WCLC 2025 - Posters & ePosters-P3.09.06 Primary Tumor Resection Confers Survival Benefit in cM0sM1a Lung Adenocarcinoma

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This study investigates the survival benefit of primary tumor resection (PTR) in patients with lung adenocarcinoma (LUAD) exhibiting pleural dissemination (clinical stage cM0sM1a), a subgroup traditionally considered incurable with poor prognosis (median survival 5–12 months). Current guidelines recommend aborting curative surgery upon intraoperative detection of pleural dissemination and instead starting systemic therapy. However, the survival advantage and optimal surgical approach for PTR in this setting remain unclear.<br /><br />Researchers retrospectively analyzed 310 LUAD cM0sM1a patients from the Sun Yat-Sen University Cancer Center, divided into two groups: 161 underwent PTR and 149 had biopsy only. Survival outcomes were assessed using Kaplan-Meier analysis, Cox regression, and propensity score matching.<br /><br />Results demonstrated a significant overall survival improvement in patients receiving PTR compared to biopsy alone, particularly in those with less advanced primary tumors (cT1-2) or those ineligible for targeted therapies. No significant survival differences were found between sublobectomy and lobectomy or between patients with and without lymph node dissection, suggesting that minimal surgical resection is sufficient to confer survival benefits without additional nodal clearance. Systemic therapies, including chemotherapy and targeted therapy, remain foundational for managing M1a LUAD and significantly extend survival.<br /><br />The findings support integrating surgical resection into a multidisciplinary treatment regimen for select cM0sM1a patients, challenging existing guidelines that discourage curative surgery in intraoperative-stage pleural dissemination. PTR should be prioritized for patients with smaller primary tumors or lacking targeted therapy options. This study provides high-quality evidence advocating for surgical intervention as a critical component of multimodal therapy, aiming to optimize clinical decision-making and improve patient outcomes in this historically poor-prognosis subgroup.

Asset Subtitle

JiaYuan Tian

Meta Tag

Speaker JiaYuan Tian

Topic Metastatic Non-small Cell Lung Cancer – Local Therapies

Keywords

lung adenocarcinoma

pleural dissemination

primary tumor resection

survival benefit

cM0sM1a stage

sublobectomy

lobectomy

lymph node dissection

systemic therapy

multimodal treatment