Prognosis of lung cancer patients with pleural dissemination and malignant pleural effusion detected at thoracotomy

Nakao Masayuki, Hishida Tomoyuki, Yoshida Junji, Nishimura Mitsuyo, Nagai Kanji

doi:10.2995/jacsurg.24.664

The purpose of this study was to evaluate the prognosis of primary lung cancer patients with pleural dissemination or malignant pleural effusion who underwent surgical intervention. We also evaluated the significance of the subclassification system of pleural dissemination (D factor) and malignant pleural effusion (E factor) in the current Japanese lung cancer staging system. Between 1992 and 2006, a total of 2,947 primary lung cancer patients underwent surgical intervention at our institution. Among them, 98 patients who had pathologically or cytologically confirmed malignant pleural effusion and/or pleural dissemination were enrolled in this study. The clinicopathological factors of each patient were reviewed, and the prognosis was evaluated retrospectively. In 98 patients, 79 had only pleural dissemination, 3 had only malignant pleural effusion, and 16 had both. Adenocarcinoma was the predominant histologic type, estimated at a rate of almost 80%. Resection of the main tumor (palliative resection or grossly-complete resection) was performed in 29 patients, and the remaining 69 patients underwent exploratory thoracotomy. The 3-year overall survival rate and median overall survival time of all 98 patients were 33.8% and 2.1 years, respectively. The overall survival rate of the 29 resected cases (3-year: 25.9%) was not significantly different from that of the 69 unresected cases (3-year: 37.8%, p=0.35). According to the D subclassification, the overall survival rate of the 30 D1 cases (3-year: 34.9%) was not different from that of the 65 D2 cases (3-year: 35.4%, p=0.79). Among 19 patients with malignant pleural effusion, few patients were subclassified into E2, and no patients were subclassified into Ep and Epn. Our present study indicated that resection of the main tumor does not improve the outcome of patients with malignant pleural effusion and/or pleural dissemination. Furthermore, the current D subclassification does not work as a prognostic indicator. With regard to E subclassification, information on the presence and cytological diagnosis of pleural effusion is sufficient as a prognostic factor.

Prognosis of lung cancer patients with pleural dissemination and malignant pleural effusion detected at thoracotomy

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