Liu Yue, Zhou Yifei, Li Shuangyi, Zhou Qianxin, Li Jun, Kanaji Nobuhiro, Ricciardi Sara, Flores Raja M, Migliore Marcello, Hisakane Kakeru, Zhu Yuming, He Wenxin, Chen Linsong, Bian Dongliang
Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.
Center of Clinical Research, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.
Transl Lung Cancer Res. 2025 Mar 31;14(3):931-939. doi: 10.21037/tlcr-2025-140. Epub 2025 Mar 25.
Pleural metastasis is a common metastatic pattern in patients with epidermal growth factor receptor-mutant lung adenocarcinoma (-LUADm); however, the value of palliative surgery for these patients remains controversial. The purpose of the present study aims to investigate whether palliative surgery benefits in stage IVA LUADm patients with pleural metastasis, who achieved complete remission of pleural lesions following targeted therapy.
From November 2014 to November 2023, patients with stage IVA -LUADm with pleural metastasis at Shanghai Pulmonary Hospital were retrospectively included in this study. All the patients received -tyrosine kinase inhibitor (TKI) monotherapy. The patients were divided into surgical- and non-surgical treatment subgroups. To reduce any selection bias, a 1:2 propensity score matching (PSM) was performed before comparing oncological outcomes between the two groups. The Kaplan-Meier method and log-rank test were used to identify the prognostic factors of these patients.
A total of 134 patients who met the inclusion and exclusion criteria were enrolled in this study. Of the 134 patients, 13 received -TKI monotherapy followed by palliative surgical treatment (the surgical group), and 121 received -TKI monotherapy alone (the non-surgical group). No significant differences in the baseline characteristics were observed between the subgroups. After PSM, the surgical and non-surgical groups comprised 13 and 26 patients, respectively. The survival analysis showed that the patients in the surgical group had significantly better progression-free survival (PFS) than those in the non-surgical group {surgical non-surgical: median PFS: 43 [95% confidence interval (CI): 30-not available] 11 (95% CI: 10-26, P<0.001)}.
Compared with -TKI monotherapy, palliative surgery combined with -TKI treatment prolonged the PFS of pleural metastatic -LUADm patients. A subset of -LUADm patients with pleural metastasis might be suitable for palliative surgery.
胸膜转移是表皮生长因子受体突变型肺腺癌（-LUADm）患者常见的转移模式；然而，姑息性手术对这些患者的价值仍存在争议。本研究旨在探讨姑息性手术对IV期A组伴有胸膜转移且在靶向治疗后胸膜病变完全缓解的LUADm患者是否有益。
回顾性纳入2014年11月至2023年11月在上海肺科医院就诊的IV期A组伴有胸膜转移的-LUADm患者。所有患者均接受-酪氨酸激酶抑制剂（TKI）单药治疗。将患者分为手术治疗组和非手术治疗组。为减少选择偏倚，在比较两组肿瘤学结局之前进行1:2倾向评分匹配（PSM）。采用Kaplan-Meier法和对数秩检验确定这些患者的预后因素。
本研究共纳入134例符合纳入和排除标准的患者。在这134例患者中，13例接受-TKI单药治疗后进行姑息性手术治疗（手术组），121例仅接受-TKI单药治疗（非手术组）。各亚组间基线特征无显著差异。PSM后，手术组和非手术组分别有13例和26例患者。生存分析显示，手术组患者的无进展生存期（PFS）显著优于非手术组{手术组 非手术组：中位PFS：43[95%置信区间（CI）：30-不可用] 11（95%CI：10-26，P<0.001）}。
与-TKI单药治疗相比，姑息性手术联合-TKI治疗可延长胸膜转移-LUADm患者的PFS。部分伴有胸膜转移的-LUADm患者可能适合姑息性手术。
