{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T16:27:42Z","timestamp":1768580862316,"version":"3.49.0"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,5,5]],"date-time":"2022-05-05T00:00:00Z","timestamp":1651708800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>Malignant cells in the pleural fluid or pleural metastasis are classified as stage IV non-small cell lung cancer. Radical surgery is generally considered not suitable for such patients. The aim of our study was to discuss the effectiveness of video-assisted thoracoscopic surgery (VATS) in such patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective analysis of the clinical records of 195 patients was performed. These patients were all diagnosed with locally advanced pulmonary adenocarcinomas with malignant pleural effusion (MPE, M1a) but no distant organ metastasis. The 195 patients included 96 patients who underwent VATS plus chemotherapy and 99 patients who received thoracic drainage plus chemotherapy. The baseline characteristics of the patients included age, gender, smoking history, Eastern Cooperative Oncology Group (ECOG) score, and number of chemotherapy cycles (2\u20134 cycles or &amp;gt;4 cycles); we also analyzed clinical characteristics including the specific surgical options of the VATS group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In multivariate analysis, when compared to the thoracic drainage group, the VATS group remained significantly associated with the overall survival [HR=0.480 (95%CI 0.301-0.765)]; when compared to the lobectomy, the sub-lobectomy and the palliative surgery, remained significantly associated with the overall survival [HR=0.637 (95%CI 0.409-0.993) and HR=0.548 (95%CI 0.435-0.832), respectively]. The median survival time (MST) of patients who underwent VATS (n = 96, 49.2%) was 25 months (95% CI 22.373\u201327.627) whereas the patients who received thoracic drainage (n = 99, 50.8%) was 11 months (95% CI 9.978\u201312.022). For patients who underwent VATS, the MST of patients who received a lobectomy (n = 50, 52.1%) was 27 months (95% CI 22.432\u201331.568), the MST of patients who received a sub-lobectomy plus pleurodesis (n = 26, 27.1%) was 27 months (95% CI 19.157\u201334.843), and the MST of patients who received only pleurodesis (n = 20, 20.8%) was 12 months (95% CI 7.617\u201316.383).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>For pulmonary adenocarcinomas with MPE, receiving a lobectomy or sub-lobectomy plus pleurodesis with VATS was associated with improved survival compared with patients who only received thoracic drainage and chemotherapy. Our results and previously published data may justify the use of VATS for treating pulmonary adenocarcinomas with MPE.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fonc.2022.843220","type":"journal-article","created":{"date-parts":[[2022,5,5]],"date-time":"2022-05-05T05:03:15Z","timestamp":1651726995000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Survival Benefits for Pulmonary Adenocarcinoma With Malignant Pleural Effusion After Thoracoscopic Surgical Treatment: A Real-World Study"],"prefix":"10.3389","volume":"12","author":[{"given":"Xin","family":"Li","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mingbiao","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jinshuang","family":"Lv","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jinghao","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ming","family":"Dong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chunqiu","family":"Xia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Honglin","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Song","family":"Xu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sen","family":"Wei","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zuoqing","family":"Song","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gang","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hongyu","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jun","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,5,5]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"iii30","DOI":"10.1093\/annonc\/mdq090","article-title":"Cancer Incidence and Mortality in Spain: Estimates and Projections for the Period 1981-2012","author":"S\u00e1nchez","year":"2010","journal-title":"Ann Oncol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2009.12.014","article-title":"Estimates of Cancer Incidence and Mortality in Europe in 2008","volume":"46","author":"Ferlay","year":"2010","journal-title":"Eur J Cancer"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.4103\/0970-2113.148461","article-title":"The Role of Indwelling Pleural Catheter in Management of Malignant Pleural Effusion: A Creative New Technique for an Old Method","volume":"32","author":"de Andrade","year":"2015","journal-title":"Lung India"},{"key":"B4","doi-asserted-by":"publisher","first-page":"277","DOI":"10.3322\/caac.20073","article-title":"Cancer Statistics, 2010","volume":"60","author":"Jemal","year":"2010","journal-title":"CA Cancer J Clin"},{"key":"B5","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1634\/theoncologist.13-S1-5","article-title":"Systemic Chemotherapy for Advanced non-Small Cell Lung Cancer: Recent Advances and Future Directions","author":"Ramalingam","year":"2008","journal-title":"Oncologist"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1038\/ncponc0075","article-title":"Importance of Local Control in an Era of Systemic Therapy","volume":"2","author":"Hellman","year":"2005","journal-title":"Nat Clin Pract Oncol"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2012.05.051","article-title":"Surgery for Oligometastatic non-Small Cell Lung Cancer: Long-Term Results From a Single Center Experience","volume":"144","author":"Congedo","year":"2012","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/j.cllc.2011.05.006","article-title":"Results of a Surgical Resection for Patients With Stage IV Non\u2013Small-Cell Lung Cancer","volume":"13","author":"Hanagiri","year":"2012","journal-title":"Clin Lung Cancer"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2014.04.007","article-title":"Definitive Primary Therapy in Patients Presenting With Oligometastatic non-Small Cell Lung Cancer","volume":"89","author":"Parikh","year":"2014","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"B10","doi-asserted-by":"publisher","first-page":"645","DOI":"10.6004\/jnccn.2013.0084","article-title":"Non-Small Cell Lung Cancer, Version 2.2013","volume":"11","author":"Ettinger","year":"2013","journal-title":"J Natl Compr Canc