Hayama M, Kataoka M, Sano Y, Inokawa H, Yamashita M, Kawamata O, Kataoka K, Toyooka S. EGFR Mutation is a Prognostic Factor in Lung Cancer Patients with Pleural Dissemination Detected During or After Surgery. Ann Surg Oncol 2023; 30:6697-6702. [PMID: 37355521 PMCID: PMC10506925 DOI: 10.1245/s10434-023-13791-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/15/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Primary lung tumors are sometimes resected when either pleural dissemination (PD) or malignant pleural effusion (MPE) exists. This study clarified the prognostic factors for non-small cell lung cancer (NSCLC) with either PD and MPE, or both, detected during or after surgery. PATIENTS AND METHODS We examined patients with NSCLC from a multicenter database who had either PD, MPE, or both, detected during or after surgery between 2005 and 2015. Hazard ratios and 95% confidence intervals were estimated using the Cox proportional hazards model adjusted for potential confounding factors. RESULTS Among 9463 registered patients, PD, MPE, or both, were found in 114 patients with NSCLC during or after surgery. Primary tumor resection and exploratory thoracotomy were performed in 65 and 49 patients, respectively. In univariate analysis, adenocarcinoma, clinically undetected lymph node metastasis (c-N0 or unknown), EGFR mutation, and combination of chemotherapy or tyrosine kinase inhibitors after surgery were better prognostic factors for overall survival (OS), whereas in the multivariate analysis, adenocarcinoma, clinically undetected lymph node metastasis, and EGFR mutation were favorable independent prognostic factors in OS. Additionally, limited to patients with EGFR mutation, patients with primary lung tumor resection showed a significantly better 5-year OS than those with exploratory thoracotomy (86.4 vs. 44.8%; p < 0.001). CONCLUSION Our findings show that surgical resection of primary tumors could improve the prognosis of patients with PD, MPE, or both, detected during or after surgery when the tumors harbor an EGFR mutation.
Collapse
Affiliation(s)
- Toshiya Fujiwara
- Department of Thoracic Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
- Okayama University Thoracic Surgery Study Group (OUTSSG), Okayama, Japan
| | - Kazuhiko Shien
- Okayama University Thoracic Surgery Study Group (OUTSSG), Okayama, Japan.
- Department of Thoracic Surgery, Okayama University Hospital, Okayama, Japan.
| | - Motoki Matsuura
- Department of Thoracic Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
- Okayama University Thoracic Surgery Study Group (OUTSSG), Okayama, Japan
| | - Junichi Soh
- Okayama University Thoracic Surgery Study Group (OUTSSG), Okayama, Japan
- Department of Thoracic Surgery, Okayama University Hospital, Okayama, Japan
| | - Hiromasa Yamamoto
- Okayama University Thoracic Surgery Study Group (OUTSSG), Okayama, Japan
- Department of Thoracic Surgery, Okayama University Hospital, Okayama, Japan
| | - Soshi Takao
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Yuho Maki
- Okayama University Thoracic Surgery Study Group (OUTSSG), Okayama, Japan
- Department of Thoracic Surgery, Shikoku Cancer Center, Matsuyama, Japan
| | - Tsuyoshi Ueno
- Okayama University Thoracic Surgery Study Group (OUTSSG), Okayama, Japan
- Department of Thoracic Surgery, Shikoku Cancer Center, Matsuyama, Japan
| | - Ryujiro Sugimoto
- Okayama University Thoracic Surgery Study Group (OUTSSG), Okayama, Japan
- Center of Chest Medicine and Surgery, Ehime University, Toon, Japan
| | - Ken Suzawa
- Okayama University Thoracic Surgery Study Group (OUTSSG), Okayama, Japan
- Department of Thoracic Surgery, Okayama University Hospital, Okayama, Japan
| | - Mikio Okazaki
- Okayama University Thoracic Surgery Study Group (OUTSSG), Okayama, Japan
- Department of Thoracic Surgery, Okayama University Hospital, Okayama, Japan
| | - Hiroyuki Tao
- Okayama University Thoracic Surgery Study Group (OUTSSG), Okayama, Japan
