To evaluate the effect of surgical resection on the prognosis of non-small cell lung cancer (NSCLC) patients with malignant pleural dissemination (PD).

Clinical data of consecutive patients who underwent surgeries for NSCLC between January 2011 and December 2015 at Shanghai Chest Hospital were collected. The patients who were found unexpected PD intraoperatively were enrolled in this study.

A total of 160 patients diagnosed with unexpected malignant PD through intraoperatively or postoperatively histological examinations were enrolled in the present study. 71 (44.4%) patients received pleural nodule biopsy only, and 89 (55.6%) received primary tumor resection. The median progression-free survival(PFS) and median overall survival (OS)were respectively 13 months and 41 months. The 3- and 5-year PFS and OS rates for all patients were 13.1%, 5.7% and 56.0%, 28.7%, respectively. In comparison, patients in the resection group had better PFS (19.0 months vs 10.0 months, P < 0.001) and OS (48.0 months vs 33.0 months, P < 0.001) than those in the biopsy group. The 3- and 5-year PFS rates of resection group were higher than biopsy group (20.8% vs 3.2%, 10.8% vs 0). Similar results were found for OS rates(67.8% vs 41.0%, 37.7% vs 18.2%). There was no significant difference in survival between patients with sublobectomy and lobectomy (P = 0.34). Univariate and multivariate analyses showed that adjuvant targeted therapy, absence of malignant pleural effusion (MPE), stage T1/T2, and stage N0 were independent prognostic factors.

NSCLC patients with malignant pleural dissemination diagnosed intraoperatively may be beneficial from surgical resection of main tumor and multidisciplinary adjuvant therapy, especially targeted therapy. Patients with adjuvant targeted therapy, no MPE, lower T stage, and lower N stage may have a better prognosis. Wedge resection tends to be a proper choice if feasible, although there is no difference in survival among different types of resection.