Tomohiko Iida1, Mitsutoshi Shiba, Ichiro Yoshino, Etsuo Miyaoka, Hisao Asamura, Hiroshi Date, Meinoshin Okumura, Hirohito Tada, Yoichi Nakanishi, Hirotoshi Dosaka-Akita, Hideo Kobayashi, Kazuhisa Takahashi, Masayoshi Inoue, Kohei Yokoi. 1. *Department of Thoracic Surgery, Kimitsu Central Hospital, Chiba, Japan; †Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan; ‡Department of Mathematics, Science University of Tokyo, Tokyo, Japan; §Division of Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan; ‖Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan; ¶Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan; #Department of General Thoracic Surgery, Suita Tokushukai Hospital, Osaka, Japan; **Department of Clinical Medicine, Research Institute for Diseases of the Chest, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan; ††Department of Medical Oncology, Hokkaido University Graduate School of Medicine, Sapporo, Japan; ‡‡Division of Respiratory Disease, National Defense Medical College, Tokorozawa, Japan; §§Division of Respiratory Medicine, Juntendo University Faculty of Medicine & Graduate School of Medicine, Tokyo, Japan; and ‖‖Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Abstract
INTRODUCTION: A subset of non-small-cell lung cancer (NSCLC) patients with malignant pleural effusion and/or malignant pleural nodules is now classified as stage IV and is generally considered a contraindication to surgery. However, several reports have demonstrated that the prognosis of patients with pleural carcinomatosis first detected at thoracotomy is relatively favorable. The aim of this study was to describe the results of surgical intervention in NSCLC patients with pleural carcinomatosis in Japan. METHODS: In 2010, the Japanese Joint Committee of Lung Cancer Registry conducted a nationwide registration of lung cancer patients who underwent surgery in 2004. Using this database, we performed a retrospective study focused on pleural carcinomatosis. We examined the clinicopathological features, the current status of therapy, and surgical outcomes in patients with pleural carcinomatosis. RESULTS: Among the 11,420 registered NSCLC patients, 329 (2.9%) patients had pleural carcinomatosis. The median survival time and 5-year survival rate of 313 patients without other metastatic disease were 34.0 months and 29.3%, respectively. Primary tumor resection was performed in 256 (81.8%) patients, and macroscopic complete resection was achieved in 152 (48.6%) patients, with 5-year survival rates of 33.1% and 37.1%, respectively. Multivariate analysis revealed that Eastern Cooperative Oncology Group performance status (p < 0.001), best stage nodal status (p = 0.002), and the presence or absence of gross residual tumor (p = 0.013) were independent predictors of survival. CONCLUSION: In our surgical registry for NSCLC, patients with pleural carcinomatosis accounted for 2.9%, and macroscopic complete resection for them was associated with better survival.
INTRODUCTION: A subset of non-small-cell lung cancer (NSCLC) patients with malignant pleural effusion and/or malignant pleural nodules is now classified as stage IV and is generally considered a contraindication to surgery. However, several reports have demonstrated that the prognosis of patients with pleural carcinomatosis first detected at thoracotomy is relatively favorable. The aim of this study was to describe the results of surgical intervention in NSCLCpatients with pleural carcinomatosis in Japan. METHODS: In 2010, the Japanese Joint Committee of Lung Cancer Registry conducted a nationwide registration of lung cancerpatients who underwent surgery in 2004. Using this database, we performed a retrospective study focused on pleural carcinomatosis. We examined the clinicopathological features, the current status of therapy, and surgical outcomes in patients with pleural carcinomatosis. RESULTS: Among the 11,420 registered NSCLCpatients, 329 (2.9%) patients had pleural carcinomatosis. The median survival time and 5-year survival rate of 313 patients without other metastatic disease were 34.0 months and 29.3%, respectively. Primary tumor resection was performed in 256 (81.8%) patients, and macroscopic complete resection was achieved in 152 (48.6%) patients, with 5-year survival rates of 33.1% and 37.1%, respectively. Multivariate analysis revealed that Eastern Cooperative Oncology Group performance status (p < 0.001), best stage nodal status (p = 0.002), and the presence or absence of gross residual tumor (p = 0.013) were independent predictors of survival. CONCLUSION: In our surgical registry for NSCLC, patients with pleural carcinomatosis accounted for 2.9%, and macroscopic complete resection for them was associated with better survival.