- Department of Thoracic Surgery, Japanese Red Cross Society Himeji Hospital, Himeji, Japan
| | - Makio Hayama
- Okayama University Thoracic Surgery Study Group (OUTSSG), Okayama, Japan
- Department of Thoracic Surgery, Japanese Red Cross Okayama Hospital, Okayama, Japan
| | - Masafumi Kataoka
- Okayama University Thoracic Surgery Study Group (OUTSSG), Okayama, Japan
- Department of Surgery, Okayama Saiseikai General Hospital, Okayama, Japan
| | - Yoshifumi Sano
- Okayama University Thoracic Surgery Study Group (OUTSSG), Okayama, Japan
- Center of Chest Medicine and Surgery, Ehime University, Toon, Japan
| | - Hidetoshi Inokawa
- Okayama University Thoracic Surgery Study Group (OUTSSG), Okayama, Japan
- Division of Thoracic Surgery, Yamaguchi-Ube Medical Center, Ube, Japan
| | - Motohiro Yamashita
- Okayama University Thoracic Surgery Study Group (OUTSSG), Okayama, Japan
- Department of Thoracic Surgery, Shikoku Cancer Center, Matsuyama, Japan
| | - Osamu Kawamata
- Okayama University Thoracic Surgery Study Group (OUTSSG), Okayama, Japan
- Department of Surgery, Onomichi Municipal Hospital, Onomichi, Japan
| | - Kazuhiko Kataoka
- Okayama University Thoracic Surgery Study Group (OUTSSG), Okayama, Japan
- Department of Thoracic Surgery, Iwakuni Clinical Center, Iwakuni, Japan
| | - Shinichi Toyooka
- Okayama University Thoracic Surgery Study Group (OUTSSG), Okayama, Japan
- Department of Thoracic Surgery, Okayama University Hospital, Okayama, Japan
| |
Collapse
|
2
|
Wang Z, Li H, Liu T, Sun Z, Yang F, Jiang G. Development and External Validation of a Nomogram for Predicting Cancer-Specific Survival of Non-Small Cell Lung Cancer Patients With Ipsilateral Pleural Dissemination. Front Oncol 2021; 11:645486. [PMID: 34350108 PMCID: PMC8327084 DOI: 10.3389/fonc.2021.645486] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 06/28/2021] [Indexed: 12/25/2022] Open
Abstract
Background Non-small-cell lung cancer (NSCLC) patients with ipsilateral pleural dissemination are defined as M1a in the eighth of American Joint Committee on Cancer (AJCC) TNM staging. We aimed to build a nomogram to predict lung cancer specific survival (LCSS) of NSCLC patients with ipsilateral pleural dissemination and to compare the impact of primary tumor resection (PTR) on LCSS among patients with different features. Methods A total of 3,918 NSCLC patients with ipsilateral pleural dissemination were identified from the Surveillance, Epidemiology, and End Results (SEER) database. We selected and integrated significant prognostic factors based on competing risk regression to build a nomogram. The model was subjected to internal validation within SEER cohort and external validation with the cohort of 97 patients from Peking University People’s Hospital. Results Age (P < 0.001), gender (P = 0.037), T stage (P = 0.002), N stage (P < 0.001), metastasis pattern (P = 0.005), chemotherapy (P < 0.001), and PTR (P < 0.001) were independent prognostic factors. The calibration curves presented a good consistency and the Harrell’s C-index of nomogram were 0.682 (95%CI: 0.673–0.691), 0.687 (95%CI: 0.670–0.704) and 0.667 (95%CI: 0.584–0.750) in training, internal, and external validation cohort, respectively. Interaction tests suggested a greater LCSS difference caused by PTR in patients without chemotherapy (P < 0.001). Conclusions We developed a nomogram based on competing risk regression to reliably predict prognosis of NSCLC patients with ipsilateral pleural dissemination and validated this nomogram in an external Chinese cohort. This novel nomogram might be a practical tool for clinicians to anticipate the 1-, 3- and 5-year LCSS for NSCLC patients with pleural dissemination. Subgroup analysis indicated that patients without chemotherapy could get more benefit from PTR. In order to assess the role of PTR in the management of M1a patients more accurately, further prospective study would be urgently required.
