Avoid common mistakes on your manuscript.
Past
Advances in imaging technology, including PET/CT, have improved the accuracy of preoperative staging of non-small-cell lung cancer (NSCLC).1 Pleural dissemination (PD) or malignant pleural effusion (MPE) was found during surgery or on postoperative pathology in some patients, although it was not noted on preoperative imaging studies.2 According to the eighth edition of the TNM staging system, NSCLC with PD or MPE is classified as stage IVA, and surgical resection is generally not indicated.3 Occasionally, primary tumor resection is performed in these patients for histological examination, genetic testing, and symptom relief. Interestingly, some patients with radiologically undetermined PD and/or MPE demonstrated long-term survival, but the prognostic factors remain unknown.
Present
A review of 9463 NSCLC patients identified 114 cases (1.2%) with PD and/or MPE detected during or after surgery.4 The favorable independent prognostic factors for overall survival (OS) were lung adenocarcinoma, clinically undetected lymph node metastasis, and EGFR mutation. An analysis of 41 patients with EGFR mutations showed significantly better 5-year OS in patients who underwent resection of the primary tumor than those with exploratory thoracotomy. However, no prognostic benefit was observed in patients with wild-type EGFR who underwent primary tumor resection as compared with patients who underwent exploratory thoracotomy.
Future
Biomarker testing is essential for determining the treatment strategy for NSCLC. Recent evidence shows that EGFR tyrosine kinase inhibitors improve the prognosis of advanced NSCLC, and they also function as adjuvant therapy after complete resection. Our study suggests that appropriate biomarker-based patient selection and primary tumor resection may improve the prognosis of patients with stage IVA NSCLC with perioperatively identified PD. A randomized controlled phase III trial is currently examining the therapeutic significance of additional primary tumor resection for stage IVA NSCLC with radiologically undetermined PD (https://jrct.niph.go.jp/en-latest-detail/jRCTs031220666). Further prospective multicenter studies stratified by biomarkers are warranted.
References
Gridelli C, Rossi A, Carbone DP, et al. Non-small-cell lung cancer. Nat Rev Dis Primers. 2015;1:15009.
Iida T, Shiba M, Yoshino I, et al. Surgical intervention for non-small-cell lung cancer patients with pleural carcinomatosis: results from the japanese lung cancer registry in 2004. J Thorac Oncol. 2015;10:1076–82.
Goldstraw P, Chansky K, Crowley J, et al. The IASLC lung cancer staging project: proposals for revision of the TNM stage groupings in the forthcoming (eighth) edition of the TNM classification for lung cancer. J Thorac Oncol. 2016;11(1):39–51.
Fujiwara T, Shien K, Matsuura M, et al. EGFR mutation is a prognostic factor in lung cancer patients with pleural dissemination detected during or after surgery. Ann Surg Oncol. 2023. https://doi.org/10.1245/s10434-023-13791-y.
Funding
Open access funding provided by Okayama University. The authors did not receive support from any organization for the submitted work.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosure
There are no conflicts of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
About this article
Cite this article
Shien, K., Fujiwara, T. & Toyooka, S. ASO Author Reflections: Prognostic Impact of the Primary Tumor Resection for Lung Cancer Patients Diagnosed with Pleural Dissemination in the Perioperative Period—Importance of Biomarker-Based Treatment Decision Making. Ann Surg Oncol 30, 6703–6704 (2023). https://doi.org/10.1245/s10434-023-13808-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-023-13808-6