The Prognostic Analysis of Lung Cancer Patients with Occult Malignant Pleural Disease at Thoracotomy

Overview

Journal Transl Cancer Res

Specialty Oncology

Date 2022 Feb 4

PMID 35117517

Authors

Shaolei Li

Xin Yang

Shanyuan Zhang

Miao Huang

Yuanyuan Ma

Yue Yang

Affiliations

Soon will be listed here.

Abstract

Background: This study aims to determine the clinicopathological prognostic factors for occult malignant pleural disease (MPD) that were first detected in patients with non-small cell lung cancer (NSCLC) at thoracotomy and to assess the outcome of surgical intervention.

Methods: A total of 120 thoracotomy-patients with MPD were examined. The Kaplan-Meier test estimated survival curves, and Cox regression analysis was performed to validate the risk factors picked. In assessing surgical intervention, clinical and pathological parameters were matched by propensity score matching (PSM).

Results: With a median follow-up of 34 months, the 5-year overall survival of 120 patients was 28.0%. Multivariate analyses showed male (P=0.044), advanced T stages (P<0.001), advanced N stages (P=0.02), pleural invasion in image (P=0.005), pleural effusion (P=0.027), surgical intervention (P=0.008) and EGFR status (P=0.003) were independent predictors of survival. The 5-year survival rate and median survival time (MST) for 21 patients with lobectomy and pleurectomy were 71.6% and undefined, compared with 25.6% and 40.0 months in 46 patients with sublobectomy. When 53 patients only subjected to open-close surgery, their 5-year survival rate and MST were 23.4% and 30.2 months. After PSM, both 21 patients were included in lobectomy with the pleurectomy group and sublobectomy /open-close group. The overall survival of lobectomy with the pleurectomy group was better than the control group (P=0.046).

Conclusions: Age, stage, pleural invasion, pleural effusion, surgical intervention, and EGFR status affected the prognosis of the MPD patients first diagnosed at thoracotomy. Selective surgery gives better recovery, and additional studies are needed.

References

Goldstraw P, Crowley J, Chansky K, Giroux D, Groome P, Rami-Porta R . The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM Classification of malignant tumours. J Thorac Oncol. 2007; 2(8):706-14. DOI: 10.1097/JTO.0b013e31812f3c1a. View

Jiwangga D, Cho S, Kim K, Jheon S . Recurrence Pattern of Pathologic Stage I Lung Adenocarcinoma With Visceral Pleural Invasion. Ann Thorac Surg. 2016; 103(4):1126-1131. DOI: 10.1016/j.athoracsur.2016.09.052. View

Fukui T, Yokoi K . The role of surgical intervention in lung cancer with carcinomatous pleuritis. J Thorac Dis. 2016; 8(Suppl 11):S901-S907. PMC: 5124590. DOI: 10.21037/jtd.2016.06.36. View

Shigemura N, Akashi A, Ohta M, Matsuda H . Combined surgery of intrapleural perfusion hyperthermic chemotherapy and panpleuropneumonectomy for lung cancer with advanced pleural spread: a pilot study. Interact Cardiovasc Thorac Surg. 2007; 2(4):671-5. DOI: 10.1016/S1569-9293(03)00197-X. View

Sequist L, Yang J, Yamamoto N, OByrne K, Hirsh V, Mok T . Phase III study of afatinib or cisplatin plus pemetrexed in patients with metastatic lung adenocarcinoma with EGFR mutations. J Clin Oncol. 2013; 31(27):3327-34. DOI: 10.1200/JCO.2012.44.2806. View

Lakha S, Gomez J, Flores R, Wisnivesky J . Prognostic significance of visceral pleural involvement in early-stage lung cancer. Chest. 2014; 146(6):1619-1626. DOI: 10.1378/chest.14-0204. View

Okamoto T, Iwata T, Mizobuchi T, Hoshino H, Moriya Y, Yoshida S . Pulmonary resection for lung cancer with malignant pleural disease first detected at thoracotomy. Eur J Cardiothorac Surg. 2011; 41(1):25-30. PMC: 3241128. DOI: 10.1016/j.ejcts.2011.04.010. View

Eberhardt W, Mitchell A, Crowley J, Kondo H, Kim Y, Turrisi 3rd A . The IASLC Lung Cancer Staging Project: Proposals for the Revision of the M Descriptors in the Forthcoming Eighth Edition of the TNM Classification of Lung Cancer. J Thorac Oncol. 2015; 10(11):1515-22. DOI: 10.1097/JTO.0000000000000673. View

Rami-Porta R, Asamura H, Travis W, Rusch V . Lung cancer - major changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA Cancer J Clin. 2017; 67(2):138-155. DOI: 10.3322/caac.21390. View

10.