Collapse
Affiliation(s)
- Zhenfan Wang
- Department of Thoracic Surgery, Centre of Thoracic Minimally Invasive Surgery, Peking University People's Hospital, Beijing, China
| | - Hao Li
- Department of Thoracic Surgery, Centre of Thoracic Minimally Invasive Surgery, Peking University People's Hospital, Beijing, China
| | - Taorui Liu
- Department of Thoracic Surgery, Centre of Thoracic Minimally Invasive Surgery, Peking University People's Hospital, Beijing, China
| | - Zewen Sun
- Department of Thoracic Surgery, Centre of Thoracic Minimally Invasive Surgery, Peking University People's Hospital, Beijing, China
| | - Fan Yang
- Department of Thoracic Surgery, Centre of Thoracic Minimally Invasive Surgery, Peking University People's Hospital, Beijing, China
| | - Guanchao Jiang
- Department of Thoracic Surgery, Centre of Thoracic Minimally Invasive Surgery, Peking University People's Hospital, Beijing, China
| |
Collapse
|
3
|
Fan L, Yang H, Han K, Zhao Y, Gao W, Schmid RA, Yao F, Zhao H. Surgical Resection of Primary Tumors Provides Survival Benefits for Lung Cancer Patients With Unexpected Pleural Dissemination. Front Surg 2021; 8:679565. [PMID: 34250008 PMCID: PMC8260680 DOI: 10.3389/fsurg.2021.679565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/28/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Surgery is not generally recommended for non-small cell lung cancer (NSCLC) patients with malignant pleural dissemination (PD). However, in some cases, PD is found unexpectedly during surgery. There is no consensus on whether surgical intervention can provide survival benefit for them. We investigated the role of surgery in NSCLC patients with unexpected PD by a cohort study. Methods: Clinical data of consecutive patients who intended to undergo radical surgery for NSCLC between January 2010 and December 2015 at Shanghai Chest Hospital and Huadong Hospital were collected from a lung cancer database. Patients diagnosed with unexpected malignant pleural nodules intraoperatively were enrolled in this retrospective study. Results: A total of 181 NSCLC patients were diagnosed with unexpected malignant PD intraoperatively and confirmed with postoperatively histological examinations. Out of these, 80 (44.2%) patients received pleural nodule biopsies alone, and 101 (55.8%) received primary tumor resection (47 with sublobar resection and 54 with lobectomy). The median progression-free survival and overall survival for all patients were 13 and 41 months respectively. Patients in the resection group had significantly better progression-free survival (19.0 vs. 10.0 months, P < 0.0001) and overall survival (48.0 vs. 33.0 months, P < 0.0001) than patients in the biopsy group. In the resection group, there was no statistical difference between patients with sublobar resection and lobectomy (P = 0.34). Univariate and multivariate analyses identified primary tumor resection, targeted adjuvant therapy, and tumor size (≤ 3 cm) as independent prognostic factors. Conclusions: NSCLC patients with unexpected intraoperative PD potentially benefited from surgical resection of the primary tumor and multidisciplinary targeted therapy, particularly when tumor size did not exceed 3 cm. Our data demonstrated that the resection type was not associated with survival differences, which remains to be defined with a larger sample size.
