Primary tumor resection of non‐small cell lung cancer patients with ipsilateral pleural dissemination (M1a) in the era of targeted therapy

Abstract Background Non‐small cell lung cancer (NSCLC) patients with ipsilateral pleural dissemination (M1a) are generally contraindicated for surgery. Recently, several studies have demonstrated that these patients might benefit from primary tumor resection (PTR). However, whether PTR is beneficial...

Full description

Bibliographic Details
Main Authors: Hao Li, Taorui Liu, Zewen Sun, Fan Yang
Format: Article
Language:English
Published: Wiley 2020-11-01
Series:Thoracic Cancer
Subjects:
Online Access:https://doi.org/10.1111/1759-7714.13649
id doaj-6cfbc8ec3beb4adc922f2581ce781838
record_format Article
spelling doaj-6cfbc8ec3beb4adc922f2581ce7818382020-11-25T04:07:15ZengWileyThoracic Cancer1759-77061759-77142020-11-0111113213322210.1111/1759-7714.13649Primary tumor resection of non‐small cell lung cancer patients with ipsilateral pleural dissemination (M1a) in the era of targeted therapyHao Li0Taorui Liu1Zewen Sun2Fan Yang3Department of Thoracic Surgery Centre of Thoracic Minimally Invasive Surgery, Peking University People's Hospital Beijing ChinaDepartment of Thoracic Surgery Centre of Thoracic Minimally Invasive Surgery, Peking University People's Hospital Beijing ChinaDepartment of Thoracic Surgery Centre of Thoracic Minimally Invasive Surgery, Peking University People's Hospital Beijing ChinaDepartment of Thoracic Surgery Centre of Thoracic Minimally Invasive Surgery, Peking University People's Hospital Beijing ChinaAbstract Background Non‐small cell lung cancer (NSCLC) patients with ipsilateral pleural dissemination (M1a) are generally contraindicated for surgery. Recently, several studies have demonstrated that these patients might benefit from primary tumor resection (PTR). However, whether PTR is beneficial for driver oncogene‐positive patients treated with targeted therapy, remains unclear. Here, we investigated the effects of PTR on survival in the era of targeted therapy. Methods In total, 105 NSCLC patients with ipsilateral pleural dissemination were identified. The mode of systemic treatment was assessed in this study. Survival analysis was performed with the Kaplan‐Meier method and Cox proportional hazards regression. The overall survival (OS) of patients with or without PTR was compared between propensity score‐matched groups (caliper: 0.02). Results In the entire cohort, PTR was associated with improved OS in both unmatched (median survival time [MST]: 50.0 vs. 29.6 months, P = 0.019) and matched (MST: 50.0 vs. 34.4 months, P = 0.052) cohorts. Multivariate regression models showed that surgery was an independent favorable prognostic factor for OS. A total of 70 patients underwent genetic testing, and targeted therapies, such as EGFR‐TKIs or ALK‐TKIs, were used in the driver oncogene‐positive patients. Subgroup analysis showed that PTR did not improve OS in the targeted therapy group (MST: 57.1 months vs. 50.4 months, P = 0.840). However, surgery significantly prolonged survival in the nontargeted therapy group (MST: 39.8 vs. 14.2 months, P = 0.002). Conclusions The results of this study indicated that PTR could prolong OS in stage IV NSCLC patients with ipsilateral pleural dissemination, especially in patients who are not candidates for targeted therapy. Key points Non‐small cell lung cancer patients with ipsilateral pleural dissemination can benefit from primary tumor resection. Primary tumor resection could prolong overall survival (OS) in non‐small cell lung cancer patients with ipsilateral pleural dissemination who are not candidates for targeted therapy.https://doi.org/10.1111/1759-7714.13649Ipsilateral pleural disseminationnon‐small‐cell lung cancerprimary tumor resectiontargeted therapy
collection DOAJ
language English
format Article
sources DOAJ
author Hao Li
Taorui Liu
Zewen Sun
Fan Yang
spellingShingle Hao Li
Taorui Liu
Zewen Sun
Fan Yang
Primary tumor resection of non‐small cell lung cancer patients with ipsilateral pleural dissemination (M1a) in the era of targeted therapy