Netw"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1097\/JTO.0b013e31812f3c1a","article-title":"The IASLC Lung Cancer Staging Project: Proposals for the Revision of the TNM Stage Groupings in the Forthcoming (Seventh) Edition of the TNM Classification of Malignant Tumours","volume":"2","author":"Goldstraw","year":"2007","journal-title":"J Thorac Oncol"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-4975(99)01579-9","article-title":"Clinicopathological and Biological Assessment of Lung Cancers With Pleural Dissemination","volume":"69","author":"Ohta","year":"2000","journal-title":"Ann Thorac Surg"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1378\/chest.09-2626","article-title":"Details and Difficulties Regarding the New Lung Cancer Staging System","volume":"137","author":"Detterbeck","year":"2010","journal-title":"Chest"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.28683","article-title":"Improving the TNM Classification: Findings From a 10-Year Continuous Literature Review","volume":"135","author":"Webber","year":"2014","journal-title":"Int J Cancer"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0142(19990101)85:1<178::AID-CNCR25>3.0.CO;2-7","article-title":"Vascular Endothelial Growth Factor in the Sera and Effusions of Patients With Malignant and Nonmalignant Disease","volume":"85","author":"Kraft","year":"1999","journal-title":"Cancer"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1097\/01.JAA.0000431507.82701.f7","article-title":"Evaluating the Adult With New-Onset Pleural Effusion","volume":"26","author":"Kruger","year":"2013","journal-title":"JAAPA"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1016\/j.arbr.2014.03.012","article-title":"Etiology of Pleural Effusions: Analysis of More Than 3,000 Consecutive Thoracenteses","volume":"50","author":"Porcel","year":"2014","journal-title":"Arch Bronconeumol"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1111\/1759-7714.12296","article-title":"Efficacy and Safety of Recombinant Human Tumor Necrosis Factor Application for the Treatment of Malignant Pleural Effusion Caused by Lung Cancer","volume":"7","author":"Li","year":"2016","journal-title":"Thorac Cancer"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1510\/icvts.2010.254789","article-title":"What is the Best Treatment for Malignant Pleural Effusions","volume":"12","author":"Zahid","year":"2011","journal-title":"Interact Cardiovasc Thorac Surg"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1378\/chest.123.6.1895","article-title":"Rapid Pleurodesis for Malignant Pleural Effusions","volume":"123","author":"Spiegler","year":"2003","journal-title":"Chest"},{"key":"B21","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1016\/j.ejcts.2004.08.034","article-title":"Rapid Pleurodesis in Symptomatic Malignant Pleural Effusion","volume":"27","author":"Yildirim","year":"2005","journal-title":"Eur J Cardiothorac Surg"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1378\/chest.127.3.909","article-title":"Phase III Intergroup Study of Talc Poudrage vs Talc Slurry Sclerosis for Malignant Pleural Effusion","volume":"127","author":"Dresler","year":"2005","journal-title":"Chest"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1016\/j.hlc.2005.02.004","article-title":"Video-Assisted Thoracoscopic (VATS) Pleurodesis for Malignant Effusion: An Australian Teaching Hospital's Experience","volume":"14","author":"Trotter","year":"2005","journal-title":"Heart Lung Circ"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1016\/j.ygyno.2012.02.029","article-title":"Outcomes of Patients With Gynecologic Malignancies Undergoing Video-Assisted Thoracoscopic Surgery (VATS) and Pleurodesis for Malignant Pleural Effusion","volume":"125","author":"Whitworth","year":"2012","journal-title":"Gynecol Oncol"},{"key":"B25","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1159\/000066516","article-title":"Combined Intrapleural and Intravenous Chemotherapy, and Pulmonary Irradiation, for Treatment of Patients With Lung Cancer Presenting With Malignant Pleural Effusion. A Pilot Study","volume":"64","author":"Su","year":"2003","journal-title":"Oncology"},{"key":"B26","doi-asserted-by":"publisher","first-page":"68","DOI":"10.4143\/crt.2004.36.1.68","article-title":"Intrapleural Chemotherapy With Cisplatin and Cytarabine in the Management of Malignant Pleural Effusion","volume":"36","author":"Kim","year":"2004","journal-title":"Cancer Res Treat"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1055\/s-0034-1396666","article-title":"Survival of M1a Non-Small Cell Lung Cancer Treated Surgically: A Retrospective Single-Center Study","volume":"63","author":"Liu","year":"2015","journal-title":"Thorac Cardiovasc Surg"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1002\/jso.20333","article-title":"Retrospective Review of Lung Cancer Patients With Pleural Dissemination After Limited Operations Combined With Parietal Pleurectomy","volume":"91","author":"Ohta","year":"2005","journal-title":"J Surg Oncol"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1097\/JTO.0000000000000554","article-title":"Surgical Intervention for Non-Small-Cell Lung Cancer Patients With Pleural Carcinomatosis: Results From the Japanese Lung Cancer Registry in 2004","volume":"10","author":"Iida","year":"2015","journal-title":"J Thorac Oncol"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.11110053","article-title":"Dry Pleural Dissemination in Non-Small Cell Lung Cancer: Prognostic and Diagnostic Implications","volume":"260","author":"Kim","year":"2011","journal-title":"Radiology"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-4975(01)03426-9","article-title":"Malignant Minor Pleural Effusion Detected on Thoracotomy for Patients With non-Small Cell Lung Cancer: Is Tumor Resection Beneficial for Prognosis","volume":"73","author":"Sawabata","year":"2002","journal-title":"Ann Thorac Surg"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-4975(02)03599-3","article-title":"Early and Late Mortality After Pleurodesis for Malignant Pleural Effusion","volume":"74","author":"Bernard","year":"2002","journal-title":"Ann Thorac Surg"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2022.843220\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,5,5]],"date-time":"2022-05-05T05:03:17Z","timestamp":1651726997000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2022.843220\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,5]]},"references-count":32,"alternative-id":["10.3389\/fonc.2022.843220"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2022.843220","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5,5]]},"article-number":"843220"}}