Ohta Ryuichi, Ryu Yoshinori, Tanaka Kaoru, Sano Chiaki, Hayashi Hidetoshi
Department of Community Care, Unnan City Hospital, Unnan City, Shimane, Japan.
Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka-Sayama City, Osaka, Japan.
Cancer Manag Res. 2025 Sep 19;17:2127-2141. doi: 10.2147/CMAR.S542123. eCollection 2025.
Peritoneal metastasis is an uncommon but clinically significant manifestation of non-small cell lung cancer (NSCLC). While traditionally associated with gastrointestinal or ovarian malignancies, emerging reports suggest that NSCLC, particularly adenocarcinoma with driver mutations, can also exhibit peritoneal dissemination. This systematic review aims to synthesize current evidence on the clinical characteristics, diagnostic modalities, molecular profiles, treatment strategies, and outcomes of NSCLC patients with peritoneal metastasis.
A systematic literature search was conducted in PubMed, Embase, and Web of Science from inception through April 2025. Studies were eligible if they reported peritoneal metastasis in histologically confirmed NSCLC patients. Data on histopathology, molecular alterations, diagnosis, treatment, and survival were extracted. The review was conducted in accordance with PRISMA 2020 guidelines.
Twenty-seven studies met inclusion criteria, comprising 19 case-based reports and seven retrospective cohort studies. Adenocarcinoma was the predominant histologic type (93%), and EGFR mutations were the most frequently reported molecular alteration. Diagnosis was primarily established via ascitic cytology, imaging, or intraoperative findings. Targeted therapy (eg, EGFR- or BRAF-directed TKIs) yielded temporary disease control in selected cases. However, median overall survival after peritoneal metastasis ranged from 2.0 to 5.2 months. Prognostic factors included poor performance status, absence of actionable mutations, and concurrent pleural metastasis.
Peritoneal metastasis in NSCLC is rare but associated with poor prognosis. Molecular-guided therapies offer transient benefit, underscoring the need for early recognition and individualized treatment approaches. Prospective studies are warranted to better define predictors and optimal management strategies for this atypical metastatic pattern.
腹膜转移是非小细胞肺癌（NSCLC）一种不常见但具有临床意义的表现。虽然传统上与胃肠道或卵巢恶性肿瘤相关，但新出现的报告表明，NSCLC，尤其是具有驱动基因突变的腺癌，也可出现腹膜播散。本系统评价旨在综合当前关于NSCLC腹膜转移患者的临床特征、诊断方法、分子特征、治疗策略和预后的证据。
从创刊至2025年4月在PubMed、Embase和Web of Science上进行系统的文献检索。如果研究报告了经组织学证实的NSCLC患者的腹膜转移，则该研究符合纳入标准。提取有关组织病理学、分子改变、诊断、治疗和生存的数据。本评价按照PRISMA 2020指南进行。
27项研究符合纳入标准，包括19篇病例报告和7项回顾性队列研究。腺癌是主要的组织学类型（93%），EGFR突变是最常报告的分子改变。诊断主要通过腹水细胞学检查、影像学检查或术中发现来确定。靶向治疗（如EGFR或BRAF靶向酪氨酸激酶抑制剂）在部分病例中产生了暂时的疾病控制。然而，腹膜转移后的中位总生存期为2.0至5.2个月。预后因素包括身体状况差、缺乏可操作的突变以及并发胸膜转移。
NSCLC中的腹膜转移很少见，但预后较差。分子导向治疗仅提供短暂的益处，这凸显了早期识别和个体化治疗方法的必要性。需要进行前瞻性研究，以更好地确定这种非典型转移模式的预测因素和最佳管理策略。