Collapse
Affiliation(s)
- Liwen Fan
- Department of Thoracic Surgery, Huadong Hospital Affiliated to FuDan University, Shanghai, China.,Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Haitang Yang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ke Han
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yang Zhao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Wen Gao
- Department of Thoracic Surgery, Huadong Hospital Affiliated to FuDan University, Shanghai, China
| | - Ralph A Schmid
- Department of General Thoracic Surgery, Department of BioMedical Research, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Feng Yao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Heng Zhao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| |
Collapse
|
4
|
Li H, Liu T, Sun Z, Wang Z, Liu X, Yang F. New horizons in non-small-cell lung cancer patients with ipsilateral pleural dissemination (M1a): review of the literature. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:959. [PMID: 34350274 PMCID: PMC8263880 DOI: 10.21037/atm-20-6188] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 01/20/2021] [Indexed: 01/07/2023]
Abstract
Non-small cell lung cancer (NSCLC) with ipsilateral pleural dissemination (pM1a) is generally contraindicated for surgery owing to the extremely poor survival. However, some studies have demonstrated that primary tumor resection (PTR) may prolong the survival of these patients. Besides, with the development of systemic therapy, it is still hard to decide the best therapy model for pM1a patients. Thus, we reviewed essential studies about NSCLC with pleural disease and summarized the progress of new techniques in recent years, trying to provide promising new horizons about the management of pM1a patients. Firstly, we suggest performing PTR for highly selected pM1a patients, combined with appropriate systemic therapies and follow-up strategies. Secondly, hyperthermic intrathoracic chemotherapy (HITHOC) can control the symptoms and prolong the survival of NSCLC patients with malignant pleural effusion (MPE). It could also combine with PTR together. Finally, application of genetic testing and circulating tumor DNA (ctDNA) monitoring may furthermore make it possible for personalized management of pM1a patients in the future.
Collapse
Affiliation(s)
- Hao Li
- Department of Thoracic Surgery, Centre of Thoracic Minimally Invasive Surgery, Peking University People's Hospital, Beijing, China
| | - Taorui Liu
- Department of Thoracic Surgery, Centre of Thoracic Minimally Invasive Surgery, Peking University People's Hospital, Beijing, China
| | - Zewen Sun
- Department of Thoracic Surgery, Centre of Thoracic Minimally Invasive Surgery, Peking University People's Hospital, Beijing, China
| | - Zhenfan Wang
- Department of Thoracic Surgery, Centre of Thoracic Minimally Invasive Surgery, Peking University People's Hospital, Beijing, China
| | - Xianping Liu
- Department of Thoracic Surgery, Centre of Thoracic Minimally Invasive Surgery, Peking University People's Hospital, Beijing, China
| | - Fan Yang
- Department of Thoracic Surgery, Centre of Thoracic Minimally Invasive Surgery, Peking University People's Hospital, Beijing, China
| |
Collapse
|
5
|
Motono N, Iwai S, Yoshihito I, Usuda K, Yamada S, Uramoto H. Predictive factors related to pleural dissemination in non-small cell lung cancer. J Thorac Dis 2020; 12:5647-5656. [PMID: 33209397 PMCID: PMC7656371 DOI: 10.21037/jtd-20-1543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 08/28/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND The prognosis of non-small-cell lung cancer (NSCLC) patients with pleural dissemination is poor, and pleural dissemination is generally considered a contraindication for radical surgery. However, if pleural dissemination is missed intraoperatively, patients with false-negative stage IV NSCLC cannot receive appropriate chemotherapy, and their prognosis might worsen. METHODS In the present study, we enrolled 144 patients who received surgery for NSCLC between January 2008 and December 2019 with available data on the maximum standardized uptake value (SUVmax) on positron emission tomography (PET) with lesions adjacent to the visceral pleura and without lesions invading the chest wall. RESULTS Seven patients who had pleural dissemination were compared with 137 patients who had not pleural dissemination. The relationships between pleural dissemination and the clinicopathological variables were analyzed, and significant differences in the histopathological type (P=0.03), and differentiation (P<0.01) were noted. It was suggested that squamous cell carcinoma tended not to show dissemination to the pleural cavity. The logistic regression analyses of the predictive factors related to pleural dissemination in non-squamous cell carcinoma patients were analyzed, and the age (P=0.01) and differentiation (P<0.01) were identified as significant predictive factors related to pleural dissemination. CONCLUSIONS Cases with non-squamous cell carcinoma, a young age, and poor differentiation of undifferentiated grade of histological differentiation are factors associated with early pleural cavity dissemination.
