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. 2025 Jan-Dec:32:10732748241311223.
doi: 10.1177/10732748241311223.

Prognostic Value of Surgical Resection for Non-small-cell Lung Cancer Patients Comorbid With Minimal Pleural Effusion

Haibo Wang  1   2 , Tao Lu  3 , Xinlong Zheng  1   2 , Kan Jiang  1   2 , Longfeng Zhang  1   2 , Xiaobin Zheng  1   2 , Qian Miao  1   2 , Shiwen Wu  1   2 , Zihua Zou  1   2 , Shanshan Yang  1   2 , Yujing Li  1   2 , Sihui Chen  1   2 , Yiquan Xu  1   2 , Gen Lin  4
Affiliations

Prognostic Value of Surgical Resection for Non-small-cell Lung Cancer Patients Comorbid With Minimal Pleural Effusion

Haibo Wang et al. Cancer Control. 2025 Jan-Dec.

Abstract

Background: The proportion and impact of minimal pleural effusion (PE) on prognosis remain blurred in operable non-small cell lung cancer (NSCLC) patients who reported minimal PE on imaging.

Methods: Clinical and prognostic data of operable NSCLC patients who presented no distant metastasis, no direct pleural invasion, but minimal PE on preoperative imaging were retrospectively analyzed. The patients were divided into surgical (81 cases) and non-surgical (10 cases) cohorts. Potential or suspected malignant PE or pleural metastases were confirmed by surgery. The overall survival (OS) was analyzed by Kaplan-Meier curve and prognostic factors by multivariate Cox regression.

Results: The surgical cohort reported no pleural invasion on preoperative imaging and no pleural metastases by postoperative pathology, with an overall median disease-free survival of 36.7 (28.6, 44.7) months and a median OS of 59.8 (45.7, 73.2) months, with the latter significantly longer in the surgical cohort than in the non-surgical cohort (59.8 months vs 20.37 months, P < 0.001). Multivariate analysis indicated surgical treatment as an independent prognostic factor for OS.

Conclusion: Malignant PE is rare in operable NSCLC patients who report the presence of minimal PE but no distant metastasis or direct pleural invasion on preoperative imaging. Surgery may be the preferred treatment for these patients.

Keywords: minimal pleural effusion; non-small cell lung cancer; prognosis; surgical resection.

Plain language summary

Subject overviewThe proportion and impact of minimal pleural effusion (PE) on prognosis remain blurred in operable non-small cell lung cancer (NSCLC) patients who reported minimal PE on imaging.MethodsClinical and prognostic data of operable NSCLC patients who presented no distant metastasis, no direct pleural invasion, but minimal PE on preoperative imaging were retrospectively analyzed. The patients were divided into surgical (81 cases) and non-surgical (10 cases) cohorts. Potential or suspected malignant PE or pleural metastases were confirmed by surgery. The overall survival (OS) was analyzed by Kaplan-Meier curve and prognostic factors by multivariate Cox regression.Results summaryWe found that the surgical cohort reported no pleural invasion on preoperative imaging and no pleural metastases by postoperative pathology, with an overall median disease-free survival of 36.7 (28.6, 44.7) months and a median OS of 59.8 (45.7, 73.2) months, with the latter significantly longer in the surgical cohort than in the non-surgical cohort (59.8 months vs. 20.37 months, p < 0.001). Multivariate analysis indicated surgical treatment as an independent prognostic factor for OS.Key takeawaysWe remain that malignant PE is rare in operable NSCLC patients who report the presence of minimal PE but no distant metastasis or direct pleural invasion on preoperative imaging. Surgery may be the preferred treatment for these patients.

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Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Flow diagram for the enrollment of NSCLC patients with minimal PE in the study.
Figure 2.
Figure 2.
The prognosis of NSCLC patients with minimal PE. (A) DFS of patients with minimal PE. (B) OS of patients with minimal PE.
Figure 3.
Figure 3.
Kaplan-Meier survival curves for NSCLC patients with minimal PE received surgical intervention or non- surgical intervention. (A) DFS of patients who received surgical intervention or non- surgical intervention. (B) OS of patients who received surgical intervention or non- surgical intervention.
Figure 4.
Figure 4.
The prognosis of NSCLC patients with minimal PE in the surgical group patients (cohort 1). (A) DFS of patients who received surgical intervention. (B) OS of patients who received surgical intervention.
Figure 5.
Figure 5.
The overall median DFS and median OS in the surgical group patients between different stages. (A) DFS of patients who received surgical intervention in different stages. (B) OS of patients who received surgical intervention in different stages.
See this image and copyright information in PMC

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