The risk of distant metastases in patients with non-small cell lung cancer (NSCLC) with cytologically proven malignant pleural effusion, stage IIIB: A retrospective analysis.

9568 Background: NSCLC patients (pts) with stage IIIB disease on the basis of malignant pleural effusion ("wet IIIB") are considered incurable because they are deemed inappropriate candidates for definitive local therapy; they are therefore treated as stage IV with systemic therapy. The risk of distant disease in such pts is not clear from the literature, so we performed a retrospective analysis of wet IIIB pts to determine their propensity for distant metastases.,We did a chart review of all pts with advanced NSCLC treated on 15 first-line protocols at M. D. Anderson Cancer Center 1997 - 2003.,Of 575 pts, 37 had cytologically confirmed wet IIIB disease at study entry; all were evaluable for survival. Key demographics included 24 male, median age of 56 (35-77), 31 with adenoca, and 6 with large cell undifferentiated ca. Nodal status (based on CT scans) were N0 (9 pts), N1 (7), N2 (17), and N3 (4). Median time to progression was 5.5 months (mos) (1.5-26.5) and median overall survival was 12.5 mos (2.5-47.5). With minimum follow-up of 13 mos, 12/37 (32%) pts have not had any distant mets despite documented local recurrence (primary, lymph node or pleural effusion); 9 of these 12 pts died without ever developing distant disease. Of these 12 pts, 6/37 (16%) > 8.5 mos (8.5-17) were without distant metastases after local recurrence. Three of these 6 pts (8% of the 37) were greater than 1yr.,We present data describing the risk of distant metastasis in cytologically-proven wet IIIB NSCLC. Though almost all these patients will die of their disease, there was an absence of distant metastases in 12/37 (32%) pts. In addition, 6 of these 12 pts, or 16% of the 37, had > 8.5 mos without evidence of distant metastases after documented local progression. This suggests that in some cases these wet IIIB cancers may have a different biology than stage IV NSCLC. Therefore, selected pts with wet IIIB malignant effusion may benefit from aggressive local treatment strategies. Updated data and analyses from matched stage IV controls from each of these trials will be presented at the poster. No significant financial relationships to disclose.