Collapse
Affiliation(s)
- Nozomu Motono
- Department of Thoracic Surgery, Kanazawa Medical University, Ishikawa, 920-0293, Japan
| | - Shun Iwai
- Department of Thoracic Surgery, Kanazawa Medical University, Ishikawa, 920-0293, Japan
| | - Iijima Yoshihito
- Department of Thoracic Surgery, Kanazawa Medical University, Ishikawa, 920-0293, Japan
| | - Katsuo Usuda
- Department of Thoracic Surgery, Kanazawa Medical University, Ishikawa, 920-0293, Japan
| | - Sohsuke Yamada
- Department of Pathology and Laboratory Medicine, Kanazawa Medical University, Ishikawa, 920-0293, Japan
| | - Hidetaka Uramoto
- Department of Thoracic Surgery, Kanazawa Medical University, Ishikawa, 920-0293, Japan
| |
Collapse
|
6
|
Li H, Sun Z, Yang F, Sui X, Liu T, Wang J. Primary tumour resection in non-small-cell lung cancer patients with ipsilateral pleural dissemination (M1a): a population-based study. Eur J Cardiothorac Surg 2020; 55:1121-1129. [PMID: 30726889 DOI: 10.1093/ejcts/ezy439] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 11/04/2018] [Accepted: 11/17/2018] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Non-small-cell lung cancer (NSCLC) patients with ipsilateral pleural dissemination (M1a) are generally contraindicated for surgery. However, several small-sample studies have demonstrated that they might benefit from surgery. We investigated the effects of primary tumour resection on survival in these patients. METHODS Stage IV NSCLC patients with ipsilateral pleural dissemination were identified from the US National Cancer Institute Surveillance, Epidemiology and End Results database entries from 2010 to 2015. Survival analysis was performed before and after matching. Multivariable regression models were built to identify prognostic factors. RESULTS Of the 5513 patients with ipsilateral pleural dissemination, 309 underwent primary tumour resection. In the entire cohort, surgery was associated with improved overall survival (OS) in both the unmatched and matched cohorts (both log rank, P < 0.001). In the surgery-recommended cohort, patients treated with surgery also had significantly longer OS before and after matching. Multivariable regression models showed that surgery was an independent favourable prognostic factor for OS [hazard ratio (HR) 0.56, 95% confidence interval (CI) 0.48-0.65; P < 0.001] and lung cancer-specific mortality (subhazard ratio 0.60, 95% CI 0.51-0.70; P < 0.001). Surgery was independently associated with improved survival in all subgroups except for those with pericardial effusion (P = 0.065) or N3 disease (P = 0.17). In the surgical cohort, patients who underwent lobe/bilobectomy had significantly better OS than those who underwent sublobar resection (log rank, P < 0.001). CONCLUSIONS Inclusion of primary tumour resection in multimodal therapy of NSCLC was associated with improved survival in selected patients with ipsilateral pleural dissemination, except for those with pericardial effusion or N3 disease.
Collapse
Affiliation(s)
- Hao Li
- Department of Thoracic Surgery, Centre of Thoracic Minimally Invasive Surgery, Peking University People's Hospital, Beijing, China
| | - Zewen Sun
- Department of Thoracic Surgery, Centre of Thoracic Minimally Invasive Surgery, Peking University People's Hospital, Beijing, China
| | - Fan Yang
- Department of Thoracic Surgery, Centre of Thoracic Minimally Invasive Surgery, Peking University People's Hospital, Beijing, China
| | - Xizhao Sui
- Department of Thoracic Surgery, Centre of Thoracic Minimally Invasive Surgery, Peking University People's Hospital, Beijing, China
| | - Taorui Liu
- Department of Thoracic Surgery, Centre of Thoracic Minimally Invasive Surgery, Peking University People's Hospital, Beijing, China
| | - Jun Wang
- Department of Thoracic Surgery, Centre of Thoracic Minimally Invasive Surgery, Peking University People's Hospital, Beijing, China
| |
Collapse
|
7
|
Li H, Liu T, Sun Z, Yang F. Primary tumor resection of non-small cell lung cancer patients with ipsilateral pleural dissemination (M1a) in the era of targeted therapy. Thorac Cancer 2020; 11:3213-3222. [PMID: 32946207 PMCID: PMC7605998 DOI: 10.1111/1759-7714.13649] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/14/2020] [Accepted: 08/16/2020] [Indexed: 12/25/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Hao Li
- Department of Thoracic Surgery, Centre of Thoracic Minimally Invasive Surgery, Peking University People's Hospital, Beijing, China
