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Effect of Surgical Resection on Isolated Pleural Dissemination in Patients with Stage IV (M1a) Non-Small Cell Lung

Yuyang Xu^1,2, Shiyou Wei^1,2, Zhenyu Yang^1,2

¹Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery

|January 25, 2026

Abstract

Objectives:

Non-small cell lung cancer (NSCLC) with pleural dissemination is categorized as stage IV (M1a) and traditionally deemed a contraindication for surgical intervention. This study aimed to explore the potential role of surgery in NSCLC patients with isolated pleural dissemination.

Methods:

Patients who either underwent primary tumour resection (PTR) or received only pleural nodules biopsy were included for analysis from the Western China Lung Cancer (WCLC) database (2005-2021) and Surveillance, Epidemiology, and End Results (SEER) database (2010-2015). Survival curves were generated using the Kaplan-Meier method, with significance assessed by the log-rank test.

Results:

A total of 289 patients (261 PTR and 28 biopsy only) from the WCLC cohort and 2232 patients (278 PTR and 1954 biopsy only) from the SEER cohort were identified for analysis. In both cohorts, patients who underwent PTR showed significantly better outcomes compared to those who received only pleural nodules biopsy, with the 5-year survival rates of 28.3% versus 5.0% in the WCLC cohort (P < .0001) and 30.5% versus 7.4% in the SEER cohort (P < .0001). Subgroup analysis indicated that PTR significantly improved survival in patients without malignant pleural effusion, regardless of tumour size and T stage. Furthermore, anatomic lobectomy with systematic lymph node dissection was associated with better overall survival than partial resection or lobectomy plus lymph node sampling (P = .008).

Conclusions:

NSCLC patients with isolated pleural dissemination may represent an M1a subgroup in whom PTR is associated with longer survival, particularly in the absence of malignant pleural effusion.

Keywords:

isolated pleural dissemination non-small cell lung cancer primary tumour resection

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