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Ann Thorac Surg 2002;74:1750
© 2002 The Society of Thoracic Surgeons

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Correspondence

Reply

^a Division of Surgery, Toneyama National Hospital, 5-1-1 Toneyama, Toyonaka, Osaka 560-8552, Japan

e-mail: nori{at}toneyama.hosp.go.jp

To the Editor:

I read a response from Riquet and colleagues to our article [1], which reported operation for non-small cell lung cancer (NSCLC) with malignant minor pleural effusion detected at thoracotomy. They pointed out that the 5-year survival rate for patients with pleural involvement was approximately 20% in other studies [2, 3], and that operation should not be discouraged. However, the number of patients who underwent adjuvant therapy was high in these studies.

The reason why our completely resected group of patients had a poor survival rate may be due not only to no adjuvant therapy but also a high rate of p1 or p2, which often is associated with a high rate of malignant pleural effusion. Malignant cells in the pleural effusion may arrive from the visceral pleura above a NSCLC. Tumor cells are detected on the pleura above a NSCLC in 20% to 30% of patients [4, 5]. Therefore, it is very difficult to distinguish frank malignant effusion from a contaminated effusion. Although pleural involvement is a poor prognostic factor [6], survival rate may be different between contaminated and primary pleural effusions.

Notwithstanding contaminated or primary effusions, malignant pleural effusion indicates a poor prognosis. However, I believe that operation for NSCLC with malignant pleural effusion should not be discouraged but should be tried with adjuvant or induction therapy. Trials of multimordality treatment may offer a good chance of survival in patients with NSCLC with pleural involvement alone and no distant metastasis.

References

1. Sawabata N., Matsumura A., Motohiro A., et al. Malignant minor pleural effusion detected on thoracotomy for patients with non-small cell lung cancer: is tumor resection beneficial for prognosis?. Ann Thorac Surg 2002;73:412-415.[Abstract/Free Full Text]
2. Ichinose Y., Tsuchiya R., Koike T., et al. The prognosis of patients with non-small cell lung cancer found to have carcinomatous pleuritis at thoracotomy. Surg Today 2000;30:1062-1066.[Medline]
3. Ohta Y., Tanaka Y., Hara T., et al. Clinicopathological and biological assessment of lung cancers with pleural dissemination. Ann Thorac Surg 2000;69:1025-1029.[Abstract/Free Full Text]
4. Ichinose Y., Yano T., Asoh H., Yokoyama H., Fukuyama Y., Katsuda Y. Diagnosis of visceral pleural invasion in resected lung cancer using a jet stream of saline solution. Ann Thorac Surg 1997;64:1626-1629.[Abstract/Free Full Text]
5. Sawabata N., Ohta M., Maeda H. Fine-needle aspiration cytologic technique for lung cancer has a high potential of malignant cell spread through the tract. Chest 2000;118:936-939.[Abstract/Free Full Text]
6. Manac’h D., Riquet M., Medioni J., et al. Visceral pleura invasion by non-small cell lung cancer: an underrated bad prognostic factor. Ann Thorac Surg 2001;71:1088-1093.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Sawabata, N. Search for Related Content PubMed Articles by Sawabata, N. Related Collections Lung - cancer