{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T06:10:17Z","timestamp":1780467017743,"version":"3.54.1"},"reference-count":64,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T00:00:00Z","timestamp":1779062400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T00:00:00Z","timestamp":1779062400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["acsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Cytopathology"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Malignant serous effusions (MSEs), including pleural, pericardial, and peritoneal effusions, are common in advanced lung adenocarcinoma (LUAD). However, integrated clinicopathologic, molecular, treatment, and outcome data across effusion sites remain incompletely defined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study retrospectively analyzed 120 cytology\u2010confirmed LUAD\u2010associated MSE cases from a single academic center by integrating gross fluid features, cytopathology, immunohistochemistry, targeted next\u2010generation sequencing (NGS), systemic therapy, and clinical outcomes, including survival from first malignant effusion (SME) and overall survival (OS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Effusions were pleural (85 of 120; 70.8%), pericardial (28 of 120; 23.3%), and peritoneal (7 of 120; 5.8%). Median SME was 3.8 months, and was shortest in the small peritoneal effusion subgroup (1.0 months). OS differed by site, with pericardial involvement showing the shortest OS (6.1 months). Thyroid transcription factor 1 (TTF\u20101) was positive in 72.5% of cases. Programmed death ligand 1 (PD\u2010L1) testing (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a085) showed a tumor proportion score (TPS) of \u22651% in 80% of cases and TPS of \u226550% in 36.5% of cases. Molecular profiling was completed in 111 of 120 cases (92.5%) by identifying\n                      <jats:italic>TP53<\/jats:italic>\n                      mutations in 47 of 111 (42.3%) and actionable driver alterations in 42.3% of cases, most commonly involving\n                      <jats:italic>EGFR<\/jats:italic>\n                      ,\n                      <jats:italic>KRAS<\/jats:italic>\n                      ,\n                      <jats:italic>BRAF<\/jats:italic>\n                      ,\n                      <jats:italic>ALK<\/jats:italic>\n                      , and\n                      <jats:italic>ROS1<\/jats:italic>\n                      . TTF\u20101 positivity was associated with higher rates of actionable driver alterations and higher PD\u2010L1 expression. PD\u2010L1 negativity, TTF\u20101 negativity, and an absence of actionable driver alterations were associated with shorter SME and OS. Dual TTF\u20101\/PD\u2010L1 negativity defined the poorest risk subgroup (median SME, 1.2 months; median OS, 1.4 months). Multivariable analysis confirmed that TTF\u20101 negativity and a lack of actionable drivers remained independently adverse. Among treated patients, immunotherapy\u2010based regimens were associated with the longest SME (6.7 months), whereas tyrosine kinase inhibitor\u2013based therapy was associated with the longest OS (26.0 months).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Integration of cytology, immunophenotype, genomics, and treatment delineates distinct prognostic subsets in LUAD with MSE. The absence of actionable driver alterations and TTF\u20101 negativity remains an independent adverse prognostic factor, with dual TTF\u20101\/PD\u2010L1\u2010negative MSE showing particularly poor SME and OS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cncy.70108","type":"journal-article","created":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T09:16:54Z","timestamp":1779095814000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Lung adenocarcinoma with malignant serous effusions: A comprehensive clinicopathologic, molecular, and outcome analysis"],"prefix":"10.1002","volume":"134","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4434-1371","authenticated-orcid":false,"given":"Weijie","family":"Ma","sequence":"first","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center Geisel School of Medicine at Dartmouth  Lebanon New Hampshire USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4023-690X","authenticated-orcid":false,"given":"Jiannan","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Pathology and Immunology Washington University School of Medicine  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. Aziz","family":"Ould Ismail","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center Geisel School of Medicine at Dartmouth  Lebanon New Hampshire USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tianhong","family":"Li","sequence":"additional","affiliation":[{"name":"Division of Hematology\/Oncology, Department of Internal Medicine University of California Davis Comprehensive Cancer Center University of California Davis School of Medicine  Sacramento California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3228-2044","authenticated-orcid":false,"given":"Darcy A.","family":"Kerr","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center Geisel School of Medicine at Dartmouth  Lebanon New Hampshire 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