Surgery improves OS in NSCLC with pleural dissemination

  • Li H & al.
  • Eur J Cardiothorac Surg
  • 4 Feb 2019

  • curated by Kelli Whitlock Burton
  • Univadis Clinical Summaries
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Takeaway

  • Surgical resection of the primary tumor had significantly better OS and lung cancer-specific mortality (LCSM) in patients with NSCLC with ipsilateral pleural dissemination, except those with pericardial effusion or N3 disease.

Why this matters

  • NSCLC with pleural dissemination was reclassified as stage IV (M1a) in the 2017 Union for International Cancer Control lung cancer staging system, and surgical resection was contraindicated.

Study design

  • 5513 patients with stage IV M1a (malignant pleural dissemination) NSCLC from the Surveillance, Epidemiology and End Results database.
  • Funding: None disclosed.

Key results

  • 5.6% of the overall cohort underwent resection.
  • Surgical patients had significantly longer OS than nonsurgical patients in the unmatched (20 vs 8 months; P<.001 and matched vs months p cohorts.>
  • Among patients recommended for surgery, those who underwent resection had significantly better OS than those who did not in the unmatched (20 vs 5 months; P<.001 and matched vs months p=".022)" cohorts.>
  • After multivariable analysis, primary tumor resection was independently associated with improved OS (HR, 0.56; P<.001 and lcsm p>
  • Surgery was an independent predictor of LCSM in all subgroups except patients with pericardial effusion (P=.065) or N3 disease (P=.17).

Limitations

  • No data on performance status or comorbidities.

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