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Surgical intervention for non-small-cell lung cancer with minimal malignant pleural effusion

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Abstract

Purpose

We assessed the clinical significance of minimal malignant pleural effusion (MPE) using liquid-based cytology (LBC) and immunocytochemistry and reviewed the postoperative outcomes of patients with non-small-cell lung cancer (NSCLC).

Methods

We reviewed 240 patients with cM0 NSCLC who underwent lobectomy. Carcinoembryonic antigen (CEA) immunocytochemistry was performed with LBC to aid in the diagnosis of minimal MPE. We assessed the efficacy of this diagnostic method, relevant clinical factors, and postoperative outcomes.

Results

LBC showed positive results in two patients and suspicious results in 21. Of the 21 patients, immunocytochemistry showed minimal MPE in 10 (47.6%); therefore, a total of 12 patients (5%) showed minimal MPE. Minimal MPE is associated with an older age, increased consolidation tumor ratio, and adenocarcinoma histology. The 12 patients with minimal MPE had a 3-year overall survival rate of 90%. Postoperative recurrence was observed in seven patients (58.3%), four of whom were treated with epidermal growth factor receptor-tyrosine kinase inhibitors or immune checkpoint inhibitors, while three are still undergoing treatment, with a survival of 2.2, 2.5 and 5.5 years.

Conclusions

CEA immunocytochemistry offers high sensitivity for the diagnosis of minimal MPE. Surgical intervention may be considered for select patients with NSCLC showing minimal MPE.

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Acknowledgements

The authors did not receive any financial support for this study.

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Authors and Affiliations

  1. Division of Thoracic Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan

    Masashi Iwasaki, Masanori Shimomura, Shunta Ishihara & Masayoshi Inoue

  2. Department of General Thoracic Surgery, Ayabe City Hospital, 20-1 Otsuka, Aono-cho, Ayabe, Kyoto, 623-0011, Japan

    Masashi Iwasaki & Tsunehiro Ii

  3. Division of Cytopathology, Ayabe City Hospital, 20-1 Otsuka, Aono-cho, Ayabe, Kyoto, 623-0011, Japan

    Tadanori Yamaguchi

  4. Department of Surgical Pathology, Kyoto City Hospital, 1-2, Mibu-Higashitakada-cho, Nakagyo-Ku, Kyoto, 604-8845, Japan

    Mitsuo Kishimoto

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  1. Masashi Iwasaki
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  2. Masanori Shimomura
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Correspondence to Masayoshi Inoue.

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The authors do not have any conflicts of interest in this study.

Ethical approval

The study protocol was approved by the Institutional Review Board of the Ayabe City Hospital (study number: 8910; February 1, 2021), and the requirement for informed consent was waived given the retrospective design of the study.

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Iwasaki, M., Shimomura, M., Ishihara, S. et al. Surgical intervention for non-small-cell lung cancer with minimal malignant pleural effusion. Surg Today 53, 655–662 (2023). https://doi.org/10.1007/s00595-022-02606-4

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  • DOI: https://doi.org/10.1007/s00595-022-02606-4

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