| | - Taorui Liu
- Department of Thoracic Surgery, Centre of Thoracic Minimally Invasive Surgery, Peking University People's Hospital, Beijing, China
| | - Zewen Sun
- Department of Thoracic Surgery, Centre of Thoracic Minimally Invasive Surgery, Peking University People's Hospital, Beijing, China
| | - Fan Yang
- Department of Thoracic Surgery, Centre of Thoracic Minimally Invasive Surgery, Peking University People's Hospital, Beijing, China
| |
Collapse
|
8
|
Park S, Chung Y, Lee HJ, Park IK, Kang CH, Kim YT. The Role of Primary Tumor Resection in Patients with Pleural Metastasis Encountered at the Time of Surgery. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 53:114-120. [PMID: 32551291 PMCID: PMC7287219 DOI: 10.5090/kjtcs.2020.53.3.114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 11/11/2019] [Accepted: 11/22/2019] [Indexed: 11/25/2022]
Abstract
Background Evidence is lacking on whether the resection of lung parenchymal cancer improves the survival of patients with unexpected pleural metastasis encountered during surgery. We conducted a single-center retrospective study to determine the role of lung resection in the long-term survival of these patients. Methods Among 4683 patients who underwent lung surgery between 1995 and 2014, 132 (2.8%) had pleural metastasis. After excluding 2 patients who had incomplete medical records, 130 patients’ data were collected. Only a diagnostic pleural and/or lung biopsy was performed in 90 patients, while the lung parenchymal mass was resected in 40 patients. Results The mean follow-up duration was 29.8 months. The 5-year survival rate of the resection group (34.7%±9.4%) was superior to that of the biopsy group (15.9%±4.3%, p=0.016). Multivariate Cox regression analysis demonstrated that primary tumor resection (p=0.041), systemic treatment (p<0.001), lower clinical N stage (p=0.018), and adenocarcinoma histology (p=0.009) were significant predictors of a favorable outcome. Interestingly, primary tumor resection only played a significant prognostic role in patients who received systemic treatment. Conclusion When pleural metastasis is unexpectedly encountered during surgical exploration, resection in conjunction with systemic treatment may improve long-term survival, especially in adenocarcinoma patients without lymph node metastasis.
Collapse
Affiliation(s)
- Samina Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Yongwoo Chung
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Joo Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - In Kyu Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Hyun Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Young Tae Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
9
|
Chen Y, Li W, Tang W, Yang X, Zhong W. [Observation - An Favorable Option Forthoracic Dissemination Patients with Lung Adenocarcinoma or Squamous Carcinoma]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2018; 21:303-309. [PMID: 29587911 PMCID: PMC5973350 DOI: 10.3779/j.issn.1009-3419.2018.04.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
背景与目的 手术非晚期期患者治疗的标准治疗,但是大量的回顾性研究显示胸腔内播散型肺癌接受主病灶切除后获益明显。非标准治疗之后患者该选择何种治疗策略?本研究通过回顾性数据去探究接受了主病灶切除的胸腔内播散型肺癌患者接下来何总治疗方式更优。 方法 回顾性收集早期肺腺癌或肺鳞癌且复发模式为胸腔内播散型患者;或拟行肺癌根治术,但术中胸腔探查发现胸腔内播散,接受主病灶切除的肺腺癌或肺鳞癌患者的一般资料、病理、淋巴结状态、基因突变状态、初始治疗方式等,随访至进展、死亡或失访,记录患者无进展生存时间、总生存时间、从确诊到开始治疗的时间。通过Kaplan-Meier绘制生存曲线,Log-rank检验比较组间生存差异,Cox比例回归风险模型分析无进展生存期(progression-free survival, PFS)和总生存期(overall survival, OS)相关预后因子。 结果 研究共纳入141例患者,70例r-M1a和71例s-M1a1患者。化疗组、靶向组、随访观察组患者中位PFS分别是14.7个月、41.0个月和31.0个月(95%CI: 19.01-26.01; P < 0.001),靶向治疗组和随访观察组患者PFS差异无统计学意义(P=0.600)。中位OS分别为39.0个月、42.6个月和38.1个月(95%CI: 32.47-45.33; P=0.478)。TTI < 3个月组和TTI≥3个月组患者的中位PFS分别是15.2个月和31.0个月(95%CI: 19.01-26.06; P<0.001),中位OS分别是41.7个月和38.7个月(95%CI: 32.47-45.33; P=0.714)。多因素分析显示性别(P=0.027)、淋巴结状态(P=0.036)、初始治疗方式(P<0.001)是PFS独立预后因子。 结论 随访观察不会缩短胸腔内播散腺癌和鳞癌患者的生存时间,是一种可选的治疗策略。
Collapse
Affiliation(s)
- Ying Chen
- The Second Medical College of Southern Medical University, Guangzhou 510515, China.,Guangdong Provincial Institute of Lung Cancer, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Wei Li
- Foshan First People Hospital, Foshan 528000, China
| | - Wenfang Tang
- Guangdong Provincial Institute of Lung Cancer, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Xuening Yang
- Guangdong Provincial Institute of Lung Cancer, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Wenzhao Zhong
