Prognostic Difference of Pleural versus Distant Metastasis after Surgery for Lung Cancer

Among patients undergoing curative-intent surgery for lung cancer, the prognostic significance of pleural recurrence remains unclear. In this study of 5089 surgically treated patients, 85 developed biopsy-proven pleural metastasis during surveillance. Overall median survival was 34 months from surgery and 13 months from recurrence. Outcomes were poorest for patients with lung adenocarcinoma whose first site of recurrence was pleural metastasis, with significantly shorter survival after recurrence compared with squamous cell carcinoma and shorter survival from surgery compared with patients who developed distant metastases first or simultaneously. These findings suggest that pleural recurrence following lung cancer surgery, particularly in adenocarcinoma, is associated with aggressive disease and may reflect underlying systemic spread rather than a localized process.