Prognosis for clinical early-stage lung cancer patients with subclinical malignant pleural effusion: Is anatomical resection a reasonable option?

[OBJECTIVE] Non-small cell lung cancer with malignant pleural effusion is generally considered inoperable. The aim of this study was to investigate the prognosis and outcomes of patients with subclinical malignant pleural effusion who underwent surgical resection for lung cancer.

[METHODS] Between 2013 and 2022, 2261 patients underwent lung resections for non-small cell lung cancer. We retrospectively reviewed the records of 29 patients with cT1-2N0 lung cancer and subclinical malignant pleural effusion < 10 mL.

[RESULTS] The surgical procedures included wedge resection (n = 8) and anatomical resection (segmentectomy or lobectomy, n = 21). Fifteen patients underwent surgery + postoperative chemotherapy. During the follow-up period, 21 patients relapsed and 18 patients died. The median overall survival was 49 months, with a 3-year overall survival rate of 65.0%. The median progression-free survival was 14 months, with a 3-year progression-free survival rate of 20.1%. The 3-year overall survival rate was significantly higher for anatomical resection than for wedge resection (85.4% vs. 12.5%; P < 0.001). The 3-year progression-free survival rate was also significantly higher in the surgery + postoperative chemotherapy group than in the surgery-alone group (33.3% vs. 0%; P < 0.002).

[CONCLUSION] Although the findings do not support surgery over conservative therapy, anatomical resection may be a reasonable option for patients with subclinical malignant pleural effusion.