- The Second Medical College of Southern Medical University, Guangzhou 510515, China
| |
Collapse
|
10
|
Li C, Kuo SW, Hsu HH, Lin MW, Chen JS. Lung adenocarcinoma with intraoperatively diagnosed pleural seeding: Is main tumor resection beneficial for prognosis? J Thorac Cardiovasc Surg 2017; 155:1238-1249.e1. [PMID: 29254636 DOI: 10.1016/j.jtcvs.2017.09.162] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 09/18/2017] [Accepted: 09/30/2017] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To evaluate whether main tumor resection improves survival compared with pleural biopsy alone in patients with lung adenocarcinoma with intraoperatively diagnosed pleural seeding. METHODS Forty-three patients with lung adenocarcinoma with pleural seeding diagnosed unexpectedly during surgery performed between January 2006 and December 2014 were included in this retrospective study using a prospectively collected lung cancer database. Each surgeon decided whether to perform main tumor resection or pleural biopsy alone. RESULTS Main tumor and visible pleural nodule resection was performed in 30 patients (tumor resection group). The remaining 13 patients underwent pleural nodule biopsy alone (open-close group). The clinical T stage was higher in the open-close group than in the tumor resection group (P = .02). The tumor resection group had longer operative times compared with the open-close group (mean, 141.8 vs 80.3 minutes). There were no other statistically significant differences in perioperative parameters. The surgical method was the sole statistically significant prognostic factor. Patients in the tumor resection group had better progression-free survival (3-year survival: 44.5% vs 0%; P = .009) and overall survival (3-year survival: 82.9% vs 38.5%; P = .013) than did the open-close group. There was no significant survival difference between sublobar resection and lobectomy for the main tumor resection. CONCLUSIONS Our study demonstrated improved progression-free and overall survival after main tumor and visible pleural nodule resection in patients with lung adenocarcinoma with intraoperatively diagnosed pleural seeding. Further randomized trials are needed to define the role of main tumor resection in these patients.
Collapse
Affiliation(s)
- Chi Li
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Shuenn-Wen Kuo
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsao-Hsun Hsu
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Mong-Wei Lin
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Jin-Shing Chen
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| |
Collapse
|
11
|
Hu R, Jiang H, Li H, Wei D, Wang G, Ma S. Intrapleural perfusion thermo-chemotherapy for pleural effusion caused by lung carcinoma under VATS. J Thorac Dis 2017; 9:1317-1321. [PMID: 28616284 DOI: 10.21037/jtd.2017.04.65] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND The aim of this study was to assess the effectiveness of intrapleural perfusion thermo-chemotherapy (IPTC) under video-assisted thoracoscopic surgery (VATS) for malignant pleural effusion (MPE) caused by lung carcinoma. METHODS In this retrospective study, fifty-four patients with moderate or large amounts of ipsilateral MPE secondary to non-small cell lung cancer (NSCLC) underwent pleural biopsy and IPTC under VATS. IPTC was performed by perfusing the pleural cavity with 43.0 °C saline solution containing cisplatin (200 mg/m2) using a devised circuit through mechanical circulation for 60 minutes. Blood pressure, heart rate, oxygen saturation (SpO2), and esophageal and rectal temperatures were monitored throughout the surgery. At the end of the perfusion, pleural biopsy was performed again for histological analysis. RESULTS The temperature at the pleural surface was stabilized at 43 °C, and pleural effusion was controlled in all patients. KPS scores increased in 89.3% of patients. No patient developed bone marrow suppression reactions with noticeable bleeding after treatment, and no liver and kidney malfunctions were observed. Apoptosis was detected by light and electron microscopy after IPTC. CEA markedly decreased in all patients 1 month after IPTC. The median survival time was 21.7 months, with a one-year survival rate of 74.1%. CONCLUSIONS IPTC under VATS is a new, safe, less invasive and more effective approach for MPE caused by lung carcinoma.
