Watanabe Yukio, Takamochi Kazuya, Hayashi Takuo, Hattori Aritoshi, Fukui Mariko, Matsunaga Takeshi, Tomita Hisashi, Suzuki Kenji
Department of General Thoracic Surgery, Juntendo University School of Medicine, 1-3 Hongo 3-Chome, Bunkyo-Ku, Tokyo, 113-8431, Japan.
Department of Human Pathology, Juntendo University School of Medicine, Tokyo, Japan.
Gen Thorac Cardiovasc Surg. 2025 Feb;73(2):102-109. doi: 10.1007/s11748-024-02055-5. Epub 2024 Jul 20.
Non-small cell lung cancer (NSCLC) patients with pleural dissemination are generally contraindicated for surgery. This study aimed to investigate the survival benefits of primary tumor resection for NSCLC patients with unexpectedly detected pleural disseminated nodules during thoracotomy in the era of targeted therapy.
Of the 4984 patients with NSCLC who underwent surgery without induction therapy between 2000 and 2021, we retrospectively evaluated 90 (1.8%) patients with unexpectedly detected pleural disseminated nodule. Survival analyses were performed with Kaplan-Meier methods and Cox proportional hazards regression.
Among the evaluated patients, 58 were male, the median age was 67, and 77 (86%) were diagnosed with adenocarcinoma. Exploratory thoracotomy was performed in 21 (23%), and primary tumor resection was performed in 69 (77%) patients, including pneumonectomy in four, lobectomy in 39, and sublobar resection in 26. Epidermal growth factor receptor gene mutation and anaplastic lymphoma kinase rearrangement were detected in 33 (37%) and 4 (4%) cases, respectively. Among them, 31 patients received targeted therapy. The overall survival (OS) was not significantly different between patients with primary tumor resection and exploratory thoracotomy (5-year OS rate: 30.2% vs. 27.8%, p = 0.81). Multivariable analysis revealed that sex (p = 0.02) and targeted therapy (p < 0.01) were independent prognostic factors for OS. Survival outcomes in patients who received targeted therapy were significantly better regardless of primary tumor resection.
Primary tumor resection might not affect the survival in NSCLC patients with unexpectedly detected pleural disseminated nodules in the era of targeted therapy.
胸膜播散的非小细胞肺癌（NSCLC）患者通常禁忌手术。本研究旨在探讨在靶向治疗时代，开胸手术时意外发现胸膜播散结节的NSCLC患者行原发肿瘤切除的生存获益。
在2000年至2021年间接受手术且未行诱导治疗的4984例NSCLC患者中，我们回顾性评估了90例（1.8%）意外发现胸膜播散结节的患者。采用Kaplan-Meier法和Cox比例风险回归进行生存分析。
在评估的患者中，男性58例，中位年龄67岁，77例（86%）诊断为腺癌。21例（23%）患者行 exploratory thoracotomy，69例（77%）患者行原发肿瘤切除，包括4例全肺切除术、39例肺叶切除术和26例肺段以下切除术。分别在33例（37%）和4例（4%）病例中检测到表皮生长因子受体基因突变和间变性淋巴瘤激酶重排。其中，31例患者接受了靶向治疗。原发肿瘤切除患者和 exploratory thoracotomy患者的总生存期（OS）无显著差异（5年OS率：30.2%对27.8%，p = 0.81）。多变量分析显示，性别（p = 0.02）和靶向治疗（p < 0.01）是OS的独立预后因素。无论是否进行原发肿瘤切除，接受靶向治疗的患者生存结局均显著更好。
在靶向治疗时代，对于意外发现胸膜播散结节的NSCLC患者，原发肿瘤切除可能不影响生存。
