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Peer-reviewedCC BY-NC-NDJournal of thoracic disease

First-line systemic treatment patterns and outcomes in lung cancer patients with malignant pleural effusion: a retrospective multicenter study.

  • Yuanyuan Zhang1,2
  • Ran Wang3
  • Yi Xiang4,5
  • Hailong Wei6
  • Yong Cao7
  • Ling Peng8
  • Changyi Li9
  • Huifang Song10
  • Hui Ren11
  • Li Jiang12
  • Ran Li13
  • Jia Zeng14
18 more authors
  • Minjiang Chen15
  • Dehe Chen16
  • Yunxiang Zeng17
  • Xueling Wu18
  • Qinghua Liu19
  • Yi Zhang20
  • Huai Liao21
  • Hongmei Zhou22
  • Na Huang23
  • Junhua Wu24
  • Pingfei Wang25
  • Rong Qiu26
  • Taibing Deng27
  • Shuanglin Liu28
  • Yuan Zhang29
  • Weimin Li1
  • Yalun Li1,2
  • Panwen Tian1,2
29 affiliations
  1. 1Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, Precision Medicine Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China.
  2. 2Lung Cancer Center/Lung Cancer Institute, West China Hospital, Sichuan University, Chengdu, China.
  3. 3Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
  4. 4Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
  5. 5Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
  6. 6Department of Pulmonary and Critical Care Medicine, The People's Hospital of Leshan, Leshan, China.
  7. 7Department of Respiratory and Critical Care Medicine, Tongji Hospital, Huazhong University of Sciences and Technology, Wuhan, China.
  8. 8Department of General Medicine, Sichuan Cancer Hospital, Chengdu, China.
  9. 9Department of Pulmonary Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
  10. 10Department of Pulmonary and Critical Care Medicine, Inner Mongolia People's Hospital, Hohhot, China.
  11. 11Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
  12. 12Department of Respiratory and Critical Care Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
  13. 13Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, China.
  14. 14Department of Respiratory and Critical Care Medicine, Guangyuan Central Hospital, Guangyuan, China.
  15. 15Department of Respiratory and Critical Care Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China.
  16. 16Department of Pulmonary and Critical Care Medicine, Bazhong Center Hospital, Bazhong, China.
  17. 17Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
  18. 18Department of Pulmonary, Shanghai Jiao Tong University School of Medicine, Renji Hospital, Shanghai, China.
  19. 19Department of Pulmonary and Critical Care Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China.
  20. 20The Second Ward of Pulmonary and Critical Care Medicine, The First Hospital of Lanzhou University, Lanzhou, China.
  21. 21Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
  22. 22Department of Pulmonary Intervention Center, Southern University of Science and Technology Hospital, Shenzhen, China.
  23. 23Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China.
  24. 24Department of Respiratory and Critical Care Medicine, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China.
  25. 25Department of Pulmonary and Critical Care Medicine, Dazhou Central Hospital, Dazhou, China.
  26. 26Department of Respiratory and Critical Care Medicine, Suining Central Hospital, Suining, China.
  27. 27Department of Pulmonary and Critical Care Medicine, Guang'an People's Hospital, Guang'an, China.
  28. 28Department of Respiratory Disease, Xinqiao Hospital, Third Military Medical University, Chongqing, China.
  29. 29Department of Pulmonary and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China.
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Abstract

Malignant pleural effusion (MPE) is a frequent complication of advanced lung cancer with poor prognosis. The optimal first-line systemic treatment for these patients remains unclear. This study aimed to evaluate first-line systemic treatment patterns and outcomes in lung cancer patients with MPE. This multicenter retrospective study across 27 centers in China evaluated the efficacy and safety of first-line systemic therapy in lung cancer patients with MPE from 2013 to 2024. The primary endpoints were progression-free survival (PFS) and overall survival (OS). Of 1,029 patients included, 88.1% had non-small cell lung cancer (NSCLC) and 11.9% had small cell lung cancer (SCLC); 87.4% received first-line systemic therapy. SCLC patients received chemotherapy alone (50.8%; 62/122) or combined with immunotherapy (47.5%; 58/122). Most driver gene-positive NSCLC patients received targeted therapy (91.4%; 415/454). Driver gene-negative NSCLC patients primarily received chemotherapy alone (27.8%; 126/453), chemotherapy plus immunotherapy (15.9%; 72/453), or chemotherapy plus bevacizumab (17.9%; 81/453). Median OS for the overall cohort was 26.1 months. Systemic therapy significantly extended median OS compared to no systemic therapy (28.1 vs. 12.7 months; P<0.001). Driver gene-positive NSCLC had longer OS than driver gene-negative patients (34.1 vs. 22.6 months; P<0.001). In SCLC, no significant PFS or OS difference was observed between the two regimens. After adjustment, targeted combination therapy versus monotherapy showed non-significant trends for PFS [hazard ratio (HR), 0.74; P=0.09] and OS (HR, 0.67; P=0.10) among driver gene-positive NSCLC. Among driver gene-negative NSCLC, chemotherapy plus bevacizumab significantly improved median OS versus chemotherapy alone (41.8 vs. 21.4 months; P=0.04) and was an independent predictor of favorable OS [HR, 0.59; 95% confidence interval (CI): 0.38-0.90; P=0.02], despite no significant PFS improvement (HR, 0.72; 95% CI: 0.51-1.01; P=0.055), with a manageable safety profile [grade ≥3 treatment-related adverse events (TRAEs): 14.8%]. First-line systemic therapy was associated with improved survival in lung cancer patients with MPE, though outcomes differed according to histologic and molecular subtypes. The addition of bevacizumab to chemotherapy was independently associated with longer OS among patients with driver gene-negative NSCLC with MPE.

