title: The prognosis after contraindicated surgery of NSCLC patients with malignant pleural effusion (M1a) may be better than expected.
abstract: Although non-small cell lung cancer (NSCLC) with malignant pleural effusion (M1a) is generally contraindicated for surgery, several reports have demonstrated favorable prognosis. This study aimed to describe the results of surgical intervention in this disease. In this retrospective study, we evaluated NSCLC patients with ipsilateral malignant pleural effusion selected from Surveillance Epidemiology and End-Results database (SEER). Primary tumor resection was compared to no tumor resection in the overall survival (OS) and lung cancer-specific survival (LCSS). Multivariate analyses and propensity score matching were applied to compare the two groups. The study included 2,217 eligible patients. Primary tumor resection group was significantly associated with better OS and LCSS compared to no tumor resection group (the median survival time (MST), 20 vs 7 months; OS, p <0.001; LCSS, p <0.001). Multivariable analyses indicated that no primary tumor resection was associated with decreased OS (Hazard Ratio (HR), 2.136; p<0.001) and LCSS (HR, 2.053; p<0.001). In propensity score-matched pairs, better OS and LCSS were further validated in patients with ipsilateral malignant pleural effusion who underwent primary tumor resection compared to no tumor resection (MST, 20 vs 6 months; OS, p <0.001; LCSS, p <0.001). Similarly, multivariable analyses also indicated that no primary tumor resection was associated with decreased OS (HR, 2.309; p <0.001) and LCSS (HR, 2.301; p <0.001) for patients with ipsilateral malignant pleural effusion. In conclusion, the prognosis after contraindicated surgery of NSCLC patients with malignant pleural effusion (M1a) may be better than expected. Thus, subsequent studies should aim to identify patients who could benefit from surgery.
authors.affiliation: Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
authors.forename: Yijiu
authors.initials: Y
authors.lastname: Ren
authors.affiliation: Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
authors.forename: Chenyang
authors.initials: C
authors.lastname: Dai
authors.affiliation: Department of Thoracic Surgery, First Affiliated Hospital of Guangzhou Medical University & Guangzhou Research Institute of Respiratory Disease, Guangzhou, People's Republic of China.
authors.forename: Jianfei
authors.initials: J
authors.lastname: Shen
authors.affiliation: Department of Thoracic Surgery, First Affiliated Hospital of Guangzhou Medical University & Guangzhou Research Institute of Respiratory Disease, Guangzhou, People's Republic of China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
authors.forename: Dong
authors.initials: D
authors.lastname: Xie
authors.affiliation: Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
authors.forename: Hui
authors.initials: H
authors.lastname: Zheng
authors.affiliation: Department of Thoracic Surgery, First Affiliated Hospital of Guangzhou Medical University & Guangzhou Research Institute of Respiratory Disease, Guangzhou, People's Republic of China.
authors.forename: Jiaxi
authors.initials: J
authors.lastname: He
authors.affiliation: Department of Thoracic Surgery, First Affiliated Hospital of Guangzhou Medical University & Guangzhou Research Institute of Respiratory Disease, Guangzhou, People's Republic of China.
authors.forename: Wenhua
authors.initials: W
authors.lastname: Liang
authors.affiliation: Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
authors.forename: Gening
authors.initials: G
authors.lastname: Jiang
authors.affiliation: Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
authors.forename: Ke
authors.initials: K
authors.lastname: Fei
authors.affiliation: Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
authors.forename: Ping
authors.initials: P
authors.lastname: Yang
authors.affiliation: Department of Thoracic Surgery, First Affiliated Hospital of Guangzhou Medical University & Guangzhou Research Institute of Respiratory Disease, Guangzhou, People's Republic of China.
authors.forename: Jianxing
authors.initials: J
authors.lastname: He
authors.affiliation: Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
authors.forename: Chang
authors.initials: C
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications / Q000401:mortality / Q000601:surgery*; D000075204:Contraindications, Procedure; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016066:Pleural Effusion, Malignant / Q000209:etiology*; D011013:Pneumonectomy / Q000009:adverse effects / Q000401:mortality*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018426:SEER Program
keywords: lung cancer; malignant pleural effusion; prognosis; surgery; surveillance epidemiology and end-results database