Thoracic Cancer
Ipsilateral pleural dissemination
non‐small‐cell lung cancer
primary tumor resection
targeted therapy
author_facet Hao Li
Taorui Liu
Zewen Sun
Fan Yang
author_sort Hao Li
title Primary tumor resection of non‐small cell lung cancer patients with ipsilateral pleural dissemination (M1a) in the era of targeted therapy
title_short Primary tumor resection of non‐small cell lung cancer patients with ipsilateral pleural dissemination (M1a) in the era of targeted therapy
title_full Primary tumor resection of non‐small cell lung cancer patients with ipsilateral pleural dissemination (M1a) in the era of targeted therapy
title_fullStr Primary tumor resection of non‐small cell lung cancer patients with ipsilateral pleural dissemination (M1a) in the era of targeted therapy
title_full_unstemmed Primary tumor resection of non‐small cell lung cancer patients with ipsilateral pleural dissemination (M1a) in the era of targeted therapy
title_sort primary tumor resection of non‐small cell lung cancer patients with ipsilateral pleural dissemination (m1a) in the era of targeted therapy
publisher Wiley
series Thoracic Cancer
issn 1759-7706
1759-7714
publishDate 2020-11-01
description Abstract Background Non‐small cell lung cancer (NSCLC) patients with ipsilateral pleural dissemination (M1a) are generally contraindicated for surgery. Recently, several studies have demonstrated that these patients might benefit from primary tumor resection (PTR). However, whether PTR is beneficial for driver oncogene‐positive patients treated with targeted therapy, remains unclear. Here, we investigated the effects of PTR on survival in the era of targeted therapy. Methods In total, 105 NSCLC patients with ipsilateral pleural dissemination were identified. The mode of systemic treatment was assessed in this study. Survival analysis was performed with the Kaplan‐Meier method and Cox proportional hazards regression. The overall survival (OS) of patients with or without PTR was compared between propensity score‐matched groups (caliper: 0.02). Results In the entire cohort, PTR was associated with improved OS in both unmatched (median survival time [MST]: 50.0 vs. 29.6 months, P = 0.019) and matched (MST: 50.0 vs. 34.4 months, P = 0.052) cohorts. Multivariate regression models showed that surgery was an independent favorable prognostic factor for OS. A total of 70 patients underwent genetic testing, and targeted therapies, such as EGFR‐TKIs or ALK‐TKIs, were used in the driver oncogene‐positive patients. Subgroup analysis showed that PTR did not improve OS in the targeted therapy group (MST: 57.1 months vs. 50.4 months, P = 0.840). However, surgery significantly prolonged survival in the nontargeted therapy group (MST: 39.8 vs. 14.2 months, P = 0.002). Conclusions The results of this study indicated that PTR could prolong OS in stage IV NSCLC patients with ipsilateral pleural dissemination, especially in patients who are not candidates for targeted therapy. Key points Non‐small cell lung cancer patients with ipsilateral pleural dissemination can benefit from primary tumor resection. Primary tumor resection could prolong overall survival (OS) in non‐small cell lung cancer patients with ipsilateral pleural dissemination who are not candidates for targeted therapy.
topic Ipsilateral pleural dissemination
non‐small‐cell lung cancer
primary tumor resection
targeted therapy
url https://doi.org/10.1111/1759-7714.13649
work_keys_str_mv AT haoli primarytumorresectionofnonsmallcelllungcancerpatientswithipsilateralpleuraldisseminationm1aintheeraoftargetedtherapy
AT taoruiliu primarytumorresectionofnonsmallcelllungcancerpatientswithipsilateralpleuraldisseminationm1aintheeraoftargetedtherapy
AT zewensun primarytumorresectionofnonsmallcelllungcancerpatientswithipsilateralpleuraldisseminationm1aintheeraoftargetedtherapy
AT fanyang primarytumorresectionofnonsmallcelllungcancerpatientswithipsilateralpleuraldisseminationm1aintheeraoftargetedtherapy
_version_ 1724429411722199040