Li C, Kuo S, Hsu H, Lin M, Chen J . Lung adenocarcinoma with intraoperatively diagnosed pleural seeding: Is main tumor resection beneficial for prognosis?. J Thorac Cardiovasc Surg. 2017; 155(3):1238-1249.e1. DOI: 10.1016/j.jtcvs.2017.09.162. View

11.

Fiorelli A, Santini M . In lung cancer patients where a malignant pleural effusion is found at operation could resection ever still be justified?. Interact Cardiovasc Thorac Surg. 2013; 17(2):407-12. PMC: 3715170. DOI: 10.1093/icvts/ivt153. View

12.

Skok K, Hladnik G, Grm A, Crnjac A . Malignant Pleural Effusion and Its Current Management: A Review. Medicina (Kaunas). 2019; 55(8). PMC: 6723530. DOI: 10.3390/medicina55080490. View

13.

Hsu J, Han I, Tsai T, Lin S, Jaw T, Liu G . Pleural Tags on CT Scans to Predict Visceral Pleural Invasion of Non-Small Cell Lung Cancer That Does Not Abut the Pleura. Radiology. 2015; 279(2):590-6. DOI: 10.1148/radiol.2015151120. View

14.

Fukuse T, Hirata T, Tanaka F, Wada H . The prognostic significance of malignant pleural effusion at the time of thoracotomy in patients with non-small cell lung cancer. Lung Cancer. 2001; 34(1):75-81. DOI: 10.1016/s0169-5002(01)00228-8. View

15.

Rami-Porta R, Bolejack V, Crowley J, Ball D, Kim J, Lyons G . The IASLC Lung Cancer Staging Project: Proposals for the Revisions of the T Descriptors in the Forthcoming Eighth Edition of the TNM Classification for Lung Cancer. J Thorac Oncol. 2015; 10(7):990-1003. DOI: 10.1097/JTO.0000000000000559. View

16.

Ng K, King Sun C, Boom Ting K, Ting Kun A . Prognostic factors of EGFR-mutated metastatic adenocarcinoma of lung. Eur J Radiol. 2019; 123:108780. DOI: 10.1016/j.ejrad.2019.108780. View

17.

Mordant P, Arame A, Foucault C, Dujon A, Le Pimpec Barthes F, Riquet M . Surgery for metastatic pleural extension of non-small-cell lung cancer. Eur J Cardiothorac Surg. 2011; 40(6):1444-9. DOI: 10.1016/j.ejcts.2011.02.076. View

18.

Kodama K, Doi O, Higashiyama M, Yokouchi H, Tatsuta M . Long-term results of postoperative intrathoracic chemo-thermotherapy for lung cancer with pleural dissemination. Cancer. 1993; 72(2):426-31. DOI: 10.1002/1097-0142(19930715)72:2<426::aid-cncr2820720218>3.0.co;2-s. View

19.

Iida T, Shiba M, Yoshino I, Miyaoka E, Asamura H, Date H . Surgical Intervention for Non-Small-Cell Lung Cancer Patients with Pleural Carcinomatosis: Results From the Japanese Lung Cancer Registry in 2004. J Thorac Oncol. 2015; 10(7):1076-82. DOI: 10.1097/JTO.0000000000000554. View

20.

Ramalingam S, Yang J, Lee C, Kurata T, Kim D, John T . Osimertinib As First-Line Treatment of EGFR Mutation-Positive Advanced Non-Small-Cell Lung Cancer. J Clin Oncol. 2017; 36(9):841-849. DOI: 10.1200/JCO.2017.74.7576. View