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Cite

BibTeXRIS
BibTeX
@article{zhang2026firstline,
  title = {{First-line systemic treatment patterns and outcomes in lung cancer patients with malignant pleural effusion: a retrospective multicenter study.}},
  author = {Yuanyuan Zhang and Ran Wang and Yi Xiang and Hailong Wei and Yong Cao and Ling Peng and Changyi Li and Huifang Song and Hui Ren and Li Jiang and Ran Li and Jia Zeng and Minjiang Chen and Dehe Chen and Yunxiang Zeng and Xueling Wu and Qinghua Liu and Yi Zhang and Huai Liao and Hongmei Zhou and Na Huang and Junhua Wu and Pingfei Wang and Rong Qiu and Taibing Deng and Shuanglin Liu and Yuan Zhang and Weimin Li and Yalun Li and Panwen Tian},
  journal = {Journal of thoracic disease},
  year = {2026},
  month = sep,
  doi = {10.21037/jtd-2026-1790},
  url = {https://europepmc.org/article/MED/42997006},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - First-line systemic treatment patterns and outcomes in lung cancer patients with malignant pleural effusion: a retrospective multicenter study.
AU  - Yuanyuan Zhang
AU  - Ran Wang
AU  - Yi Xiang
AU  - Hailong Wei
AU  - Yong Cao
AU  - Ling Peng
AU  - Changyi Li
AU  - Huifang Song
AU  - Hui Ren
AU  - Li Jiang
AU  - Ran Li
AU  - Jia Zeng
AU  - Minjiang Chen
AU  - Dehe Chen
AU  - Yunxiang Zeng
AU  - Xueling Wu
AU  - Qinghua Liu
AU  - Yi Zhang
AU  - Huai Liao
AU  - Hongmei Zhou
AU  - Na Huang
AU  - Junhua Wu
AU  - Pingfei Wang
AU  - Rong Qiu
AU  - Taibing Deng
AU  - Shuanglin Liu
AU  - Yuan Zhang
AU  - Weimin Li
AU  - Yalun Li
AU  - Panwen Tian
PY  - 2026
DA  - 2026/09/28
JO  - Journal of thoracic disease
DO  - 10.21037/jtd-2026-1790
UR  - https://europepmc.org/article/MED/42997006
AB  - Malignant pleural effusion (MPE) is a frequent complication of advanced lung cancer with poor prognosis. The optimal first-line systemic treatment for these patients remains unclear. This study aimed to evaluate first-line systemic treatment patterns and outcomes in lung cancer patients with MPE. This multicenter retrospective study across 27 centers in China evaluated the efficacy and safety of first-line systemic therapy in lung cancer patients with MPE from 2013 to 2024. The primary endpoints were progression-free survival (PFS) and overall survival (OS). Of 1,029 patients included, 88.1% had non-small cell lung cancer (NSCLC) and 11.9% had small cell lung cancer (SCLC); 87.4% received first-line systemic therapy. SCLC patients received chemotherapy alone (50.8%; 62/122) or combined with immunotherapy (47.5%; 58/122). Most driver gene-positive NSCLC patients received targeted therapy (91.4%; 415/454). Driver gene-negative NSCLC patients primarily received chemotherapy alone (27.8%; 126/453), chemotherapy plus immunotherapy (15.9%; 72/453), or chemotherapy plus bevacizumab (17.9%; 81/453). Median OS for the overall cohort was 26.1 months. Systemic therapy significantly extended median OS compared to no systemic therapy (28.1 vs. 12.7 months; P<0.001). Driver gene-positive NSCLC had longer OS than driver gene-negative patients (34.1 vs. 22.6 months; P<0.001). In SCLC, no significant PFS or OS difference was observed between the two regimens. After adjustment, targeted combination therapy versus monotherapy showed non-significant trends for PFS [hazard ratio (HR), 0.74; P=0.09] and OS (HR, 0.67; P=0.10) among driver gene-positive NSCLC. Among driver gene-negative NSCLC, chemotherapy plus bevacizumab significantly improved median OS versus chemotherapy alone (41.8 vs. 21.4 months; P=0.04) and was an independent predictor of favorable OS [HR, 0.59; 95% confidence interval (CI): 0.38-0.90; P=0.02], despite no significant PFS improvement (HR, 0.72; 95% CI: 0.51-1.01; P=0.055), with a manageable safety profile [grade ≥3 treatment-related adverse events (TRAEs): 14.8%]. First-line systemic therapy was associated with improved survival in lung cancer patients with MPE, though outcomes differed according to histologic and molecular subtypes. The addition of bevacizumab to chemotherapy was independently associated with longer OS among patients with driver gene-negative NSCLC with MPE.
SN  - 2072-1439
SN  - 2077-6624
ER  -