The prognosis of pulmonary adenocarcinoma with malignant pleural disease is poor and is generally not subjected to surgery. However, whether main tumor should be resected when pleural seeding is first detected at thoracotomy remains controversial. The aim of the study is to investigate the prognostic factors of pulmonary adenocarcinoma with unexpected pleural seeding at thoracotomy.
The medical records of non-small cell lung cancer (NSCLC) patients who underwent thoracic surgery in our institute between January 1990 and December 2012 were retrospectively reviewed. Patients with unexpected pleural seeding and proved pathologically during operation were included. The clinical variables were investigated for correlation with overall survival.
Among the 5321 NSCLC patients, 163 (3.0%) patients had unexpected pleural seeding, most were adenocarcinoma (82.2%). In 134 patients with pulmonary adenocarcinoma, the 5-year survival rate was 30.2% and median survival time was 29.3 months. Univariate analysis revealed tumor size, operative method, adjuvant therapy and epidermal growth factor receptor (EGFR) mutation status were prognostic factors of survival. In multivariate analysis, only presence of EGFR mutation correlated with better survival (p = 0.001). Main tumor resection seemed confer a better outcome in EGFR mutation unknown or wild type patients (p = 0.062), but not in EGFR mutation positive patients.
In patients with pulmonary adenocarcinoma with unexpected pleural seeding detected at thoracotomy, presence of EGFR mutation was associated with better survival. Identifying EGFR mutation status before surgery may be useful for clinical decision making.
Clinical trial identification
All authors have declared no conflicts of interest.