Non-small cell lung cancer with carcinomatous
pleuritis is considered to be a
contraindication of surgical resection. The objective of this study was to clarify the prognosis of patients with
non-small cell lung cancer in whom carcinomatous
pleuritis was found at
thoracotomy. A questionnaire survey on the survival of patients with carcinomatous
pleuritis found at
thoracotomy between January 1985 and December 1994 was conducted by the Japan Clinical Oncology Group. According to the data collected from 21 hospitals, 8813 patients with
non-small cell lung cancer underwent
thoracotomy, 284 (3.2%) of whom were found to have carcinomatous
pleuritis. Information on survival was available for 227 of these patients, 34 (15%) of whom underwent
thoracotomy alone without resection, whereas 193 (85%) underwent surgical resection. Of the 193 resected patients, 155 had no macroscopical
residual tumor apart from the carcinomatous
pleuritis. The 5-year survival rate was 14%. According to a univariate analysis, female sex, the presence of
adenocarcinoma, a
tumor size of less than 3.0 cm, no clinical
lymph node metastasis, and no macroscopical
residual tumor had a significantly favorable impact on survival. A multivariate analysis revealed that the extent of clinical
lymph node metastasis (P = 0.006), histology (P = 0.028), and the absence or presence of a macroscopic
residual tumor after the operation (P = 0.045) were predominant prognostic factors. The 5-year survival rate of 83 patients with three positive variables was 24%. The prognosis of patients with
adenocarcinoma found to have carcinomatous
pleuritis at
thoracotomy was not necessarily unfavorable if there was no clinically detected
lymph node metastasis and no
residual tumor apart from the carcinomatous
pleuritis.