Primary tumor resection of non‐small cell lung cancer patients with ipsilateral pleural dissemination (M1a) in the era of targeted therapy

Abstract

Background Non‐small cell lung cancer (NSCLC) patients with ipsilateral pleural dissemination (M1a) are generally contraindicated for surgery. Recently, several studies have demonstrated that these patients might benefit from primary tumor resection (PTR). However, whether PTR is beneficial for driver oncogene‐positive patients treated with targeted therapy, remains unclear. Here, we investigated the effects of PTR on survival in the era of targeted therapy. Methods In total, 105 NSCLC patients with ipsilateral pleural dissemination were identified. The mode of systemic treatment was assessed in this study. Survival analysis was performed with the Kaplan‐Meier method and Cox proportional hazards regression. The overall survival (OS) of patients with or without PTR was compared between propensity score‐matched groups (caliper: 0.02). Results In the entire cohort, PTR was associated with improved OS in both unmatched (median survival time [MST]: 50.0 vs. 29.6 months, P = 0.019) and matched (MST: 50.0 vs. 34.4 months, P = 0.052) cohorts. Multivariate regression models showed that surgery was an independent favorable prognostic factor for OS. A total of 70 patients underwent genetic testing, and targeted therapies, such as EGFR‐TKIs or ALK‐TKIs, were used in the driver oncogene‐positive patients. Subgroup analysis showed that PTR did not improve OS in the targeted therapy group (MST: 57.1 months vs. 50.4 months, P = 0.840). However, surgery significantly prolonged survival in the nontargeted therapy group (MST: 39.8 vs. 14.2 months, P = 0.002). Conclusions The results of this study indicated that PTR could prolong OS in stage IV NSCLC patients with ipsilateral pleural dissemination, especially in patients who are not candidates for targeted therapy. Key points Non‐small cell lung cancer patients with ipsilateral pleural dissemination can benefit from primary tumor resection. Primary tumor resection could prolong overall survival (OS) in non‐small cell lung cancer patients with ipsilateral pleural dissemination who are not candidates for targeted therapy.

Surgical choice of non-small cell lung cancer with unexpected pleural dissemination intraoperatively

“…In subgroup analysis, we found that patients could not get survival benefit from tumor resection if they received targeted therapy, while tumor resection could improve OS in the patients who received chemotherapy alone. The results was in accordance with the recent study that reported by Li et al [ 24 ]. These indicated that tumor resection may be only beneficial for a subgroup of patients with UPD who did not have the driver gene mutation or could not receive targeted therapy due to cost, allergy, adverse events or other factors.…”

POU2F2 promotes the proliferation and motility of lung cancer cells by activating AGO1

“…In view of the lack of significant early symptoms of lung cancer, patients are often in an advanced stage [ 6 ]. In recent years, the targeted therapy of lung cancer has made important progress, and a variety of targeted drugs emerge in endlessly [ 7 , 8 ]. In order to further improve the prognosis of patients, it is still necessary to identify more potential therapeutic targets.…”

New horizons in non-small-cell lung cancer patients with ipsilateral pleural dissemination (M1a): review of the literature

“…However, in the non-targeted therapy group, PTR significantly prolonged survival (MST: 39.8 vs. 14.2 months, P=0.002) (37). This single-center retrospective study suggested PTR conferred a better outcome in M1a patients who were not candidates for targeted therapy.…”

“…(I) For cM0 but pathological staging pM1a patients, which means "unexpected" pleural dissemination during surgery, surgeons should try to resect the main tumor to prolong patients' survival and harvest enough tissue for gene testing. (II) For clinical staging pM1a patients, such as MPE confirmed by cytopathology, surgical intervention should be carefully included as an important option of multimodal therapy regimens, especially for patients with negative driver mutations and lymph node-negative (37). (III) The surgery would only be considered in operable patients, and should be relatively contraindicated for patients with N2/N3 metastasis or malignant pericardial effusion because of the poor survival after PTR (33) make patients receive systemic therapy sooner, thoracic surgeons should consider the VATS technique superior to thoracotomy.…”