Collapse
Affiliation(s)
- Runlei Hu
- Department of Thoracic Surgery, Hangzhou First People's Hospital, Nanjing Medical University, Hangzhou 310006, China
| | - Hong Jiang
- Department of Thoracic Surgery, Hangzhou First People's Hospital, Nanjing Medical University, Hangzhou 310006, China
| | - Hu Li
- Department of Thoracic Surgery, Hangzhou First People's Hospital, Nanjing Medical University, Hangzhou 310006, China
| | - Dongshan Wei
- Department of Thoracic Surgery, Hangzhou First People's Hospital, Nanjing Medical University, Hangzhou 310006, China
| | - Guoqing Wang
- Department of Thoracic Surgery, Hangzhou First People's Hospital, Nanjing Medical University, Hangzhou 310006, China
| | - Shenglin Ma
- Department of Radiation Oncology, Hangzhou First People's Hospital, Nanjing Medical University, Hangzhou 310006, China
| |
Collapse
|
12
|
Xu Y, Chen N, Wang Z, Zhang Y, Mei J, Liu C, Liu L. Should primary tumor be resected for non-small cell lung cancer with malignant pleural disease unexpectedly found during operation?-a systemic review and meta-analysis. J Thorac Dis 2016; 8:2843-2852. [PMID: 27867560 DOI: 10.21037/jtd.2016.10.19] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Non-small cell lung cancer (NSCLC) with malignant pleural disease (MPD) was considered to be contraindication for surgery, but sometimes MPD was unexpectedly found intraoperatively. There was no consensus on the role of surgical intervention on the primary tumor in patients with MPD. The object of this research was to assess whether exairesis of primary tumor could prolong survival time. METHODS A systemic research of literature was performed on the databases of PubMed, Embase and Web of Science. Literatures examining surgical benefit or other prognostic factors among NSCLC patients with MPD unexpectedly found during operations were included. Hazard ratio (HR) with 95% confidence interval (95% CI) as well as P value is applied for prognostic role of surgical removal or other potential factors. RESULTS Nine articles with a total number of 861 patients fulfilled the eligibility criteria, five of them compared the survival benefit between exploration and resection among NSCLC patients with unexpected MPD, and other studies also investigated the prognostic factors in these patients. There was a significant survival benefit in patients with primary tumor resection (HR =0.443; 95% CI: 0.344-0.571; P<0.001). This role was further detected when stratified by analysis method and ethnicity. Female was an independent favorable predicted factor (HR =0.788; 95% CI: 0.648-0.959; P=0.017) while higher N-stage was a risk factor (HR =1.879; 95% CI: 1.307-2.701; P=0.001). Among patients who received primary tumor resection, higher N-stage was also a risk factor for poorer survival (HR =2.021; 95% CI: 1.496-2.730; P<0.001). CONCLUSIONS Resection of primary tumor, female and lower-N stage were suggested to be beneficial prognostic factor among NSCLC patients who were detected with MPD for the first time in the operating room. And among these people who received surgical removal of primary tumor, lower N-stage also indicated a better survival.
Collapse
Affiliation(s)
- Yuyang Xu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China;; West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Nan Chen
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China;; West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Zihuai Wang
- West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Yingyi Zhang
- West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Jiandong Mei
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Chengwu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China;; Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu 610041, China
| |
Collapse
|